Hip Replacement: The Facts

History
Hip replacements were first attempted towards the end of 1800’s with gold and ivory being used to replace the femoral head.    In the 1930’s Mr Philip Wiles tried to make a hip replacement out of metal at the Middlesex Hospital in London but it was not until after the Second World War that hip replacement surgery really took off.

Sir John Charnley, pioneer hip surgeonImage of Sir John Charnley "pioneer of total hip replacement in the U.K."

In Paris Professor Robert Judet and his brother designed a partial hip replacement to treat hip fractures whilst in Norwich Mr McKee and Mr Watson-Farrer and in Manchester Professor John Charnley also devised their own hip replacements.  Their results, although not perfect, in reality became the first generation of modern hip replacements with further advances in time being made by Professor Muller from Switzerland and Professor Ling in Exeter.

In the United Kingdom over 95,000 primary (first time hip replacements) hip replacements are performed each year with an overall success of this major operation being approximately 92%.

Indications
The main reasons for having a hip replacement are osteoarthritis, (wear and tear), of the hip joint limiting the patients’ quality of life due to pain and loss of independence and mobility.   Sometimes ‘hip replacements’ are also performed for inflammatory arthritis, (such as rheumatoid arthritis) and for fractures and less commonly for cancer. The operation normally takes one to one and a half hours with most patients being in hospital for three days and going home when they can safely manage some stairs using crutches.

Illustration of a Normal Hip. Please click here to enlarge this image. Diseased Hip with Roughened Ball and Socket Joint. Please click here to enlarge this image.
Please click the illustrations above to enlarge them.

X-ray Image of an Arthritic Hip & a Normal Hip
An Arthritic Hip and a Normal Hip X-ray.


A Modern Cementless Total Hip Replacement Post-Operative X-Ray.

Implant Design
Mr Charnley uses a trabecular metal version of the Trilogy acetabular shell, an implant that has excellent results since it was introduced into the United Kingdom in 2004.  Mr Charnley was the first Surgeon to implant this in the United Kingdom and since that time has used, from 2004, this cup in over 1,000 hip replacements.

When Mr Charnley uses a cemented hip it is called the CPT (Collarless Polished Tapered) which was designed by Professor Ling and has been available with successful results for over 25-years.

 

The hip socket (acetabulum) may also be cemented or cementless and the ball articulates usually with a plastic like material – a high density polyethylene.

Illustration of a Replaced Hip. Please click here to enlarge this image.
Artists Impression Of A Cemented Hip Replacement, The Green Ink Representing The Cement.
Please click here to enlarge the image.

In younger and very active patients, ceramic modular femoral heads are used along with a cementless stem.

The cementless stem is called the Corail and has been in clinical use for over 30 years. It was originally designed in France but now is in widespread use, not only in the United Kingdom where it is the most commonly used cementless stem, but also in Scandinavia and the USA.

Mr Charnley uses a trabecular metal version of the Trilogy acetabular shell, an implant that has excellent results since its introduction into the United Kingdom in 2002.


Hip socket component for insertion without cement, the magnified image, showing bone cells growing onto the roughened surface for secondary anchorage.


A cementless femoral component with bio-active surface (Hydroxyapetite) and a ceramic modular head.

When Mr Charnley uses a cemented hip it is a standard hip replacement called the CPT (Collarless Polished Tapered) which was designed by Professor Ling and has been available for over twenty years.

CPT Hip Replacment
Collarless Polished Tapered Hip Replacement.

The results of this hip replacement are equal to, if not perhaps slightly better, than many other standard designs.  Research at the Avon Orthopaedic Centre in Bristol, by Mr Gordon Bannister, Secretary of the European Hip Society, has revealed very good results with this hip prosthesis and excellent results are also reported in the Danish Hip Registry.

Benefits
The main reason for any patient having a hip replacement performed is to rid them of their arthritic pain.    In doing so unless multiple joints are affected by arthritis, this should lead to an improvement in an individual’s mobility and quality of life.   Indeed patients having had a satisfactory hip replacement believe their quality of life is improved as much as a patient having coronary artery by-pass for heart attacks or a renal transplant for kidney disease!

The alternatives to joint replacement will also be discussed by Mr Charnley, but frequently these have been explored by family doctors in terms of physiotherapy, weight loss, analgesia and anti-inflammatory medication.

Complications
The average lifespan of all hip designs is 15-20 years.

As with any operation there are acknowledged risks.   Most patients are worried about their anaesthetic but modern day anaesthesia is extremely successful with rarely patients not waking up after their anaesthetic, (perhaps a 1 in a million risk).  Patients in their 8th decade do have more pre-existing medical problems than younger patients and have thus a raised risk of non orthopaedic post operative medical problems and need to be in good health to consider hip replacement.

Other risks associated with the surgery itself are infection from bacterial organisms and to reduce this Mr Charnley uses antibiotics around the time of surgery as well as using bone cement with antibiotics in it.   There is still a chance of one or two patients in every hundred having this complication.

Dislocation (the ball coming out of the socket), does occur with hip surgery with a reported frequency of 1-5%.  Mr Charnley uses an incision which has the lowest reported rate of dislocation to try and minimise this problem and also uses larger diameter bearings, again, to reduce this risk.

Blood clots in the legs or the lungs (deep venous thrombosis or embolism), is a risk, in particular, in those patients who smoke.  It is advisable to give up for at least six weeks before the operation, if not for ever.  To avoid this risk as well as early mobilisation, Mr Charnley’s patients have mechanical and chemical treatments to minimise the risk of blood stasis in their legs.


There is a remote chance of damage to the nerves and arteries around the hip (less than 1 in 100), more so with those hips that have had previous surgery or are of a rather abnormal shape.

Fractures around the time of implant insertion, (peri prosthetic fractures) may occur with a frequency of 1%.

Finally following a hip replacement the surgeons performing the operation try and balance the leg lengths of the affected and unaffected sides but this is limited by the more important goals of a stable joint replacement and leg length discrepancies can be satisfactorily treated with orthotic aids.

The Post-Operative Period
Your hip surgery will be performed by an experienced team of surgeons, nurses, physiotherapists and occupational therapists.   The whole team will try and help you get over the post-operative period with advice about dos and don’ts (see additional information). 

You will normally be sent home on a pair of crutches once you are safe and not before.   The team are happy to give additional information regarding return to work, driving and sexual intercourse.

Self-Help
Patients can help themselves by preparing for surgery.  A visit to a physiotherapist or osteopath may enable patients to learn muscle strengthening exercises, which will speed up there rehabilitation.  In addition, stopping smoking will reduce the risk of thrombosis and a healthy diet with vitamins and zinc may also help wound healing.

Training, Education and Research

Mr Charnley is one of the most experienced hip replacement surgeons in Essex with over 25-years of Consultant experience of both primary and revision hip replacement surgery.  His academic track record in the field of hip replacement surgery has led to multiple presentations and publications across Europe and elsewhere. 

In non-Covid years, he would perform four to ten hip replacements per week. 

At Springfield Hospital Mr Charnley performs all of the hip replacement surgery himself irrespective of whether the patient is a private patient or an NHS patient and sees the patients both pre-operatively and post-operatively. 

At Broomfield he supervises his Trainees, encouraging them to learn good techniques as these motivated young Surgeons will, in time, become independent hip replacement surgeons locally and more distant to Essex.

All illustrations on this page are acknowledged and are supplied for patient information by Schering-Plough/Doctor Direct Ltd.

This page was last updated on 06/Mar/2012