Total hip replacement : Relieving pain and restoring function

Total hip replacement is one of the most common orthopaedic reconstructive procedures performed today, with more than 40 000 replacements completed annually in Canada. New surgical techniques and materials have led to procedures that produce profound changes in the lives of patients and allow them to resume virtually all of their previous activities. Sir John Charnley developed low-friction arthroplasty in the 1960s. Since then, procedures have evolved to address the issues of wear and bone loss and permit joint replacement in patients younger than 65. Pain is the primary indication for a hip replacement, with osteoarthritis being the most common cause. State-of-the-art implants in 2016 include cemented, uncemented, or hybrid components; metal or ceramic femoral heads; and polyethylene or ceramic acetabular liners. In British Columbia, the standard of care is a metal acetabular shell with a polyethylene liner and a cemented or uncemented femoral stem with a metal femoral head. Hip resurfacing is an option for young active patients, although its use worldwide has declined dramatically. Early mobilization after total hip replacement is recommended. While complication rates are low, possible postoperative problems include venous thromboembolism and nerve injury in the short-term, and periprosthetic fracture and osteolysis in the long-term. If there is a failure of the hip replacement for some reason, the likelihood of a revision procedure succeeding is good. Total hip replacement is a remarkable procedure that can relieve pain and restore function. According to the Canadian Institute for Health Information, more than 40 000 hip replacements are completed annually in Canada (https://secure .cihi.ca/estore/productFamily.htm? locale=en&pf=PFC2945&lang=en). For most patients with a destructive process occurring in the hip joint, total hip arthroplasty (THA) is a viable option. Since the first successful THA was performed in the 1960s, procedures and the components used have evolved and we now have a better understanding of post-op considerations and possible complications. History Beginning in the 1800s, a number of attempts were made at hip replacement for infection and fracture using implants of ivory, glass, ceramic, and metal. These trials continued through to the 1960s, when Sir John Charnley Drs Ashman and Cruikshank are residents in the Department of Orthopaedics at the University of British Columbia. Dr Moran is an orthopaedic surgeon at the University Hospital of Northern BC and a clinical professor in the Department of Orthopaedics at the University of British Columbia. This article has been peer reviewed.