When Total Hip Replacement was first made possible, surgeons would delay surgery as long as possible. The reason was quite simple: we did not know how long the implants would last. It was not uncommon to wait until a patient was nearly wheelchair-bound with pain and disability before undertaking a hip replacement. Up until about 20 years ago, it was rare to see a hip replacement in any patient under the age of 65.
Today, the number of hip replacements performed in the US has exploded, with nearly 300,000 performed each year. Hip replacement has also become more common for patients in their 40s, 50s, and 60s. In a field where we now have follow-up data of up to 30 years, we can start to examine how well hip implants truly work and how long they can be expected to last.
A recent paper out of the Journal of Bone and Joint Surgery evaluated the risk of having to replace, or revise, a total hip implant that had been implanted in a patient. The authors compared patients 75 years and older at the time of the first hip replacement to those patients 65-75 years old.
The risk of a hip implant requiring revision was shown to be higher in younger patients and in male patients. This and other studies have shown that male patients, younger patients, patients with higher level of activity, and surgeons that perform less than 6 hip replacements per year all increase the risk of a patient needing a hip revision. Male patients, especially those who are younger tend to use the hip more and “wear” it out sooner, as do those patients with higher levels of activity. This is a manmade device with only so many cycles of use. In addition, surgeons who perform only a few total hip replacements a year are more likely to have subtle errors in technique such as implant angle of placement, which can lead to a need for revision.
As a hip replacement surgeon, I often see patients younger than 75 with severe osteoarthritis and patients who tend to be more active. In an effort to try to diminish the hip revision surgery rates, I will still have the patient delay hip replacement surgery as long as possible, altering their activity levels and prescribing effective nonsteroidal anti-inflammatory medication. If a hip replacement has to be done, the patient is better served by seeing a surgeon who performs a significant number of them (at least a dozen a year). The San Antonio Orthopaedic Group has several surgeons who operate at or above this level and complete the surgery in an efficient manner. Technology and materials are better as well, allowing better control of revision due of instability, or dislocation, and wear generated by the head of the hip on the socket. Finally, we try to match the implant and bearing type with the patient’s anatomy and their age, using more resilient bearings in all candidates.
As we accumulate data on the current generation of hip implants and manage the increased need, we as surgeons will continue to strive for improved longevity of your total hip replacement. As more patients receive this type of surgery, we will continue to see the need for revision surgery, but patients will better served by seeking out more experienced surgeons and improved implant technology.
Dr. David T Schroder is a board-certified orthopaedic surgeon, fellowship trained in total joint replacement, with The San Antonio Orthopaedic Group. He treats patients aged 11 years and up for most orthopaedic conditions, with the exception of spinal surgery. His special interests include total joint replacement of the shoulder, hip, and knee. To schedule an appointment with Dr. Schroder, call 210.281.9595.