Current issues in Hip Surgery Roger Gundle MA DPhil FRCS(Orth) Consultant Orthopaedic Surgeon Hon Senior Clinical Lecturer in Orthopaedic Surgery University of Oxford

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Current issues in Hip Surgery Roger Gundle MA
DPhil FRCS(Orth)Consultant Orthopaedic
SurgeonHon Senior Clinical Lecturer in
Orthopaedic SurgeryUniversity of Oxford

Joint Reconstruction Service Nuffield Orthopaedic
Centre NHS Trust Oxford
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Issues in Hip Replacement for General
Practitioners

• Questions you might be asked
• Should I have a hip resurfacing ?
• Should I have minimally-invasive hip surgery?
• What about porcelain hips ?
• What can I do after my hip replacement?
• Will I get MRSA?

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Hip Resurfacing

• The Birmingham Hip
• Popularised in the UK by Derek McMinn in
  Birmingham
• Huge increase in use in last 10 years

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An example
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Hip Resurfacing

• Advantages
• Potential longevity ( metal on metal )
• Scope for revision
• Lower risk of dislocation
• (NICE approved)

• Disadvantages
• Lack of long-term clinical follow-up data
• Femoral neck fracture (2)
• Bigger operation
• Adverse reaction to metal particles (1,
  mostly female)
• (implant cost)

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Hip Resurfacing for whom?

• Physically active men in their 50s or younger
  with a long life expectancy
• Physically active pre-/peri-menopausal women
• Grey area -
• men 55-70
• women 50-65

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Hip Resurfacing

• Remember
• A conventional hip replacement is NOT second
  best
• No functional advantage to resurfacing

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Minimally-invasive hip surgery (MIS)

• General trend towards more minimally-invasive
  surgery
• MIS rather a passing fad
• No evidence of benefit
• Some evidence of adverse effects

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Hard bearings

• Bearings in hip replacement
• Metal on polyethylene (UHMWPE)
• Ceramic on polyethylene
• Metal on metal
• Ceramic on ceramic
• Highly crosslinked polyethylene
• (Metal on ceramic)
• One of the major issues in THR today
• Cost is approximately proportional to longevity

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Young adult hip arthritis protusio acetabulae
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Another example of protusio acetabulae
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Young adult hip arthritis inflammatory and
dysplasia
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What can I do after my hip replacement?

• A lot more than you might think!
• Non-contact sports, including skiing
• Limit high impact exercise
• Develop a sixth sense to reduce risk of
  dislocation

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Will I get MRSA ?

• Very unlikely at the NOC

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Thank you

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Femoroacetabular impingement

• Increasingly recognised and talked about
• Thought to be a frequent precursor of hip
  arthritis
• Treatment controversial ( NICE )
• Illustrative case

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Case of femoroacetabular impingement

• 23 yr female
• Enjoys dancing
• Sudden hip pain on certain movements
• On examination, no adduction of the flexed hip

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MR Arthrogram
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Young male almost certainly a sequel to FAI