Chapter 1 Total Hip Arthroplasty
Surgical Overview
• The successful outcome of a THA is based on several factors: patient selection, type of implant, method of fixation, and surgical technique.
• The determination of implant selection is individualized and based on specific patient characteristics (i.e., level of activity and bone quality) in addition to the experience of the surgeon.
• There is a wide variety of implant designs and materials available. The materials most commonly used for implants are cobalt-chromium and titanium.
• Implant surfaces can have different finishes, such as porous-coated, plasma-sprayed surfaces, roughened titanium surfaces, and hydroxyapatite-coated surfaces. The different surfaces may enhance the strength between the implant and cement or fixation of implant to bone.
• The type of implant component selected depends on whether the THA will be cemented, porous, or a hybrid.
• The profile of the most common THA performed at HSS is a hybrid THA that combines an uncemented acetabular component and a cemented femoral component. This hybrid combination provides excellent results and is more popular in North America.
• In addition to the standard THA procedure, HSS is currently using minimally invasive surgery (MIS) on a select group of patients to perform hip arthroplasties.
1 The minimally invasive total hip arthroplasty surgery is a modification of the standard surgical technique performed for THA.
2 An article by Sculco et al. states that “with modern techniques, implants, and instrumentation, THA could be performed safely and reproducibly through smaller incisions with increased patient satisfaction and without adversely affecting outcome.”
• It has been demonstrated that adequate repair of the capsule and the short external rotator hip muscles reduces the risk of hip dislocation after a posterior approach.
• Longevity of the implant depends on activity level of the patient, implant type, method of fixation, and technique of insertion.
• At the authors’ institution, patients undergoing THA are given a combination of spinal/epidural anesthesia, and a few surgeons combine the spinal/epidural anesthesia with a psoas block for enhanced postoperative pain control. A patient-controlled analgesia (PCA) pump attached via a catheter is used to control pain for the initial 24 to 48 hours.
Rehabilitation Overview
• The measurement of patient progress addressing functional limitations has been documented in the acute care setting following elective THA.
1 At HSS, the patient’s functional progress is documented on the HSS Rehabilitation Department Functional Milestones Form. This form was developed to measure functional progression of patients with joint replacements during their hospitalization and has been proven to be statistically valid and reliable.
2 The rehabilitation department has been using the Functional Milestones Form to collect outcome data on the total joint arthroplasty patient population for more than 2 decades.
3 In the early 1990s, the THA clinical pathway and rehabilitation guidelines for phase I were developed using data generated from the Functional Milestones Forms and with the collaboration of HSS surgeons and members of an interdisciplinary team.
• Physical therapy management of patients who have undergone a THA is based on the theoretical framework of the disablement model addressing pathology, impairment, functional limitation, and disability.
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