Increasing numbers of patients are requiring hip replacement surgery and they are one of the most successful operations of their kind, with evidence that the operation gives patients a marked improvement in their quality of life. As with all operations, there are clear risks and rewards that patients must understand before opting for surgery. With this in mind, surgeons are continually learning and exploring more and more about the factors that lead to successful – and less successful – outcomes. It is this process of continual knowledge development that helps push medical technology forwards.
With this in mind, surgeons are continually learning and exploring more and more about the factors that lead to successful – and less successful – outcomes. It is this process of continual knowledge development that helps push medical technology forwards.
We are fortunate that across our own health service and those in some other countries around the world, there are opportunities to gather and analyse patient data, which can help identify trends and patterns in patient recovery. Results from data collected by the NYU Langone Medical Center/New York University School of Medicine indicate that those with spinal problems have greater issues with hip replacement recovery: “people with spinal deformity also requiring a total hip replacement are at greater risk for dislocation or follow-up revision surgery”.
What this means is that issues that would not usually be seen in the recovery period following a ‘normal’ hip replacement are more likely to present themselves in patients with spinal deformities. The recovery time is likely to be longer, there is a higher chance they will face more complex challenges and in the longer term they are more likely to have to undergo a second phase of surgery to correct a problem caused by the spinal abnormality.
Does that mean that people with spinal deformities are not suitable for total hip replacements?
The answer to this is no – people suffering a deformity of the spine would be classed as a higher risk category, a factor which should be flagged at consultation stage. With this knowledge of a pre-existing condition, the approach taken to their hip replacement surgery would just need to be more bespoke, and tailored more to the needs of the individual and their specific spinal complaint.
How different are the risks?
The study looked at over 100 individuals who had undergone almost 140 hip replacements (some individuals had both hips replaced). In this research sample, patients who had an underlying spinal abnormality demonstrated a greater risk that the new hip would become dislocated. The rate of dislocation was 8% in the group with spinal issues, compared with just 1% in patients without. Although both are small percentages when the total research population is considered, the difference between the two groups is significant.
The NHS in the UK is pushing for greater levels of ‘joined up care’ across the whole organisation, which is a more integrated way of managing patient care and rehabilitation. Findings such as this will mean that there will be a greater need for joined up working across orthopaedic and spinal units, ensuring that patients who are in a higher risk category get the more tailored care and support they require.