Total hip arthroplasty

Why are we operating?

The operation of the century by results: the worn joint is replaced by a cup, a stem and a bearing, and a life's mobility often comes back with it.

Indication: End-stage hip arthritis with failed conservative care; displaced intracapsular neck-of-femur fractures in the right patient.

The operation in 4 steps

1. 01Approach and dislocation

   Through a posterior or lateral approach, the capsule is opened and the femoral head dislocated from the acetabulum.

2. 02Neck cut and acetabular preparation

   The femoral neck is osteotomised at templated height, the head removed, and the acetabulum reamed to bleeding bone at the planned angles.

3. 03Femoral preparation and implants

   The femoral canal is broached to fit, trial components tested through a full range for stability and length, then definitive stem, head and cup bearing are seated.

4. 04Closure and first steps

   Capsule and rotators repaired where taken, layered closure, and mobilisation the same day where possible.

Danger zones

• Sciatic nerve

  The approach works millimetres from it: retractor blades lever near it, the hip is dislocated by rotating the leg around it, and limb lengthening stretches it.

Anatomy you need

The acetabulum and proximal femur: the neck cut, the canal, and the pelvis the cup is seated in.

What can go wrong

• Venous thromboembolism

  Unilateral leg swelling, or sudden dyspnoea, pleuritic pain, tachycardia, sometimes the only sign is unexplained hypoxia.

• Surgical-site infection

  Wound erythema, warmth, discharge, and pain out of proportion, typically from postoperative day 4–7.

• Postoperative bleeding

  Tachycardia first, hypotension late; falling urine output; a distending abdomen or rising drain output.