Hip Arthritis and Total Hip Arthroplasty

Question 1

what are the 2 most common surgical measures

Answer 1

Total Hip Arthroplasty (THA) or Total Hip Replacement (THR)

-terms are almost synonymous

Question 2

what can the term THA include that THR does not

Answer 2

hip resurfacing as they don’t involve replacing the entire femoral head so they aren’t technically THR

Question 3

what is the ‘gold standard’ that all other THA results must be compared against

Answer 3

cemented metal/polyethylene THR

Question 4

why does any THA ultimately fail over time

Answer 4

loosening of one or both of prosthetic components and wear and tear

Question 5

in an elderly low demand patient how long can the cup of a hip replacement be expected to last

Answer 5

15 years

Question 6

in an elderly low demand patient how long can the stem of a hip replacement be expected to last

Answer 6

20 years

Question 7

what percentage of implants loosen before 10 years

Answer 7

5

Question 8

are cemented or uncemented components better

Answer 8

both the same

Question 9

why might uncemented components be widely used

Answer 9

aim of bone growing into a roughened porous surface

Question 10

what are conservative measures

Answer 10

analgesia, physio, use of a stick (reduces joint force by 15%), weight reduction and activity modification

Question 11

when might THA be considered

Answer 11

conservative measures failed and significant pain and disability

Question 12

how can a patients pain level be gauged

Answer 12

analgesic use, rest pain and sleep disturbance

Question 13

how can a patients disability level be gauged

Answer 13

walking distance, daily activities (dressing and bathing), interruption of hobbies

Question 14

what are some early local complications of THA

Answer 14

infection, dislocation, nerve injury (sciatic), leg length discrepancy

Question 15

what are some early general complications of THA

Answer 15

medical complications from surgery (MI, chest infection, UTI, blood loss and hypovolaemia), DVT and pulmonary embolisms (0.5% incidence)

Question 16

what are some late local complications of THA

Answer 16

early loosening, late infection (haematogenous spread from distant site), late dislocation (component wear)

Question 17

after a failed hip replacement fails a revision hip replacement can be done what are some risks

Answer 17

bigger and more complex surgery, substantial blood loss, twice the complications rate, poorer functional outcome, don’t last as long

Question 18

what are the implications of performing THR in younger patients

Answer 18

higher risk of needing revision surgery (due to more demand and living longer)