Selecting the right hip replacement

Joint replacement is one of the most successful major surgical interventions, being highly effective at relieving the pain and morbidity associated with arthritic joints. Hip replacement achieves improvements in general health comparable to coronary revascularisation and renal transplantation,1 is cost effective, and patients report high levels of satisfaction.2

Joint arthroplasty replaces an organic (but failed) self healing system with an inorganic system subject to fatigue and wear. Currently available prostheses cannot compare with a natural joint in terms of longevity. Ultimately, all components wear or fatigue; consequently, a further (more complex) operation may be needed. In the quest for enhanced longevity, researchers and manufacturers have used new materials and designs in particular patient groups whose replacements are known to fail earlier. Unfortunately, not all innovations have been successful, as was recently highlighted by the problems with metal-on-metal bearings.3

In a linked paper (doi:10.1136/bmj.f7592), Makela and colleagues review the methods by which an implant is attached to bone.4 They report a population study from the combined Nordic arthroplasty registers that assessed the use and …