Management of Complex Total Hip Arthroplasty

It depends on the pathology and the type of activity. A well-selected hip replacement lets most patients resume daily activities and many general activities, but for physically demanding sports like football or basketball a total hip replacement is not really compatible with returning to the same sport, and changing to a less demanding sport is usually the better path. Where the underlying problem is femoroacetabular impingement rather than true arthritis, hip arthroscopy to clean up the impingement and cartilage, combined with stem cell therapy, allows the hip to regenerate over about six months with good results on repeat MRI.

The X-ray tells the story: if the joint space and cartilage are still maintained, surgery is not the first answer even if pain has started. Arthroscopic cleanup of osteochondral bone formation or damaged cartilage combined with stem cell therapy is a good option at that stage. Hip replacement is reserved for once the cartilage is completely damaged and there is no blood flow left to the femoral head.

Hip arthroplasty is not recommended below 17 to 18 years of age because the skeleton has not matured. For sickle cell disease specifically, bone marrow transplant, ideally done early in childhood, remains the standard curative treatment and gives the best results. In children who do need hip intervention before that age, arthroscopy and osteotomy techniques that reshape the weight-bearing surface of the hip are used instead of replacement, relieving pain while the child grows.

A well-fitted hip replacement lasts 30 to 35 years, and since most hip replacement candidates are older, most will not need it again in their lifetime. Longevity depends on the patient avoiding certain positions and activities that stress the implant, including sitting cross-legged or squatting on the floor, and avoiding high-energy sport activity.

Stem cells are osteoprogenitor cells capable of turning into bone, cartilage or other tissue types. For damaged islands of hip cartilage, the area is cleaned up arthroscopically and stem cells are injected. On follow-up MRI over about six months, the cartilage visibly starts regrowing, similar to grass regrowing, and the damaged area shrinks along with the patient's symptoms.

A straightforward primary hip replacement can be completed in about 40 to 45 minutes, while a complex or revision hip replacement can take two to two and a half hours because of the additional reconstruction involved.

Unlike knee arthritis or degenerative spine disease, which patients can often manage day to day, a damaged hip does not allow free movement at all, making it one of the conditions most likely to genuinely stop a patient from functioning.