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Total hip replacement is one of the most successful operations that you can have. A successful one can literally be transformational. It can take a patient who is living with constant pain, dependent on strong pain killers, with very limited mobility and overnight, cure their pain and allow them to lead a fulfilling life. Because of the National Joint Registry, here in the UK, we can track patients after their surgery and see how long the implants last. We know that on average, if you have a well-designed implant (such as an Exeter), over 96% will still be in place and functioning well at 14 years. It is reasonable to predict that those implants will last 20 to 30 years. However, we know that if the components are not put in correctly or if the leg length or soft-tissue balance is not right, it can have a significant impact on the complication rate or how well the implant functions. This has led to the development of robotic hips.

 

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Mako robot

Recently, some work has been done on what people are doing with their hip replacements after surgery. One paper published in 2019 showed that while all their patients returned to activity, there was a general move from high to low impact exercise. Another showed that after 10 years, 89% remained active but again there was a significant decrease in high impact sport. What is not clear is was that because patients were told to reduce their activity by their doctor/surgeon or was it because they themselves did not want to wear the new joint out? Perhaps by improving the accuracy of surgery and the muscle balance, we can have the confidence to enable people to maintain their desired level of activity?

 

The market leader by far in robotic assisted hip surgery is Stryker and the MAKO robot. They have well in excess of 500 machines around the world and over 20 in the UK. At the Manchester Hip Clinic,  we started doing MAKO procedures in 2018 and are now one of the highest volume centres in the UK. Essentially, what MAKO does, is use CT scans to accurately map the shape of the patients own hip so that the new artificial one mirrors it exactly and then the robotic element ensures that the surgeon puts it in perfectly. Recent publications have shown that when using this technology, there is increased accuracy, improved patient function and quicker recovery.

 

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Mako surgical planning

The use of MAKO has transformed how we do hip replacements. We see a lot of younger patients who have abnormally shaped hips that would previously have been very challenging to replace. With MAKO, we now have the confidence to know that we are choosing the correct implant and putting it in in the best possible position. That confidence allows us to encourage patients to return to sport and a range of different activities. If I was having a hip or knee replacement, I would definitely have it done using MAKO!

Understand more about MAKO…click HERE

Hear Oshors story…click HERE

 

 

 

 

 



Who does this effect?
Hip arthritis in young patients occurs when there is degeneration in the hip causing damage to the joint surface (figures 1 and 2). There are numerous different causes but the most common is osteoarthritis. However, it can occur earlier due to abnormalities within the hip. This may be due to a previous injury, childhood hip disease, femero-acetabular impingement (A misshapen hip that catches and causes damage to the hip joint) or problems with the blood supply to the hip.

How does it present?
Commonly, this causes groin pain, often going down the thigh to the knee. The hip is stiff, and the patient walks with a limp. As arthritis becomes more widespread and severe, the pain becomes more constant, it may occur at night and be associated with increased stiffness, decreased mobility and ability to exercise.

What investigations do you need?
X-rays of the hip to confirm the diagnosis are taken as standard. More complex scans such as CT or Magnetic Resonance may be needed to pin down the diagnosis and help surgical planning.

Non-surgical Treatment
To begin with, simple measures are tried such as painkillers, weight loss and activity modification. Oral supplements such as glucosamine and chondroitin may benefit some patients, especially with early arthritis. Injections such as steroid, hyaluronic acid or PRP may be used to either confirm the source of the pain (e.g. if the patient also has back pain) or in those patients who are not ready for a joint replacement.

When a patient has severe arthritis and painkillers no longer control the pain, hip joint replacement is advised. This has the benefit of relieving the pain and allowing the patient to return to a near normal level of activity.

In simple terms, the ball of the hip is removed and the thigh bone is prepared before the metal stem is inserted. The pelvic cup is then prepared and the artificial cup is inserted and held using either bone cement or an artificial coating that bonds directly to the surrounding bone surface (figures 3,4 and 5).

There are different forms of hip replacement and each one has a role to play depending on the patient’s age and activity level. Younger (<70) and more active patients, will have implants where the cup liner is made of a wear resistant plastic and the ball of the hip will be made of ceramic, which is very smooth, hard wearing and produces less wear debris than traditional implants. Since 2018, we have pioneered the use of Robotics in hip replacement surgery. This allows for greater accuracy in positioning the implants and a faster recovery afterwards. For more information about Mako robotic hips go to Robotic assisted hip replacement


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Hip Arthritis Who does this affect?

Hip arthritis occurs when there is degeneration in the hip causing damage to the joint surface (figures 1 and 2). There are numerous different causes but the most common is osteoarthritis and this is most often seen in the older patient. However, it can occur earlier due to abnormalities within the hip. This may be due to a previous injury, childhood hip disease, femero-acetabular impingement or problems with the blood supply to the hip.

Symptoms

Commonly, this causes groin pain often going down the thigh to the knee. The hip is stiff, and the patient walks with a limp. As the arthritis becomes more widespread and severe, the pain becomes more constant, it may occur at night and be associated with increased stiffness, decreased mobility and activitu.

Investigations

X-rays of the hip to confirm the diagnosis are taken as standard. More complex scans such as CT or Magnetic Resonance may be needed to aid surgical planning.

Non-surgical Treatment

To begin with, simple measures are tried such as painkillers, weight loss and activity modification. Oral supplements such as glucosamine and chondroitin may benefit some patients, especially with early arthritis. Occasionally, steroid injections may be used to either confirm the source of the pain (e.g. if the patient also has back pain) or in those patients who are not fit for a joint replacement.

For more information about arthritis see the NHS website


The Manchester Hip Clinic is committed to helping all kinds of people with hip problems to be free from pain and often to resume near-normal levels of physical activity – even those who may have thought that such relief would never be possible.

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