Total Hip Arthroplasty

Background

  • A total of 22,453 primary THAs were performed in the Netherlands in 2005, and 202,500 primary THAs were performed in the United States in 2003.

Pre-operative Exercise

The benefits of pre-operative exercise and therapy have recently come into question. Gilbey and colleagues (2003) showed that 8 weeks of pre-operative exercise improved scores for the Western Ontario and McMaster Universities Osteoarthritis Index (total score, stiffness, and physical function components) and combined hip strength one week prior to surgery compared to controls. These Patients had improved hip flexion range of motion in the diseased hip compared with patients in the control group. Significant differences in outcome measures between the groups were observed throughout the postoperative phase from Weeks 3 to 24. In Rooks et al (2005), among THA patients, the exercise intervention was associated with improvements in preoperative Western Ontario and McMaster Universities Osteoarthritis Index function score and Short Form 36 physical function score. Exercise participation increased muscle strength preoperatively. Exercise participation prior to total joint arthroplasty substantially reduced the risk of discharge to a rehabilitation facility in THA and TKA patients. The intervention had no effects on outcomes 8 and 26 weeks postoperatively. Gocen et al (2004) showed no benefit of pre-surgical physical therapy routine. Vukomanović et al (2008) showed that a short-term preoperative program of education with the elements of physical therapy accelerated early functional recovery of patients (younger than 70) immediately after THA. Wijgman et al (1994) concluded preoperative exercise and instruction is not useful for patients who in the near future will be treated with a total hip arthroplasty for primary coxarthrosis.

Surgical Approaches

The most common surgical approaches are the anterolateral, direct lateral, and the posterior. During the anterolateral approach an incision is made between the TFL and the guteas medius with either partial reflection of the medius or takedown of the greater trochanter. After the components are placed, the medius repaired or the greater trochanter is reattached. The posterior approache involves splitting the gluteus maximus and takedown of the deep hip external rotators and conjoint tendon to expose the posterior aspect of the hip. After the components are placed the posterior capule and conjoint tendon are repaired.

Types of Arthroplasty Surfaces

  • Metal on Metal
  • Ceramic on Ceramic
  • Metal on Polyethylene
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