Orthopaedic Surgery


Spire Yale (Private Only)
Anna Gizzi
01978 268 065

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Robert Jones and Agnes Hunt Orthopaedic Hospital (RJAH), Oswestry (private and nhs)
Sarah Sides
01691 404 194

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Hip Replacement Patient
Clare P riding 4 months after hip replacement

Total Hip Replacement

Total hip Replacement (THR) is a surgical procedure primarily for pain from an arthritic hip joint. It is usually considered in patients who have exhausted other non operative techniques to manage their pain. These may include analgesics (pain killers), anti-inflammatories, activity modification(if it hurts don't do it!),physiotherapy and even a walking stick.

Pain from a hip is typically felt in the groin, front of thigh and into the knee. Around 30% of patients also have pain in the front of their shin. Because of this distribution of the pain it can often be confused with a groin strain that doesn't settle and even be thought to be a knee and not hip problem! Some patients do not fit this typical pattern of pain but a thorough consultation and examination is usually enough to identify the pain source.

Pain that is preventing your normal sleep pattern regularly and preventing your preferred day to day activities is bad enough to think about intervening. On the NHS some authorities are now ranking patients using scoring systems with only the worst patients qualifying for NHS funding. These scores were not designed for this task. As a private patient the decision remains solely between you, the patient, and me, the surgeon.

There are a wide variety of designs of THR, some radically different from others, but they are all Total Hip Replacements. There are advantages and disadvantages to all designs of hip replacement, I will discuss with you which type of prosthesis is best suited to you as an individual, and why.

Hip replacements can be cemented or un-cemented. In cemented hips the artificial joint is held in place by "glue" . In un-cemented hips the metal making up the implant is designed to allow the bone to grow onto and into the surface of the metal, this creates a biological bond.

Of equal importance is the bearing surface of your hip. (the bits that rub together)

The "Gold Standard" hip replacement probably remains a cemented THR, with a metal on polyethylene (plastic) bearing. In my hands this is an Exeter THR manufactured by Stryker/Howmedica. There are a number of other excellent examples of this type of hip design but this is the one that I use, having done over 900 in the past nine years.

In younger more athletic patients there are newer materials available such as ceramic on ceramic hips, metal on metal hips and even ceramic on metal hips. There are also new plastics that appear to wear less than the earlier plastics used in hip replacement.

l have undertaken over 150 metal on metal resurfacing total hip replacements (the"Birmingham Hip") These may be appropriate in younger, athletic patients, but patients need to be aware of a recent Medicines and Healthcare products Regulatory Agency (MHRA) product warning issued on ALL metal on Metal hip replacements in April 2010.

I will discuss with all my patients whether surgery is appropriate for them, and also what design of hip replacement is best suited to them.

Total Hip Replacement
Total Hip Replacement

Cemented Hip
Cemented Hip Replacement

Uncemented Hip Replacement
Uncemented Hip Replacement

Hip Resurfacing
Hip Resurfacing