Hip Replacement Types


Diagram Showing a Healthy Hip

Diagram Showing a Healthy Hip

Hip replacement surgeries are the most successful orthopedic procedures today. In the United States alone, hip replacement surgeries are performed over 300,000 times a year. Hip replacement types vary depending on a patient’s age, activity, disease and injury.

Ostearthritis of the Hip

Ostearthritis of the Hip

Although hip replacement surgery may be required for various reasons, it is often due to osteoarthritis of the hip.

Hip replacement surgery modifies the damaged joint by creating a bearing using implants.

The new joint restores some mobility and relieves pain for the patient.

Depending on the type of procedure, hip replacement surgery can use the existing femoral head or acetabulum or replace one or both with implants.  Three hip replacement types are:

  • Partial Hip Replacement
  • Total Hip Replacement
  • Hip Resurfacing

For this article, we will not discuss hip revision, which is a surgery that later revises one of the hip replacement types of surgeries listed.

Use this information to understand the different hip replacement types in order to educate yourself or a loved one who is preparing for hip replacement surgery. Knowing hip replacement types and their advantages and disadvantages will help when talking with your surgeon or health care professional.

Hip Replacement Types – Partial Hip Replacement

Partial hip replacement is also known as partial hip arthroplasty, hemi-arthroplasty and partial-arthroplasty. In this surgery, only one surface is replaced – the femoral stem – and the natural or existing ‘healthy’ acetabulum is used.  Usually the surgery is required for someone who has fractured the femoral neck of his or her femur bone. Unlike the term suggests, partial hip replacement is not less invasive: it requires the same amount of cutting into the leg by the surgeon. The risks for surgery are the same as total hip replacement.

Type of Hip Replacement - Partial Hip Replacement

 

Characteristics of Partial Hip Replacement

  • Femoral head designed larger to match existing acetabulum
  • Since implanted femoral head is larger, there is less chance of dislocation
  • Good for those who do not have arthritis
  • Less blood loss than total hip replacement
  • Good for beginning or less experienced surgeons
  • Relieves pain
  • Only addresses arthritis of the femoral head

Hip Replacement Types – Total Hip Replacement

The surgery involves the replacement of both the top of the femur – femoral head and stem – and the acetabulum.  The top of the femur is removed and a stem implant with a femoral head is inserted into the opened cavity of the femur bone. Sometimes the femoral head is a separate ball made of various materials which include metal, ceramic and polyethylene.

3 Hip Replacement Types - Total Hip Replacement

With the acetabulum, the ligaments and cartilage are removed, and the socket is smoothed out with a machining tool. The acetabulum is normally made of two pieces. The metal cup attaches to the pelvis and a liner is inserted into the cup. The liner can be made of various materials including metal, ceramic and polyethylene. Metal on polyethylene is the most popular material combination used in the total hip replacement implant.

Total hip replacement is more successful than partial hip replacement surgery.  With many partial hip replacements, the cartilage around the acetabulum eventually needs repairing, requiring a revision.

Total hip replacements were once thought of as surgeries only for those over 65 and who were inactive. Waiting until the patient was older and inactive reduced the need for a revision and lessened the risk of failure due to excess wear. Today’s materials and techniques help total hip replacement implants last 20, 30 or more years and are seen in increasingly younger patients.

Hip Replacement Types – Hip Resurfacing

During hip resurfacing, the orthopedic surgeon removes ligaments and cartilage from the diseased or damaged femoral head, smooths it and places a cap over it. The cap may have a short narrow stem that is inserted into a hole drilled into the proximal femur. The cap is normally metal. The surgeon then removes ligaments and cartilage from the acetabulum, smooths the area of the pelvic bone, and surgically implants a metal cup in the prepared acetabulum area.

Benefits of Hip Resurfacing Over Other Hip Reconstructive Surgeries

  • Attractive to young and active patients due to bone conservation
  • Added hip stability due to larger large diameter of femoral component
  • Recipients experience a greater range of motion
  • Compared to other hip replacement surgeries, recipients can return to a higher level of physical activity
    • mixed martial arts participants
    • tennis players
    • rock climbers
  • More accurate in restoring leg lengths and other calibrations
  • Less wear
  • Easier revision surgery3 Hip Replacement Types - Hip Resurface

Drawbacks of Hip Resurfacing over Other Hip replacement Surgeries

  • Smoothing of the femoral head creates greater risk for later bone fracture
  • Femoral cap must be thin and is difficult to design and manufacture
  • Risk of metallosis and allergic reactions to the metal
  • Hip revisions after resurfacing occur more frequently than in total hip replacement after 20 years

Hip Replacement Types – Cement/Non-Cement Implants

Implants can be installed with or without cement. The method used depends on your surgeon, the implant used, your age, and your activity level.

Uncemented Stem Implants Characteristics

  • Non-cemented prosthetics – Good for younger patients
  • Helps reduce bone loss
  • Helps with any future revision surgery
  • Implants use a special coating call hydroxyapatite
    • Permits ingrowth of the bone
    • Improves fixation of the prosthesis to the bone
  • Stems are more costly with more expensive materials and manufacturing and more elaborate design
  • Can cause pain in first 2 years of use as the bone adapts to the placement of the stem

Cemented Stem Implant Characteristics

  • Stems require better surgical technique
  • Pain in cemented stems is rarely seen
  • Good for older patients
  • Good for patients who have increased risk of fractures

Hip Replacement Types – My Hip Replacement

I received a total hip replacement in October of 2014. It was performed using an anterior approach and used a cementless stem and acetabulum. The stem was metal with a ceramic femoral head and polyethylene two-piece acetabulum.

After the surgery, the surgeon reviewed my progress at several points during the year to assure the pain was not too great, He took X-rays to assure the bone was meshing well with the implant.

After one year, I exercise five days out of the week, sometimes up to 90 minutes per day. Sometime it feels achy in the leg and there are times when my endurance on the leg is limited.

However, my life with a hip replacement is much better than it was before the surgery. Then, I was in pain walking and standing. I couldn’t ride a bike and I had a very noticeable limp.

Hip Replacement Types: Conclusion and Engagement

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Resources in This Post

PubMed – NCBI.com: Total Hip Arthroplasty – over 100 years of operative history

Colorado Hip Resurfacing: History of Hip Resurfacing – The Early Years Total Hip Replacement

Wikipedia, the free encyclopedia: Hip replacement

BBC News: Metal-on-metal hip replacements ‘high failure rate

Science Direct: Thompson hip hemiarthroplasty: Asymptomatic after 44 years; a case report

The Leone Center for Orthopedic Care: Partial vs. Total Hip Replacement Surgery

PubMed – NCBI: Hip hemiarthroplasty – from Venable and Bohlman to Moore and Thompson

Medscape: Hip Resurfacing

Stryker: Cemented Stems – Exeter : Stryker

Dr. Fritz Boettner – NY: Hip Resurfacing Surgery New York City

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