Hip

THA - principles, consent and survivorship

Aims of hip replacement, implant longevity and pre-operative consent discussion

11 questions 3 source pages 1 fact-check flags

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Q1What is the goal of total hip replacement (THR)?▸

Painless, stable, mobile hip

Q2Which biomechanical parameters should be restored at THR?▸

Restore hip centre and offset
Equalization of LLD
Correct orientation of components

Q3What are the surgical principles of THR relating to leg length and soft tissues?▸

Equalization of LLD
Good soft tissue balance

Q4What registry data are referenced for total hip survival?▸

Refer to AONJRR
UK joint reg – revision at 15 yrs
AUS joint reg – revision at 15 yrs

Q5What are the 15-year revision rates for THR by fixation type in the UK joint registry?▸

Overall: cemented 4.85%, cementless 5%, hybrid 4%
<55: hybrid 4%, cementless 6%, cemented 7%
>75: cemented 2%, cementless 4%

Q6What are the 15-year revision rates in the AUS joint registry?▸

Overall: cemented 5.7%, cementless 6%, Hybrid 5.5 %

Q7What general and anaesthetic risks would you discuss when consenting for THR?▸

Anaesthesia risk --> CVA, AMI, death
Wound complications; bleeding requiring transfusion
Clinical DVT ~2%
UTI and chest infection ~10%
Mortality ~0.5% in hospital

Q8What thromboembolic risks are quoted for THR?▸

Symptomatic PE ~2.5%
Fatal PE <0.5%

Q9What are the intraoperative risks of THR?▸

Fracture: primary cement 1%, cementless 10%
Fracture: revision cement 3%, cementless 30%
Nerve palsy 1-3 %
Vascular injury 0.2%
LLD: 1.5 cm lengthening in 18%

Q10What are the postoperative risks of THR?▸

Infection ~1% (Lidwell BMJ 1982)
Dislocation 3%
HO 2-90%
Periprosthetic fracture
Loosening: 10-year survivorship ~90%

Q11What are the consent figures for revision THR?▸

Mortality 2.5% in 90 days
1% not satisfied

Fact check

Consent for THR: clinical DVT ~2%, symptomatic PE ~2.5% and fatal PE <0.5% — outdated / higher than modern series — Contemporary THA data report symptomatic DVT ~0.3-0.6%, symptomatic PE ~0.2-0.5% and fatal PE ~0.03-0.1% with modern prophylaxis and early mobilisation — (medium confidence) — source

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THA - principles, consent and survivorship

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