Hip Treatment & Replacement
We are not all the same shape and size!
Over 93000 hip replacements are carried out in the UK every year and the vast majority have excellent outcomes for the patient in terms of pain and mobility. The operating surgeon will advise patients of the options available to them, including whether a custom hip implant would be a suitable option, although a standard hip implant will usually be recommended by the consultant. Although there are some choices about the material a standard hip implant is made from, particularly at the bearing surface, the so called ‘ball and socket’, a standard implant doesn’t offer any scope to be tailored to fit the actual shape of a patient’s hip joint, what we call their anatomical requirements. Symbios specialises in the design and production of Custom hip implants understanding that every person’s anatomy is individual to them. Our custom hips are made to exactly reproduce the patient’s native hip joint anatomy, offering improved outcomes over standard implants in patients who are young, particularly active or considered ‘high demand’.
Unlike standard implants, Custom implants require a detailed ‘roadmap’ of the patient’s anatomy. Symbios obtain this ‘road map’ from a CT scan, this is an extremely detailed X- Ray which not only shows us the motorway network and A & B main roads, it also shows us the country lanes and public footpaths! The patient’s CT scan is processes by our HipPLAN® software and a 3D model of the patient’s hip joint is modelled as is their anatomically matched Custom hip implant.
Most hip implants are carried out using standard implants and the vast majority achieve excellent outcomes with long term implant longevity expected. However, we at Carrothers Orthopaedics believe custom implants can offer even better results and this is why.
In hip replacements, the femoral component and socket hip implants are the components that are intimately related to the patient’s anatomy, being implanted at the time of surgery. Both are not tailored to fit the individual and the surgeon has to make the patient’s host bone fit the nearest appropriate ‘off- the- shelf’ hip implant. This means that it is not an exact match to the person’s anatomy – the unique shape and size of their hip joint.
In some cases, this can result in minor inconsistencies in bony or soft tissue fit or hip alignment, which, over time, can lead to discomfort or loosening of the implant.
By contrast, a customised implant is designed to fit the individual’s anatomy precisely. They are designed and manufactured to reproduce the person’s natural hip joint, down to the tiniest detail.
Over the life of the implant this can lead to better outcomes, particularly in younger patients who may be more active or place a higher demand on the implant than older, less active people.
What is HipPlan?
HipPlan® is a 3D pre- operative planning tool (software) that uses the images acquired during a CT examination (normally undertaken at the local hospital) to accurately plan the ensuing surgery. The restoration of equal leg lengths and muscle function and assuring stability of the ‘ball and socket’ coupling during Total Hip Replacement are three very important parameters where HipPlan can assist the expertise of the operating surgeon to optimise results. Further benefits of this planning process is to achieve the best possible outcomes including prompt discharge from hospital and return to normal activity, feeling almost ‘unaware’ of having had a hip replacement.
The scope and accuracy of our HipPLAN® pre- operative planning software was published in the peer reviewed Journal of Bone and Joint Surgery (Br) 2009:
In 223 patients: The component implanted was the same as that planned in 86% of the hips for the acetabular implant, 94% for the stem, and 93% for the neck-shaft angle. The rotational centre of the hip was restored with a mean accuracy of 0.73 mm (SD 3.5) craniocaudally and 1.2 mm (SD 2) laterally. Limb length was restored with a mean accuracy of 0.3 mm (SD 3.3) and femoral offset with a mean accuracy of 0.8 mm (SD 3.1).
Understanding the scope and power of HipPlan® pre- operative planning software requires Symbios work closely with it’s surgeon partners to produce optimal results, one of those key partnerships is London International Patient Services (LIPS) who’s ethos is to deliver the very best possible care for patients, ”
Whether the result of a sports injury or hip dysplasia, hip pain is debilitating and can af fect both your posture and your mobility. London International Patient Services has extensive experience of treating a wide range of hip conditions”
Mr Culpan, the Managing Partner at LIPS is one of a handful of surgeons globally performing customised hip replacements utilising minimally invasive techniques and more complex hip replacement surgery including lower limb reconstruction surgery, revision surgery and knee replacement surgery.
“Mr Culpan is a highly regarded and skilled surgeon who managed my Hip Replacement with complete success. He was accessible, highly competent and professional. He and his team gave me complete confidence in the procedure and recovery, and I am very pleased with the result” Sir Tom Jones.
Symptoms of an arthritic hip
Patients who need a total hip replacement generally feel localised pain in the area of the groin. This pain can be debilitating in everyday life and at night, often disturbing peaceful sleep patterns.
The options for the surgical procedure involving the implantation of a prosthesis are wide ranging. The short and medium-term results can vary considerably and affect the quality of life of the patient. Patients who want to maintain their lifestyle need to understand what options are available.
Standard cemented prostheses
These prostheses are composed of the following elements:
- A femoral stem inserted into the femur or thighbone
- A femoral head, made of metal or ceramic fixed mechanically onto the femoral stem trunion
- An acetabular cup, often consisting of a separate shell and articulating liner, fitted into the pelvis
- Standard prostheses are fixed using special medical cement, polymethylmethacrylate or PMMA. This ‘cemented’ system approach allows for immediate component fixation
Standard cementless prostheses
These prostheses are coated with HA or hydroxyapatite (pure bone crystal), which fixes the prosthesis to the bone through a biological process called oseointegration.
The stimulated bone cells colonise the micropores on the surface of the metal and thus allow the long-term fixation of the prosthesis to the bone.