Clinical Partnerships

Upon agreeing a suitable operation, its location, its planning, choice of implant and rehabilitation protocol, the surgeon and patient establish a partnership. The likely outcomes of this partnership are:

Pain

It is highly probable that the patient will no longer feel any pain after the surgical procedure.

Activity

A well planned and executed procedure will allow the patient to lead a normal and fulfilling lifestyle, domestic, working, social, and sports activities all undertaken post operatively.

Longevity

The functional lifespan of the prosthesis can vary depending on the levels of activity and demands placed upon the implant. It should last for 15 years or more. A quality friction couple is considered to be key to success, and Symbios find itself recommending large ceramic on ceramic bearings wherever possible.

Complications

The surgeon will explain to his/her patient the possible complications of total hip and knee replacement surgery. Often, these complications will be described by order of severity. They may occur either very soon after the operation or after the prosthesis has been in place for some time. The rate of complications, although low, can never be zero.

All surgeons audit their activity through the National Joint Registry (NJR) and patients may wish to discuss this NJR data with their operating surgeon. For example, interoperative infection rates are generally <1% and dislocation (instability of the ball and socket friction couple) following total hip replacement <2%. Figures vary from hospital to hospital and from surgeon to
surgeon.

Further analysis of the literature on this vast subject allows us to identify the most frequent complications. These are:

  • Wear
  • Aseptic loosening
  • Recurrent dislocation

References

Kurt et al. National Hospital Discharge Survey Data (NHDS) J Bone Joint Surgery 2005 Bozic et al. J Bone Joint Surgery, 87-A, 2005

The use of cementless implants, ceramic on ceramic friction couples and dislocation prevention techniques tend to decrease the rate of these complications.

Dislocation prevention techniques include:

  • The use of large diameter femoral heads
  • A tapered prosthetic neck (small diameter)
  • Reproduction of the correct musculo-ligamentary tension (muscular balance) which is very much down to the skill of the surgeon
  • Orientation and sizing of the implants for which HipPlan can be a valuable asset in this process