Total Hip Replacement (THR)

Total Hip Replacements (or THRs) have been used to treat hip arthritis for many decades and are some of the most tried and tested forms of orthopaedic intervention.

There are factors which make some patients unsuitable for conservative hip operations like a BHR or a BMHR. In the absence of these options, Mr McMinn will use a total hip replacement to treat the existing hip condition.

In many cases, Mr McMinn performs a total hip replacement if a patient‘s femoral head bone has become very brittle or where there has been severe bone loss. There are also anatomical conditions such as severe hip dysplasia or severe Perthes disease which make conservative options unsuitable for certain patients.

Mr McMinn will often suggest a total hip replacement for older patients who have less demand for activity after surgery. It is this demographic who form the largest proportion of THR users.

A THR procedure involves resecting the head and neck of the femur and implanting a metal stem down the shaft of the femur. Generally speaking, a THR consists of three or four components (the variations are pictured in the diagram below) - a stem, a femoral head (ball), an acetabular cup and in some cases, a cup liner.

When performing a total hip replacement, Mr McMinn’s preferred choice of stem is an uncemented Anthology stem - manufactured by Smith & Nephew Orthopaedics. Anthology stems are somewhat shorter than conventional THR stems. This is advantageous because, if at some stage a patient requires revision surgery, there is more femoral bone preserved for the revision.

The stem is fitted with a femoral head component which articulates inside the acetabular cup. When a cup liner is used, the head articulates inside the liner. Ultimately, the materials used for this articulating “couple” should produce as little wear as possible.

For many of his patients, Mr McMinn uses a ceramic femoral head component articulating in a cross-linked polyethylene cup liner (A, in the diagram below). This coupling has been shown to have low wear properties. The reason a metal cup is used to house the liner is because polyethylene cannot fix on to the acetabular bone. Instead, the metal cup fixes onto the acetabular bone on the outside, whilst housing the low-wear liner inside.

In some circumstances, Mr McMinn will opt to use an Anthology stem fitted with a metal head. The metal femoral head component articulates within a metal acetabular cup (B, in the diagram below). Since the metal cup is able to fixate onto the acetabular bone, there is no need for a liner. The joint would be a Metal-on-Metal (MoM) articulation. MoM joints, such as the one shown in the photograph above, have also been shown to have extremely low wear properties.

There are some factors such as gender, age or anatomy which mean that Mr McMinn would have to use a variation on the components mentioned above. However, he has a wide range of THR components available at surgery and his ultimate aim is to match the appropriate THR procedure to the individual patient for a successful outcome.

Mr McMinn has an excellent success rate with the total hip procedure. All of his THR patients are able to get back to their normal lives and are happy with their hip function following surgery. Mr McMinn has performed in excess of 6,000 total hip replacements in his career. To book a consultation with Mr McMinn, please click here.