FAQ’s

With all the problems in the news about ‘metal on metal’ hip replacements, what do you use?

The term ‘metal on metal’ means the two bits that articulate together, namely the head and the socket. This is known as the ‘bearing surface’ and there are several alternatives. A lot of the stories in the papers and on the TV are exaggerated and have caused quite a bit of panic.

Metal on metal hips were first used in the 1970’s but didn’t work very well. They were redesigned over 10 years ago amidst a lot of advertising directly aimed at the patients telling them the advantages of big metal heads and better range of movement, along with stories of sportsmen having them done. Whilst the original designs are still working well, research has shown that there is quite a specific group of patients they work well in and a number of groups of patients that may have some problems with them. The other problem is that other companies copied the designs and they have not worked well, one has even been withdrawn from use. We now know that they don’t work as well as the tried and tested types of hip replacement unless they were performed by well trained high volume surgeons.

Most surgeons who did use the metal on metal hips have now stopped doing so, and their patients are under close follow up on a yearly basis under guidelines issued by the health service regulatory bodies. Patients’ are to have blood tests and sometimes scans to check on the state of their hip and if there are any problems then they should be seen by a trained Revision Surgeon (someone who can perform ‘re-do’ surgery).

With all the options for hip and knee replacements, how do I know which would be the best for me?

This can be very confusing for patients when they are often bombarded with good intended advice from friends, family, their local doctor and more recently from internet searches (often run by the companies that make the implant and are trying to directly advertise their own product!)

Each individual patient should be assessed and treated with the best type of implant for their particular condition. One single implant doesn’t work for every situation. The best person to make this decision is the Surgeon, so patients should make sure they are seeing a well qualified, reputable surgeon working in a well established Hospital. Patients should feel happy to question the surgeon as to how many of the procedures he/she performs per year and their success rates.

How do I get referred to see the surgeon of my choice?

The decision to come to see a surgeon is a joint one made by the patient and their family doctor (GP). The GP will assess the patient and discuss the options available. These may be as simple as taking painkillers, using a walking stick or having a stair lift fitted at home. If the GP feels that the patient will benefit from a review with a surgeon then they will refer the patient on. The patient has the right to ask to be seen in a certain hospital by a certain surgeon and if they explain why, the GP should do their best to make sure their wishes are met.

Am I too young to consider a hip or knee replacement?

The main group of patients being discussed here are the ones who have had childhood problems with their joints or previous injuries.

In the past, patients have been made to wait until they were in their 70’s to have a joint replacement however this is not the case today. Hip replacement technology has improved vastly and much younger patients are having them done. It is a balance between quality of life and how long the replacement will last.

Hip Replacement Case Study...

A 38 year old father of two has suffered with his right hip since he was a child. A dysplatic hip with infection and surgery had left him with a very short right leg and pain to the point where he could not sleep, even with taking painkillers, he was unable to carry on at work (a desk job) and could not play with his children.Even though he is young, he has reached the stage where he desperately wants something doing to rid him of the pain.

The first two pictures show an X-ray of his pelvis and hips and a CT scan taken to look at the abnormal anatomy and bone loss to help plan surgery. The final picture shows his post operative X-ray where I have realigned his hip, his legs are now the same length and he is pain free.

He was willing to accept the risks of surgery and the very likely possibility of further surgery in the future when this one wears out because of the level of his symptoms.

This type of surgery is very specialised, involving several different surgical techniques over a four hour period and should therefore only be undertaken in a specialist centre.

Knee replacement surgery has not moved on quite as quickly as hips have. Yes, younger patients are having knee replacements nowadays but they still only last for 10-15 years in the best case scenarios. If the patient is under 50 years old and is overweight, then studies have shown up to half of the operations fail before this time. All is not lost for these patients though, weight loss and targeted physiotherapy have good results.