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What’s Inside Responding to the reader Quality of life The artificial joint Improvements Research Views Fatigue and illness Adolescent nutrition and lifestyle Basic research: the foundation for medicine Learning to walk...again At the Forefront Researchers in the making Heritage Youth Researcher Summer (HYRS) Program 2006 Reader Resources Responding to the reader AHFMR frequently receives letters requesting information about Heritage research or about various medical conditions. “Responding to the Reader” is an AHFMR Research News feature intended to provide up-to-date information related to readers’ questions, with the help of experts in the Alberta research community. AHFMR cannot provide medical advice, however; please see your family physician about your specific health concerns. In the orthopaedic field, hip replacement is one of the most common major surgical procedures done in Canada. Known technically as total hip arthroplasty, the surgery has been performed around the world for more than 40 years. It removes diseased or fractured bones of the hip joint and replaces them with artificial components. The major indication for hip replacement is chronic pain that does not respond to medical treatment; the cause of the pain and disability is usually arthritis. A reader has asked about outcomes of hip-replacement surgery. To answer this question, we spoke with Dr. Bill Johnston, an Edmonton orthopaedic surgeon who specializes in arthroplasty surgery and who has done research on outcomes following total joint arthroplasty and hip fractures in elderly patients. Quality of life “Total hip arthroplasty is a very successful procedure in giving people back a functional quality of life,” he says. “The patients who need the procedure are in significant pain, which prevents them from working, doing any kind of recreational activity, or even managing activities of daily living. When you see patients six weeks after the operation—walking without crutches or canes—they are different people. Their smiles tell the story.” Dr. Johnston notes that outcomes for total hip arthroplasty have continually improved because of advances in both the materials used to make the prostheses and the surgical techniques employed. These improvements have led to a rethinking of the age considered appropriate for surgery. Twenty years ago, hip replacements were done mainly in individuals older than 65 and younger than 80. Now hip replacements are done in people in their 50s and people well into their 80s. The artificial joint There are three elements to an artificial hip joint: a stem that is inserted into the femur (thigh bone); a ball to replace the head of the femur; and a cup that is inserted into the pelvis. Titanium alloys have been used for the stem for about 10 years. While titanium is very strong, it does not make a good surface for the ball and cup. Other options for surfaces now include cross-linked polyethylene (as a lining for the cup), metal balls, ceramic cups and balls, and all-metal cup and balls. To help them decide what kind of hip joint to use, orthopaedic surgeons use research results obtained by tracking outcomes for patients with different types of prostheses. Improvements Surgical techniques have also improved over the years. One major trend is toward smaller incisions. Dr. Johnston now routinely uses an incision about 10 to 12 centimetres long, compared to the traditional 20-centimetre incision, but not every patient qualifies for this approach. “I advocate using the size of incision that lets you do the operation safely and at a high standard of quality.” Patients can enhance their own outcomes, especially by losing weight before the operation. Rehabilitation is also very important. “We used to tell people to take it very easy after the operation,” says Dr. Johnston. “Now patients are standing and walking on either the day of surgery or the next day. We recommend weight-bearing as tolerated, and this more aggressive approach to rehabilitation has decreased complications such as blood clots. “I tell patients they have a 95-percent chance of a good result, lasting at least 15 years. Total hip arthroplasty is one of the most successful surgical procedures ever devised. It gives people their lives back.” Dr. Bill Johnston is an orthopaedic surgeon and clinical professor in the Department of Surgery in the Faculty of Medicine and Dentistry at the University of Alberta. He is also a site medical director of the University of Alberta and Stollery Children’s hospitals. He received support from the Health Research Fund, administered by AHFMR on behalf of Alberta Health and Wellness, for his study entitled “The effect of patient comorbid conditions on pain and functional recovery after total hip and knee arthroplasties”. Back to Top