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The future for hip replacement surgery

Tagged In:  Allied Health

A rising trend in elective hip replacements looks set to continue. New techniques and technology could help NHS England meet the growing demand for this life-changing surgery.

Hip surgery has come a long way since Professor John Charnley carried out the first full replacement at Wrightington Hospital in 1960. With refinements, new techniques and new materials introduced over the years, it's now a relatively fast, simple and routine operation for most people, with a much-reduced recovery time. Indeed, it's now such a common occurrence that we all tend to take it for granted as a standard procedure in a modern healthcare system.

Sharp increase in elective hip replacements

However, the fact that hip surgery is easier and more widely available has its downside. According to a recent report by the King's Fund, there has been a 90% increase in demand for elective hip replacements in England over the last six years. And with our ageing population, this upward trend is set to continue. That's against a backdrop of increasing financial strain on the NHS and increasing pressures on doctors, nurses and allied health professionals, such as physiotherapists and occupational therapists.

The future of minimally invasive surgery

Further technical and procedural innovations could help. Minimally invasive surgery is a technique that involves a much smaller incision with specially designed equipment used to support the leg and pull back the surrounding tissues so the surgeon can see the joint. With less tissue damage, the recovery period is generally reduced. A systematic review of 1,205 patients published in 2009 found that the mean length of hospital stay was significantly shorter after minimally invasive procedures than standard-incision procedures.

Minimally invasive surgery is currently used in only a small proportion of hip replacements carried out by the NHS and waiting times are generally longer than for traditional standard-incision surgery. However, it could be more widely used in the future to free up hospital beds and reduce the impact of increased demand.

Computer-assisted surgery (CAS) is another important innovation and can be used to support a minimally invasive approach. It enables more accurate alignment of the hip joint, which is crucial to its overall function. This has the potential to reduce the risk of post-operative issues and prolong the life of the artificial joint. The new joint feels much more natural for the patient, so the need for post-operative intervention by physiotherapists could also be reduced.

New materials such as ceramics, titanium alloys and cross-linked polymers are also producing longer-lasting replacement hip joints. Consequently, there could be less risk of older patients requiring repeat hip replacement surgery.

By 2040, almost one in seven people is projected to be over 75. Therefore, the rising demand for hip replacement operations is likely to continue. Developing more efficient techniques and technology will help ensure that the NHS can continue to meet that demand.

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