Hip iSAWE 1

Preoperative planning

• Optimise medical comorbidities, anaemia, diabetes, smoking and weight
• Screen for skin, dental and urinary infection
• Template on a calibrated AP pelvis for cup and stem size, centre of rotation, offset and leg length
• Check for deformity, previous surgery, retained hardware and spinopelvic mobility

Bearing and fixation options

• Ceramic or metal head on highly cross linked polyethylene is most common
• Ceramic on ceramic has low wear but risks squeaking and fracture
• Metal on metal is no longer used because of adverse reaction to metal debris
• Uncemented press fit cups are common in Australia, with cemented stems favoured in older patients with poor bone, as shown by AOANJRR data
• Dual mobility cups for patients at high risk of dislocation

Consent

• Expected benefits of pain relief and function, with high satisfaction and about 90% survival at 15 years
• Infection about 1%, dislocation 1 to 2%, leg length discrepancy, periprosthetic fracture and nerve injury (sciatic nerve with the posterior approach)
• VTE, medical complications and death
• Wear, loosening and revision
• Document the discussion and provide written information

Related pages

• Primary Total Hip Arthroplasty