Types
of
Hip Replacement Surgery
When Considering Joint Replacement Surgery?
When considering overseas
surgery both The Sunday Times and David Hancock,
the author of The Complete Medical Tourist
suggest certain points to take into consideration:
Be realistic. A stay in a
tropical location may sound alluring, but
could you get the same treatment or better
nearer home?
Work out the travel costs.
India has fantastic medical centres but it
is a nine-hour flight away. Think of the cost
of taking a companion along to accompany you
too.
Think of the physical implications
of the journey —a day in economy
class is a long time when you are recovering
from an operation. Business class is comfier
but much more expensive.
Stay in constant touch with
the medical facility you have chosen. Ask
which doctor will be performing the operation,
how many he has done before.
Ask what kind of post-operative support the
facility has.
Ask what arrangements are
made for transfers between the airport and
the medical centre on arrival and departure.
What arrangements are made for your carer?
Ask for testimonials of patients
who have undergone procedures at the medical
facility. Contact the people personally.
We
offer the following types of Surgery:
 
Total
Hip Replacement
Hip
Resurfacing (Durom™ Hip Resurfacing)
Hip
Resurfacing (Birmingham Hip)
Hip
Arthroscopy
Hip
Revision
Bilateral
Hip Replacement (Double Hip)
Bilateral
Hip Resurfacing (Birmingham Hip)
Total
Hip Replacement
Should you have a Total Hip Replacement or
Hip Resurfacing known as The Birmingham Hip?
Total
Hip Replacements allow good mobility, but
reduce the range of movement of the leg. Following
a Total Hip Replacement It is not possible
to return to full active sports however light
activity such as golf is OK even light tennis
(one of our clients was beaten at tennis before
coming for her hip replacement by a lady that
had previously had two total hip replacements)!
Today candidates prefer Hip Resurfacing rather
than Total Hip Replacement. There are several
reasons why candidates have a preference for
resurfacing these are addressed further on
in this publication.
The Total Hip
Replacement are recommended when the candidate
is unsuitable for resurfacing such as:
- Males
over 70 and females over 65 (with week or
thin bone stock)
- Those
with a degenerative bone disease such as
AVN or arthritis
The prosthesis may be constructed of various
materials but is usually made of forged
steel rather than cast steel (these were
prone to break). The exterior of the unit
is rough and porous so that the unit when
press fitted with combine with the bone,
which actually grows into the unit. This
creates an immensely strong bond, which
is hard to separate (rather like barnacles
on a ship).
The
ball will probably be titanium, cobalt crome
plated or ceramic (there is some concern from
patients as to whether the ceramic ball will
break but providing the unit is properly engineered
this is extremely unlikely). The advantage
of ceramic is that it is both extremely robust
and has a very low friction coefficient, which
means a low wear rate.
Sometimes the cap may be ceramic but these
in rare cases have been known to break under
excessive stress conditions. One popular combination
is a ceramic ball and composite cap, these
are found to have less wear. Modern units
can wear at the rate of 1 micron a year; some
years ago wear rates were more likely 200
microns a year so great improvements have
been made. One thing to be weary of is ensure
that your surgeon is fitting a leading manufacturers
unit not a generic copy such as those that
you may receive in cheaper surgery. If it
is possible find out what the surgeon will
be fitting and do they fit a very good standard
of unit. If you are a private patient that
is paying their way you should be able to
ask these questions and receive a satisfactory
answer. Government health services will fit
units from a standard procurement list. This
list may be quite limited by the number of
models and sizes, as health services seek
discounts by bulk purchasing methods. In addition
the prosthesis on the procurement list may
be dated as it takes time for new products
to be accepted. Zimmer is our organisations
brand of choice simply because we consider
them the best on the market, they have an
excellent proven track record and are the
largest makes in the market. Incidentally
their units are also the most expensive but
when choosing prosthesis we always choose
the best.
To
summarise, some things to look out for are:
Which Unit is being Fitted?
– Who is the manufacturer? What is it
made of? Remember a good reliable prosthesis
should last over 15 years but a bad generic
unit may only last 2 or three. I have come
across ones that lasted 6 months. A leading
manufacturers unit has the security of a guarantee
should any problems arise later on.
Who is Fitting the Unit?
– Skill level is important, you need
to ask how many of these surgeries the surgeon
carries out each year; more practised means
higher skill. I am not sure that I would like
to fly with a pilot that has only flown 40
times a year. A good surgeon will undertake
a procedure 150 times a year.
Is the unit cemented or press fit? - Total
Hip Replacements can be either cemented or
press fit. This can apply to either sections
or just one this is then called a hybrid.
Some surgeons have a preference for cemented
however the cemented fit is generally used
when there is a weakness in the bone stock.
Typically this may be due to hormonal activity
brought on by the menopause or some form of
degenerative bone disease. Lately it has been
reported that continuous and heavy use of
ibuprofen may also cause thinning in the bones.
The press fit (in our opinion) is stronger
as the bone grows into the rough porous exterior
of the prosthesis.
What Length is the Hospital Stay?
– I have heard of some facilities sending
the patient home after 3 or 4 days, usually
to save money. This doesn’t give sufficient
time to ensure that patient is on the path
to recovery. Major joint surgery needs good
physiotherapy at least one week of one to
one physiotherapy is recommended.
Size of Physiotherapy Department?
– look for a fully equipped
physiotherapy department where patients get
a personal physiotherapist that works towards
a goal. Remember if you are older say in your
late seventies or are relatively unfit then
you need longer physiotherapy - an extra week
at least. Look for a facility that offers
one to one physiotherapy where you should
receive 2 hours of physiotherapy per day.
Do they permit an extended stay should you
require some extra physiotherapy? If you plan
to travel a long distance or take a long haul
flight then an extra weeks stay at the facility
should be considered.
Hip
Resurfacing (Durom™ Hip Resurfacing)
Hip resurfacing the solution for the young
and active!
Today
more and more people are hearing about the
benefits of hip resurfacing over conventional
hip replacement. This relatively new technology
started with the invention of the “Birmingham
Hip replacement” approximately 15 years
ago.
What is a Hip
Resurfacing?
With Hip Resurfacing instead of the Femur
being cut through just below the head, the
head of the femur is capped with a ball cap.
This cap is then inserted into the cup implant
which is press fitted into the prepared hip
socket.
Indications
are that this is an extremely durable solution
for young and active patients that wish to
keep full natural mobility and return to full
active sports.
Hip resurfacing is suitable for Women below
the age of 65 and Men below the age of 70
where the condition and strength of the bone
is suitable.
Hip resurfacing ensures a faster recovery
time than conventional hip replacement and
the patient finds that they can return to
normal life sooner.
Direct Healthcare International fit the Zimmer
hip-resurfacing unit. We believe it is the
best and most widely used prosthesis with
over 300,000 units successfully fitted.
There are no known instances of a hip-resurfacing
unit dislocating.
What
is Durom™ Hip Resurfacing
Since
1988 Metasul™
has been successfully used for total hip replacement.
Today’s metal on metal technology is
the result of over one and a half decades
of intense development, research and clinical
evaluation. This has formed the foundation
for the latest evolutionary development –
DuromTM Hip Resurfacing.
Advanced engineering and materials technology
coupled with Swiss precision manufacturing
has resulted in this exceptional Hip Resurfacing
prosthesis. Developed for the younger and
more active patient, it is designed to provide
high levels of joint stability whilst removing
as little bone as possible. The articulating
components are made of Metasul™
alloy ProtasulTM-21 WF, the first wrought-forged
CoCr resurfacing prostheses, which is the
same material used to restore mobility of
over 300,000 patients.
Design Detail
In designing the femoral component, many important
factors needed to be considered. Bone conservation,
precise positioning and an optimum cementing
technique were of utmost importance. The guide
pin, whilst removing less bone than comparable
systems, allows for an ideal physiological
transfer of load, whilst ensuring accurate
positioning of the prostheses. The unique
grooves, on the inner side, allow for even
pressurisation of cement into the cancellous
bone (a spongy type of bone with a very high
surface area found at the ends of long bones),
but avoids a taper effect, providing additional
rotational stability.
Minimal
Thickness with Maximum Strength!
The acetabular cup is a flattened hemisphere,
offering a greater range and freedom of movement.
With a constant wall thickness of 4 mm throughout
all sizes, thecup maintains an inner diameter
as large as possible, whilst maintaining maximum
implant strength and minimum bone resection.
A coating of pure titanium, using a plasma
spray under vacuum and static load is applied
to the outer surface. This unique manufacturing
method gives a surface roughness of 20–50
microns with a porosity of at least 25%, shown
in vitro testing to significantly improve
primary stability. As shown in laboratory
tensile tests the adhesive strength of the
titanium coating of 66.2–76.5 MPa, significantly
exceeding FDA requirements of 22 MPa.
Lower Wear Rate!
The high carbon CoCr alloy is produced by
a forging rather than a casting process. This
means that the size of block carbides is up
to eight-times smaller compared to cast CoCr
prostheses. The resulting lower surface roughness
subsequently leads to a lower wear rate when
compared with cast CoCr alloys. Co-28Cr-6
Mo-0,2C/ProtasulTM-21 WF (ISO 5832-12): a
carbide-containing and therefore low-wear
cobalt chrome alloy was chosen for MetasulTM.
The Key to Successful
Resurfacing!
As with almost any joint replacement system,
precise and easy-to-use instruments are key
to a success.
In developing of the Durom™
Hip Resurfacing the engineers not only focused
on implant design and material technology
but also concentrated on the surgical procedure,
and how to resurface the hip in the best way
possible. As a result, an ingenious method
to accurately and precisely position components
was created.
Low
Wear and Greater Joint Stability
The large diameter of the Metasul™
ball head offers low wear coupled with greater
joint stability and a high range of motion.
This is available in combination with the
extensive range of cemented and un-cemented
femoral implants from Europe’s largest
manufacturer of joint prostheses.
Designed to
Outlast a "Conventional" Hip Prosthesis
The Durom Hip Resurfacing has been specifically
designed for use in young active patients
who are likely to outlast a "conventional"
hip prosthesis. Emphasis has been placed on
a high quality bearing surface, preservation
of bone stock and durable fixation of the
components.
The Metasul bearing surface is a proven low
wear, low-friction articulation, having been
implanted in over 300,000 patients since 1988.
No other metal-on-metal bearing has such a
track record.
The Durom acetabular and femoral components
have been designed to allow maximum preservation
of bone stock. The wall thickness of the acetabular
component is as low as practically possible
and the cup subtends an angle of 165°,
similar to the natural acetabulum. These features
facilitate preservation of the acetabular
bone stock.
The sophisticated femoral instrumentation
permits very accurate positioning of the femoral
component, allowing the smallest possible
femoral implant to be used, which in turn,
allows the insertion of the smallest possible
acetabular component, again preserving acetabular
bone stock.
The Porolock Ti VPS surface coating of the
Durom acetabular component is vacuum plasma-sprayed
pure titanium. This coating is associated
with reliable bone in-growth, ensuring long-term
secondary fixation. The carefully controlled
vacuum spraying process results in a very
high adhesive strength between the chrome
cobalt substrate and the Porolock Ti VPS coating,
reducing the risk of the generation of titanium
3rd-body-wear particles.
The femoral instruments produce an even cement
mantle of approximately 1 mm, reducing the
risk of fatigue failure of the bone cement.
The recesses within the femoral component
enhance rotational stability of the implant.
Hip
Resurfacing (Birmingham
Hip)
Why is a BIRMINGHAM HIP RESURFACING NECESSARY?
A
hip replacement is necessary when the hip
joint becomes so badly damaged that it causes
pain, which interferes significantly with
your quality of life and can not be controlled
with simple measures such as painkillers.
Whilst
for many patients a cemented or uncemented
total hip replacement is recommended, this
is not always ideal for the young active patient
who wishes to continue with sports or high
levels of physical activity. For this patient
group there is a significant likelihood that
a traditional hip replacement would wear out
or “fail” within a short time,
as this type of hip replacement was not designed
to undertake the stresses of high impact activity.
The Birmingham Hip Resurfacing technique offers
an alternative to traditional hip replacement,
for those patients wishing to continue an
active lifestyle.
What
are the BENEFITS OF BIRMINGHAM HIP RESURFACING?
A
successful Birmingham Hip Resurfacing operation
will give relief from pain in the hip and
should allow sufficient movement in the hip
joint for you to undertake most normal activities.
The overall aims of surgery are:
- Relief
of Pain in the Hip
- Correction
of any Deformity
- Restoration
of any Loss of Function in the Hip
- Improvement
in your Quality of Life
What
are the ADVANTAGES compared to a traditional
Hip Replacement?
A
Birmingham Hip Resurfacing usually allows
you to continue with an active lifestyle as
it restores normal anatomy and has a lower
dislocation rate than traditional hip replacements.
It is also easier to remove and convert to
a total hip replacement should it eventually
wear out.
Hip
Arthroscopy
Hip
arthroscopy is performed through small incisions
using a camera to visualize the inside of
a joint. Through several small incisions (about
1 centimeter each) your surgeon will insert
a camera into one incision, and small instruments
through the other incisions.
What
is the benefit of hip arthroscopy compared
to open surgery?
The
nice part about hip arthroscopy is that it
is much less invasive than traditional hip
surgery. This means:
-
Early Rehab
- Accelerated
Rehab Course
- Outpatient
Procedure
- Smaller
Incisions
- Early
return to Sport
Hip
Revision
Hip
revision surgery involves the repair of an
artificial hip joint that has been damaged
or loosened over time or as the result of
infection. The use of artificial hip implants
has become quite widespread in recent years.
They can be extremely effective in improving
hip joints that have been severely damaged
by injury or some form of arthritis.
In
hip replacement surgery the diseased portions
of the hipbones are cut away and replaced
with a two-part prosthesis, or artificial
hip joint. With revision surgery the first
prosthesis is removed and replaced with a
new one. Sometimes this is a long process
involving more than one surgical procedure,
and is certainly more taxing than the original
replacement surgery.
The
human hip, like the shoulder, is a ball and
socket joint, in which the ball of one bone
(the femur, or bone of the upper leg) fits
into the socket of another (the pelvic bone).
As a free-moving joint in the body, the normal
hip can move backwards and forwards, from
side-to-side, and can perform twisting motions.
Like
other free-moving, or synovial joints, the
hip contains a liquid, which lubricates the
joint whenever you move it. It is held together
with ligaments-- straps of tough, sinewy tissue,
which hold the joint together. Full function
of the hip joint depends on the successful
coordination of many interrelated parts, including
bones, muscles, tendons, ligaments, and nerves.
Bilateral
Hip Replacement (Double
Hip)
Patients
with both hips equally painful and stiff often
wonder whether both hips will need total hip
replacement operation, and whether it will
be possible to walk on two artificial hip
joints.
The
surgery that replaces both worn hips is called
bilateral total hip operation.
You
should know that bilateral hip surgery is
done routinely and it presents one of the
most spectacular successes of the total hip
replacement surgery.
This
is so because two impaired hips cause much
more symptoms than twice the symptoms caused
by one diseased hip. Patients with both hips
affected have no healthy leg to rely on!
Bilateral
Hip Resurfacing
(Birmingham Hip)
As with bilateral hip replacement bilateral
hip resurfacing is also available. Like total
hip replacement this surgery is also carried
out one week apart with the patient staying
in hospital a total of 22 nights.
The
surgery is normally carried out on a Tuesday
giving 6 days of physiotherapy before the
other side is operated on. With bilateral
surgery the patient is advised to avail themselves
of the additional weeks stay and physiotherapy.
During this period the patient is accommodated
with their partner in the Direct Healthcare
International in hospital family B&B unit
where they may take advantage of the freedom
to move about at their will and visit some
nearby tourist areas such as Bruges.
Advantages
of Hip Resurfacing
- Femoral
head is preserved.
- Femoral
canal is preserved and no associated femoral
bone loss with future revision.
- Also,
the risk of microfracture of femur with
uncemented stem implantation is eliminated.
- Larger
size of implant "ball" reduces
the risk of dislocation significantly.
- Stress
is transferred in a natural way along the
femoral canal and through the head and neck
of the femur. With the standard THR, some
patients experience thigh pain as the bone
has to respond and reform to less natural
stress loading.
- Use
of metal rather than plastic reduces osteolysis
and associated early loosening risk.
- Use
of metal has low wear rate with expected
long implant lifetime.
|
