In Total Hip Replacement the worn or damaged femoral head is surgically removed, allowing access to the socket.  The damaged surface of the socket or acetabulum is reamed away with spherical reamers, to expose healthy bone underneath.  A titanium socket is then inserted into the prepared bony cavity.  A single screw is often utilized to hold the socket firmly in position, allowing bone ingrowth to occur relaibly.  The Highly Crosslinked Polyethylene surface is then placed onto the socket, and attention is turned to the femur.  The inner portions of the femoral canal are fashioned into the appropriate shape for the femoral component using tapered broaches.  Care is taken to choose the implant geometry and size that best fits the individual bone.  The implant is inserted and an initial "press-fit" is achieved through the intimate contact of the porous surface of the implant to the bone.  The bone then grows directly into the porous surface, making the implant an actual part of the patient's body.  The new femoral head, or the ball portion of the ball and socket joint, is then placed onto the femoral component in a way that optimizes the leng length and tension within the muscles and ligaments.  The femoral head is then "reduced" or placed back into the socket, and closure is performed.

We utilize 3 different techniques in approaching the hip for total hip replacement.  The choice is made based on the individual anatomy of the patient, and associated clinical details.

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With this technique the lower portions of the traditional posterior exposure has been diminished, with less muscle dissection.  Specially designed instruments allow bone preparation and implant insertion with reproducibility.  The posterior capsule and 3 small tendons are repaired to their anatomic positions

The Direct Anterior Approach to the hip allows a preservation of all of the muscle attachments to the hip, in most cases simply retracting them away, and allowing a return to an anatomic position without the need for repair.  One benefit to this approach is fewer restrictions in post operative motion, because the tendons the prevent dislocation remain intact.

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This technique uses a percutaneous instrumentation to further limit dissection of the lower portion of the incision, with direct access to the socket achieved with through a cannula (metal tube) placed while preserving most of the posterior tendons of the hip.

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