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THR Myths Facts and Fictions

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Location: http://www.thehipclinic.co.uk/thrfacts.htm

Description: Fiction: Hip replacement is easy. Even registrars (residents) can do them without supervision. Fact: Most hip replacements are easy. In elderly patients minor errors of technique will be tolerated quite well as long as hip stability is enough to prevent dislocation. It is when the pathology is even a little unusual or the patient is young that things can unravel and this is when there is no substitute for experience. Myth: Hips need to be redone because they "wear out". Fact: Hips need to be redone because they loosen with time. Fact: Metal-on-metal Hip Resurfacing has changed the ground rules regarding age and hip arthroplasty. Patients can be considered for surgery when they need it regardless of age. Fiction: Outpatient Physiotherapy (Physical Therapy) is always required after hip replacement to get the best out of the operation. Fact: Most patients do splendidly on their own at home. Some may benefit, especially if there was unusual stiffness or deformity/scarring beforehand. Myth: Hips can only be redone once or twice. Fact: Hips can be redone several times. It does get more tricky and bad revisions lead tomore surgery…………. Fact: Epidural or regional anaesthesia greatly reduces morbidity and mortality. Myth: Hip prostheses are all basically the same. Surgeons know which to use appropriately. Fact: Field of Hip Arthroplasty is littered with examples of bad choices! It is still in turmoil. Myth: Surgeon knows how long patient should be off work, before they can drive a car etc. Fact: Depends largely on patient perception, motivation and personality. Fact: Cause of Primary osteoarthritis of Hip remains completely unknown. Fiction: Patients needing Hip replacement are getting older as population ages. Fact: Patients are getting both older and younger. We are not sure why younger. Myth: Hip replacements only last 10 to 12 years. Fact: If Surgeon is not getting survival of>95% at 18 to 20 yrs something is not right! Fiction: OA of the Hip is easy to diagnose. Diagnosis is rarely missed. Fact: Often masquerades as knee pain. Can be exquisitely difficult to differentiate between low back or sacro-iliitis and OA of Hip. Fiction: X-ray tells Surgeon when to operate. Fact: We treat patients not X-rays! Often no correlation between X-ray and symptoms. Fact: some NSAID’s unfriendly to cartilage: can cause accelerated degeneration." Dissolving Hip" . Naproxen probably best known and worst! Fiction: Leg length is easy to measure intra-operatively and so if there is a discrepancy post-op the Surgeon is negligent. Fact: Intra-operative leg length measurement is crude and errors are very easy to make. Fact: Leg length discrepancy is better tolerated if leg is made slightly short than even very slightly long. Best of all is to get it just right! Experience is best teacher. 1Fact: All the important, major developments in the field of Hip Arthroplasty over the last 40 years have mostly been British! Myth: Hip replacements are a commodity that can be bought or sold like groceries. Fact: It is more like buying a good car: look at the manufacturers reputation, the dealer efficiency and cleanliness as well as the after sales service and spare parts supply! Myth: Small incision= better. Fact: This is only true if size of incision does not limit Surgeon’s ability to fix everything in properly and if appropriate implants used for age and activity. Fiction: Small incision= faster recovery, earlier discharge. Less bruising. Fact: These are influenced more by general fitness and therefore age than anything else. Also heavily influenced by patient attitude, personality. Bruising often more with small incision because of need to stretch skin to get implants in.

Type: Reference Material
Author/Contact: Bloomfield
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Language: English

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Added: Thu Sep 14 2006