Miss Samantha Tross, Consultant Orthopaedic Surgeon discusses her approach to hip replacement surgery
Seek advice early with respect to hip pain. Choose your surgeon carefully
Total Health asks ten top hip Consultant Surgeons the following questions:
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Q1: Which type of hip prosthesis do you routinely use and why?
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Q2: How long have you used this choice?
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Q3:Do you use this hip prosthesis exclusively?
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Q4:If you sometimes use alternative hip prostheses please specify which type(s) and why?
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Q5: What procedure do you use?
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Q6: If you needed a hip replacement now which prosthesis and procedure would you opt for?
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Q7: What over-riding piece of advice would you give to someone considering having hip replacement?
Q1: Which type of hip prosthesis do you routinely use and why?
"For a primary hip replacement, I use an uncemented cup whenever possible, irrespective of the patient's age. I would only consider cementing a cup if insufficient bone stock is available."
"My current cup of choice is the Trident cup manufactured by Stryker, preferably the solid back version. If I have concerns about the fixation, I would use the cluster holed shell instead, when supplementary screws can be used. The reason for this is that looking at the information from Joint Registries, when a hip replacement fails it is more commonly on the cup side. The most common cause of failure outside of infection is cement fragmentation and subsequent prosthetic loosening."
"The cemented cup would be an Exeter cemented polyethylene cup."
"On the femoral side, my implant of choice is the Exeter stem for patients over 65 years, or those who are unsuitable to have an uncemented component. This stem has excellent long term results backed by Registry data. In patients below 65 years, I use the Stryker Accolade stem whenever possible. Registry data support the use of uncemented components in younger patients as it is associated with improved survival of components in this age group."
"The bearing surface for younger patients would be ceramic on ceramic or ceramic head on polyethylene liner. For the older patient it would be a metal head on polyethylene liner."
Q2: How long have you used this choice?
"I have used the above components for 9 years."
Q3: Do you use this hip prosthesis exclusively?
"Yes"
Q4: If you sometimes use alternative hip prostheses please specify which type(s) and why?
"I use these standard components for all my primary hip replacement surgeries unless underlying pathology precludes their use, such as underlying metal work, when I may be forced to use a femoral component with a shorter stem. This has only been the case in two or three instances."
Q5: What procedure do you use?
"For my primary hip replacements I use a minimally invasive incision using an anterolateral approach. This carries a small risk of a persistent limp 2-4% and risk of dislocation of 1-2%. The minimally invasive scar is more cosmetic and the approach less traumatic to tissues and hence there is less pain, bleeding and a faster recovery."
Q6: If you needed a hip replacement now which prosthesis and procedure would you opt for?
"I would choose a minimally invasive procedure with use of uncemented components (Trident cup/ Accolade stem) and ceramic bearings."
Q7: What over-riding piece of advice would you give about hip replacement?
"Seek advice early with respect to hip pain. Choose your surgeon carefully. Be confident of their ability to perform the procedure offered. Be clear on the procedure offered and the reasons for doing so and be confident of their ability to perform the procedure offered."
See also answers the following hip replacement experts:
- Mr Phillip Stott
- Mr Howard Ware
- Mr Ed Davies
- Mr Winston Kim
- Mr Charles Willis-Owen
- Mr Mark Rickman
- Mr Jeremy Latham
- Mr Paul Jairaj
- Mr Stephen Jones
- Mr Warwick Radford:
