Optimising outcomes in primary total hip replacement

Student thesis: Doctoral ThesisDoctor of Medicine (MD)

Abstract

This thesis explores factors that affect successful primary total hip replacement (THR)
surgery. Future success in THR will likely occur through reducing the incidence of
adverse events and need for revision surgery. Such improvements rely on precision
in addressing patient, implant and surgical factors and are essential as the demands
on THR are ever higher. The key topics of contention in contemporary THR concern
stem fixation, bearing surfaces and infection.

Stem fixation

Patient age and activity influence the longevity of THR. This thesis will examine the
evidence for femoral stem fixation, i.e. cemented or uncemented, according to patient
age group and the influence of femoral stem offset on the survivorship of cemented
stems. Furthermore, the reliability of short cemented stems will be examined. Patients
requiring THR often have bilateral disease and the surgeon may offer single-anaesthetic bilateral total hip replacements. This thesis investigates if this is safe when using cemented stems.

Bearing surface factors

This thesis will examine the New Zealand Joint Registry to determine the best
performing bearing surface couple in THR. In addition, the evidence for the latest
polyethylenes will be investigated.

Preventing and diagnosing infection

Prosthetic joint infection is a devastating complication of THR, its incidence is
increasing and the success of diagnosis and treatment is time-critical. Prevention and
early diagnosis are of paramount importance in improving THR outcomes. This thesis
examines the evidence for the surgeon’ decisions regarding operating theatre
environment factors such as the use of laminar flow and modern spacesuits. The
evidence for the use of diagnostic biomarkers to improve diagnostic accuracy will be investigated.
Date of Award21 Apr 2021
Original languageEnglish
Awarding Institution
  • The University of Bristol
SupervisorAshley W Blom (Supervisor)

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