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Hip arthritis and joint replacement

THRWear and tear hip arthritis, so-called "osteoarthritis" results from gradual degeneration and the loss of thickness of the cartilage lining of the hip joint. As the cartilage layer wears away, the bone underneath is gradually exposed and eventually the cup of the hip joint (acetabulum) and the head of the thigh bone (femur) are rubbing against each other with every step.

Physiotherapy, modification of activities, and anti-inflammatory medications are often recommended as initial treatment measures.

Persistent pain of hip osteoarthritis may require surgery. Hip replacement surgery involves replacing the affected joint with a metallic cup, and a metallic stem in the thigh bone. Then the head is attached to the metal stem and this links up with a lining inside the metal cup.

Materials of the head and cup liner, the so-called "bearing surfaces" vary. The most common is to use a metallic head with a plastic cup liner. Perhaps in younger patients, a ceramic head with a plastic liner may have better wear characteristics and could theoretically last longer. The best (lowest) rate of wear in laboratory research are achieved with ceramic heads on ceramic liners, but this combination is not used that commonly because of a 1 in 10,000 risk of either the ceramic head or ceramic liner fracturing (breaking or cracking). Finally, metal-on-metal hip replacement bearings have recently fallen out of favour because some hip replacement designs using metal-on-metal bearing have been associated with severe problems with release of metal ions into the surrounding hip tissues.

All this being said, hip replacement surgery has a very high satisfaction rate of over 95-98% in most research studies, and long term joint replacement registry data suggest that 95-95% of hip replacements last for 10 years, 85-90% last for 20 years, and likely at least 70-75% of hip replacements might even last for 30 years based on computer prediction models.

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