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Hip replacement Surgery.... Direct Healthcare International make your hip replacement surgery simple
and straight forward with our fully inclusive package offering total care, minimally invasive
surgery, physiotherapy and journeys to and from the airport. We can even arrange flights
and wheelchair assistance throughout your journey. 
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 Total hip replacement involves removing the top of the femur. |
 The cup implant is fitted into the prepared hip socket |
 Inserting the tapered hip prosthesis into the femur |
 The femoral head is fitted to the prosthetic stem |
 The
femoral head is inserted into the cup implant |
 The finished hip replacement |
Total hip replacements allow good mobility, but may slightly reduce the range of movement of the leg. If it is your intention to return to full active sports a hip resurfacing should first be considered, however the latest technology in total hip replacement with a Magnum head known as Metal-on-Metal Hip Replacement allows for an increased level of activity such as golf and even tennis! This is an ideal solution for an active person over 70 years of age.
The reasons why candidates have a preference for resurfacing are
addressed further on..
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Hip replacement prosthesis may be constructed of various materials but is usually made of forged steel rather than cast steel (these would be prone to break). The exterior of the unit is rough and porous so that the unit when press fitted will combine with the bone, which actually grows into the unit. This creates an immensely strong bond, which is hard to separate (rather like barnacles on a ship). Most surgeons will haver a prefrence for a carefully engineered and measured press fit as teh final result is stronger and longer lasting. Were the bone stock is thinner then a cemented fit is preferred as the cement will reinforce the weekend bone struckture.
What is a Hip Resurfacing?
With Hip Resurfacing instead of the Femur being cut through just below the head, the head
of the femur is capped with a ball cap. This cap is then inserted into the cup implant which
is press fitted into the prepared hip socket
 The head of the femur is capped with a ball cap. |
 The cap is inserted into the cup implant which is press fitted into the prepared hip socket. |
Indications are that this is an extremely durable solution for young and
active patients that wish to keep full natural mobility and return to full active sports.
Hip resurfacing is suitable for Women below the age of 65 and Men below the age of 70 where
the condition and strength of the bone is suitable.
Hip resurfacing ensures a faster recovery time than conventional hip replacement. The patient
is able to resume a normal active life sooner.
Direct Healthcare International fit Zimmer prosthetics. Zimmer is in our opinion the best
and most widely used prosthesis with over 300,000 units successfully fitted.
We have no known instances of a hip-resurfacing unit dislocating.
Total hip replacement with a Magnum head (Metal on metal) the ideal solution for an active person over 70 years of age
In metal-on-metal hip replacement the articulating surfaces are made from cobalt-chrome. Cobalt chrome offers high wear resistance and has much smaller debris particles than the metal-on-plastic polyethylene plastic articulation. Metal-on-metal implants have been available in Europe for more than 20 years. Metal-on-metal implants are made by several manufacturers. Hips by Wright Medical, Zimmer (Metasul) and Biomet (M2a and M2a Magnum), and DePuy ASR XL are FDA approved in the US.
Metal-on-Metal Hip Replacement - Using a Large Diameter Femoral
Head |
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Metasul®
The Strength of Metal-on-Metal
Developed and refined in Europe for over 40 years, Metasul has helped over
140,000 patients worldwide. In 1988, after rigorous testing at 15 independent clinical sites
in the United States, Metasul was cleared for use in the United States.
In the Metasul implant, the conventional plastic polyethylene insert has a cobalt chrome
metal inlay. This helps minimize wear over time, potentially increasing the longevity of
the implant.
Patients are placing more demands than ever before on their hip implants.
Like any piece of equipment, a conventional polyethylene hip insert can wear down over time.
The motion of a hip implant relies on the articulation of a metal head within a plastic
polyethylene cup in the hip socket. The problem with polyethylene is that it can wear over
time. Microscopic particles may break off and settle around the implant and surrounding
tissue. The body’s immune system rejects this polyethylene debris, often causing osteolysis
or "eating away" of the bone.
As the patient loses bone in his or her hip, the implant may become loose and no longer
function properly. The patient then must undergo major surgery once more to replace the
implant.
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Metasul offers the promise of greater longevity than traditional hip implants. The Metasul System has a metal inlay inside the polyethylene insert. This is known as metal-on-metal articulation because the metal ball rubs against the metal inlay as the patient moves. The body’s natural synovial fluid lubricates the metal surfaces. Microscopic analyses have shown that even scratches are actually smoothed over by the gliding movements of the components. |
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Rigorous testing has shown that Metasul’s wear particles are so small
that they cannot be measured using the same methods for measuring polyethylene wear particles.
(the particles are about 200 times smaller) This suggests that the volume and size of the
metal particles are such that they may be more readily cleared by the body, thus potentially
diminishing the local immune response that leads to osteolysis (bone loss).
As life expectancies continue to increase, so will the demand for long-lasting implants.
Metasul is ready.
Hip
Resurfacing is the first preference for the young and active!
Today’s younger candidates prefer Hip Resurfacing rather than Total Hip Replacement.
There are several reasons why candidates have a preference for resurfacing these are addressed
further on.
Total Hip Replacement is recommended when a candidate is unsuitable for resurfacing such
as:
The prosthesis is usually made of forged steel. The exterior of the unit is rough and porous so that the unit when press fitted will combine with the bone, which actually grows into the unit. This creates an immensely strong bond, which is hard to separate (rather like barnacles on a ship).
The ball may be titanium coated, cobalt chrome plated or ceramic (there
is sometimes concern from patients as to whether the ceramic ball will break but providing
the unit is properly engineered this is extremely unlikely). The advantage of ceramic is
that it is both extremely robust and has a very low friction coefficient leading to a low
wear rate.
Sometimes the cap may be ceramic but these in rare cases have been known to break under
excessive stress conditions. One popular combination is a ceramic ball and composite cap
with a metal liner, these are found to have less wear. Modern units can wear at the rate
of 1 micron a year; some years ago wear rates were more likely 200 microns a year so great
improvements have been made. One thing to be weary of is ensure that your surgeon is fitting
a leading manufacturers unit not a generic copy such as those that you may receive in cheaper
surgery. If it is possible find out what the surgeon will be fitting and do they fit a very
good standard of unit. If you are a private patient that is paying their way you should
be able to ask these questions and receive a satisfactory answer. Government health services
will fit units from a standard procurement list. This list may be quite limited by the number
of models and sizes, as health services seek discounts by bulk purchasing methods. In addition
the prosthesis on the procurement list may be dated as it takes time for new products to
be accepted. Zimmer is our organisations brand of choice simply because we consider them
the best on the market, they have an excellent proven track record and are the largest makes
in the market. Incidentally their units are also the most expensive but when choosing prosthesis
we always choose the best.
To summarise, some things to look out for are:
Is the unit cemented or press fit? - Total Hip Replacements can be either cemented or press
fit. This can apply to either sections or just one this is then called a hybrid. Some surgeons
have a preference for cemented however the cemented fit is generally used when there is
a weakness in the bone stock. Typically this may be due to hormonal activity brought on
by the menopause or some form of degenerative bone disease. Lately it has been reported
that continuous and heavy use of ibuprofen may also cause thinning in the bones. The press
fit (in our opinion) is stronger as the bone grows into the rough porous exterior of the
prosthesis.
What is a Hip Resurfacing?
Today more and more people are hearing about the benefits of hip resurfacing over conventional
hip replacement. This relatively new technology started with the invention of the “Birmingham
Hip replacement” approximately 15 years ago.
What is Durom™ Hip Resurfacing
Since 1988 MetasulTM has been successfully used for total hip replacement. Today’s
metal on metal technology is the result of over one and a half decades of intense development,
research and clinical evaluation forming the foundation for the latest evolutionary development
– DuromTM Hip Resurfacing.
Advanced engineering and materials technology coupled with Swiss precision manufacturing
has resulted in this exceptional Hip Resurfacing prosthesis. Developed for the younger and
more active patient, it is designed to provide high levels of joint stability whilst removing
as little bone as possible. The articulating components are made of MetasulTM alloy ProtasulTM-21
WF, the first wrought-forged CoCr resurfacing prostheses, which is the same material used
to restore mobility of over 500,000 patients.
Design detail
In designing the femoral component, many important factors needed to be considered. Bone
conservation, precise positioning and an optimum cementing technique were of utmost importance.
The guide pin, whilst removing less bone than comparable systems, allows for an ideal physiological
transfer of load, whilst ensuring accurate positioning of the prostheses. The unique grooves,
on the inner side, allow for even pressurization of cement into the cancellous bone (a spongy
type of bone with a very high surface area found at the ends of long bones), but avoids
a taper effect, providing additional rotational stability.
Minimal thickness with maximum strength!
The acetabular cup is a flattened hemisphere, offering a greater range and freedom of movement.
With a constant wall thickness of 4 mm throughout all sizes, the cup maintains an inner
diameter as large as possible, whilst maintaining maximum implant strength and minimum bone
resection. A coating of pure titanium, using a plasma spray under vacuum and static load
is applied to the outer surface. This unique manufacturing method gives a surface roughness
of 20–50 microns with a porosity of at least 25%, shown in vitro testing to significantly
improve primary stability. As shown in laboratory tensile tests the adhesive strength of
the titanium coating of 66.2–76.5 MPa, significantly exceeding FDA requirements of
22 MPa
Lower wear rate!
The high carbon CoCr alloy is produced by a forging rather than a casting process. This
means that the size of block carbides is up to eight-times smaller compared to cast CoCr
prostheses. The resulting lower surface roughness subsequently leads to a lower wear rate
when compared with cast CoCr alloys. Co-28Cr-6 Mo-0,2C/ProtasulTM-21 WF (ISO 5832-12): a
carbide-containing and therefore low-wear cobalt chrome alloy was chosen for MetasulTM.
The key to successful resurfacing!
As with almost any joint replacement system, precise and easy-to-use instruments are key
to a success.
In developing of the DuromTM Hip Resurfacing the engineers not only focused on implant design
and material technology but also concentrated on the surgical procedure, and how to resurface
the hip in the best way possible. As a result, an ingenious method to accurately and precisely
position components was conceived.
Low wear and greater joint stability
The large diameter of the MetasulTM ball head offers low wear coupled with greater joint
stability and a high range of motion. This is available in combination with the extensive
range of femoral implants from Europe’s largest manufacturer of joint prostheses.
Designed to outlast a "conventional" hip
prosthesis
The Durom Hip Resurfacing has been specifically designed for use in young active patients
who are likely to outlast a "conventional" hip prosthesis. Emphasis has been placed
on a high quality bearing surface, preservation of bone stock and durable fixation of the
components.
The Metasul bearing surface is a proven low wear, low-friction articulation, having been
implanted in over 300,000 patients since 1988. No other metal-on-metal bearing has such
a track record.
The Durom acetabular and femoral components have been designed to allow maximum preservation
of bone stock. The wall thickness of the acetabular component is as low as practically possible
and the cup subtends an angle of 165°, similar to the natural acetabulum. These features
facilitate preservation of the acetabular bone stock.
The sophisticated femoral instrumentation permits very accurate positioning of the femoral
component, allowing the smallest possible femoral implant to be used, which in turn, allows
the insertion of the smallest possible acetabular component, again preserving acetabular
bone stock.
The Porolock Ti VPS surface coating of the Durom acetabular component is vacuum plasma-sprayed
pure titanium. This coating is associated with reliable bone in-growth, ensuring long-term
secondary fixation. The carefully controlled vacuum spraying process results in a very high
adhesive strength between the chrome cobalt substrate and the Porolock Ti VPS coating, reducing
the risk of the generation of titanium 3rd-body-wear particles.
The femoral instruments produce an even cement mantle of approximately 1 mm, reducing the
risk of fatigue failure of the bone cement. The recesses within the femoral component enhance
rotational stability of the implant.
Indications for hip resurfacing
Hip resurfacing is most appropriate for physically active patients with good bone quality
and adequate femoral and acetabular bone stock. Such patients will generally be under the
age of 65. However patients with the following indications are also suitable for hip resurfacing.
Patients with the following indications are NOT suitable for hip resurfacing.
Planning your Journey
Our staff will assist you in planning your journey. This is especially necessary when undergoing
hip and knee surgery to ensure that you return home in comfort.
Before Surgery
Please read our hip surgery brochure carefully or information on how to best prepare for
your surgery.
Once you have Arrived
When you arrived hospital staff will great you and ensure that you are settled in the privacy
of your own room in the family B&B unit. You will be asked your dietary preferences
and be given a short guide to the hospital and its facilities.
Your Hospital Stay
The next day after the preliminary consultation, your consultant surgeon will carefully
assess your condition and will decide with you which surgery is best suited. There is a
short pre-surgery questionnaire to complete and it is likely that some investigations will
be done at this stage, such as a blood test and x-rays.
You will be fully briefed on what to expect and how to prepare for your operation. The surgeon
will ensure that you are comfortable and explain all about your surgery. The anaesthetist
will visit you and answer any questions you may have.
After Surgery
A physiotherapist will visit and instruct you in a program of exercises to assist
your restoration to peak physical condition. Within a short while you will be safely on
the road to recovery!
The typical program
Our program offers you the opportunity to swiftly obtain the corrective surgery you need,
taking advantage of the benefit of our experience and expertise in the field of orthopedic
surgery.
Our orthopedic surgery program takes you step by step through the procedure; from your outgoing
journey and preparation, through to your physiotherapy program and aftercare pathway leading
to full health and fitness.
An additional weeks stay with physiotherapy is available on request. This is particularly suitable to those of senior age or where the muscle activity has reduced in recent months leading to low muscle streangth.
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