Primary hip replacement (THR) has been used to treat hip arthritis for nearly half a century now. It is one of the most tried and tested orthopedic procedures with a great degree of patient satisfaction.
I use this procedure when the patient is unsuitable for a short stem hip replacement.
In some conditions, the anatomy is not suited for a short stem procedure and I prefer a total hip replacement. These are non union fracture neck, dysplastic hips, acetabular fractures, Coxa vara, Perthes disease, septic arthritis sequelae. Also when limb length discrepancy is a concern, primary hip replacement is a better option.
In this procedure, the neck of the femur is cut one inch above the lesser trochanter. The portion of the head and neck of the femur is replaced with a stemmed prosthesis. The socket is reamed and fitted with a liner. The stem is anchored in the femur bone with or without the use of bone cement. Cemented or cement-less fixation is used to anchor the socket also. In young patients, cement less replacements are preferred. In older patients, cemented fixation is chosen. Hard and soft bearings are available for lining the socket. The material for the ball is always a hard one like metal, delta motion ceramic or oxidized zirconium.
I prefer ceramic bearings in young patients. For older patients, I prefer metal on plastic.
For the femoral side, I prefer the Corail, M/L taper or Synergy uncemented stems. On the acetabular side, I prefer the Trilogy, Continuum and Pinnacle shells.
I will have all possible liners like ceramic, metal, plastic during surgery.
The above x rays are that of a patient with sequeale of child hood septic arthritis of the hip. She received an SROM stem and metal head primary total hip replacement.
I have treated several difficult cases like the one above. I started doing primary hip replacements during my UK training in 1994.
After a primary total hip replacement, my patients are able to walk the same or next day. They are very happy with their restored mobility and return to normal activities.
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