Technique

One of three approaches are commonly made for a total hip replacement:

• anterolateral - between tensor fascia lata and gluteus medius
• posterior - through the posterior hip capsule
• lateral or Charnley approach - with detachment of the trochanter

Each has its own advantages and disadvantages but the principles are the same. After good exposure and resection of the femoral neck and head, the acetabulum is reamed out and fitted with a cup. The femoral head is then replaced with a metal ball attached to a stem inserted into the femoral shaft and articulating with the acetabular cup.

The prosthesis may be fixed mechanically or with cement.

The cup is usually composed of high density polyethylene which has a low rate of wear. The femoral components are usually high fatigue strength stainless steel or cobalt chrome alloy. The cement, where used, is an acrylic plastic - methyl methacrylate.

NICE state consider a posterior or anterolateral approach for primary elective hip replacement (1)

Reference:

1. NICE (June 2020). Joint replacement (primary): hip, knee and shoulder