Are there controversies about Hip Replacement technique?


I am pleased to note that by 2021, almost all controversy is missing from the total hip replacement (THR) materials conversation.  With more than 500,000 THRs per year, researchers and doctors have come to the conclusion that a ceramic or chrome-cobalt-nickel femoral head (ball) against a crossed-linked polyethylene socket (acetabular liner) will provide decades of wear-free use.  Concern for those patients who received “metal-on-metal THR” still exists, and anyone with a metal-on-metal THR who develops a painful hip years after implantation should see an orthopedic surgeon for x-rays and possible blood tests, as metal wear may require surgical revision.

Surgical Approach

 The posterolateral THR approach has always been the gold standard, and early attempts at the anterior THR approach were fraught with difficulties.  Heavy commercial marketing brought the anterior THR approach into popularity with claims of quicker recovery.  Not true!  At the same time, advances in THR ball size (larger size decreases chance of post-operative dislocation) and better pain control regimens have resulted in posterolateral hip replacements to be relatively pain-free.  A significant portion of patients can be discharged the same day.

If your doctor proclaims the anterior THR is superior, ask him/her if they have read Early Rate of Revision of Total Hip Arthroplasty Related to Surgical Approach.[1] 

In an analysis of 122,345 primary THRs, the anterior approach resulted in a “higher rate of early major revisions and femoral complications compared with the posterior and lateral approaches.”

[1] JBJS 2020:102:874-82