Our joints tend to experience a bit of a pounding over the course of a lifetime, and the accumulated stresses and strains on them often result in wear and tear, particularly to the protective layers of cartilage covering the extremities of the bones and which would normally serve to smooth the contact between them. Even if the surface of just one of these bones becomes exposed, it will be subjected to frictional forces that can cause erosion and splintering, leading to swelling and pain. Particularly in the case of knee or hip problems, replacement joints inserted by specialists will eventually be the only long-term solution.
In order to establish the cause of a swollen and painful joint, an orthopaedic surgeon may order a radiographic examination but, rather than just relying on the X-ray findings, may wish to take a closer look at the affected joint and the surrounding soft tissues. For this purpose, hip replacement specialists can employ an instrument known as an arthroscope. This is inserted into the joint through a tiny incision where it is used to provide the surgeon with a video image of its interior. The scope can be moved around as necessary, which then ensures that the full extent of any damage can be assessed before deciding on the most appropriate intervention.
Where there is significant damage to both the acetabulum and the head of the femur, total arthroplasty will be required. However, if only one of the articulating surfaces is severely affected, some hip replacement specialists may prefer to perform hemiarthroplasty, treating only the surface that was damaged.
During the previous decade, an alternative technique has re-emerged and has been gaining popularity. Known as joint resurfacing, it was first attempted during the ‘50s, but quickly abandoned because the materials used were insufficiently robust and the new surface became worn after a couple of years. Advances in metallurgy and a switch from ceramic-on-ceramic to metal-on-ceramic structures have vastly improved the effectiveness of resurfacing procedures with some surgeons recommending it for young patients. Many hip replacement specialists, however, still harbour some serious doubts with regards to the potential longevity of the resurfacing technique, given that although the initial statistics appear encouraging, they are only based on findings obtained over less than ten years.
That said, those who support this procedure, tend to do so because it only involves re-shaping the femoral head, so as to accommodate a protective metal cap which then articulates with a ceramic socket fitted to the acetabulum. This, they argue, minimises overall bone loss. By contrast, in order to fit a conventional femoral prosthesis, hip replacement specialists must first completely remove the head of the femur along with a significant portion of the femoral stem.
Nevertheless, the result is an exceptionally stable and robust artificial joint that has been proven to reverse pain and swelling, and to restore full mobility. Unlike the uncertainty that still surrounds the potential lifespan of hip resurfacing procedures, there are innumerable THR (total hip arthroplasty) patients whose prosthesis have served them effectively for two to three decades, and continue to do so. Many THR patients owe their condition to being overweight, yet hip replacement specialists consistently report the same long-term success when treating patients who weigh in at as much as 200 kilograms or more. In fact, the consensus among these highly skilled surgeons is that arthroplasty is probably the single most effective surgical intervention in the history of orthopaedics.
Another significant development that has been proving of value to patients is the use of arthroscopy to develop less invasive techniques with which to perform arthroplastic procedures. While these minimally invasive techniques call for even greater skill and experience on the part of the hip replacement surgeons who undertake to perform them, the potential benefits to the patient include a reduced risk of haemorrhage and infection, as well as cutting the time required for post-operative recovery. Not all surgeons offer this option and those who do tend to, do so only after conducting a thorough evaluation of the patient’s age, condition, and general health.
Apart from accidental damage, the main reason for patients to require hip arthroplasty is osteoarthritis. This condition is not only on the increase, but it is affecting younger patients than in the past. Consequently, the demand for hip replacement specialists to relieve their pain, restore their mobility, and change their lives for the better keeps growing.