The problem: Replacements dramatically improve the lives of most people who have them. But long-term success depends largely on the type of artificial joint (implant) used and the skill of the surgeon. Research shows older-style implants usually last longer than newer models.
Why have a hip replacement? Osteoarthritis, a painful joint disease, is the main reason. This mostly affects older people. About 40,000 hip replacements are performed annually on the NHS, mainly on people over 60. The operation, where part of the hip joint is replaced with an artificial socket and ball, relieves pain and improves mobility for most people.
Are all replacements the same? No. Success rates vary significantly according to among other things the type of implant, the method of fixing it and who does the operation. About one in 10 replacements are repeats, because the artificial joint has worn out. Repeats are not always available and don't work as well, so it is vital to get the operation right first time.
What's the best chance of success? Studies show surgeons who perform large numbers of replacements have the best results. Operations by junior doctors are more than 10 times more likely to need repeating than those done by consultants, says a major trial.
Which implant is best? Most of the 60 types of artificial joints used in Britain have not been properly tested over time. Long-term studies show that older, conventional and cheaper designs, like the Charnley and the Stanmore, fixed with a cement "grouting", have the lowest failure rates. Around 90% of patients with these implants report little pain after 10 to 20 years. Other cemented implants show less favourable results over 10 years. New-generation implants, which are fitted without cementing, have been less well tested. In Norway, where data is collected from all hip operations, non-cemented implants are replaced more than twice as often as cemented versions.
So what should I do? Ask your surgeon who is going to perform the operation and, if it is a junior doctor, whether the consultant will supervise throughout. Check which implant will be used and ask for evidence of long-term success. Ask for the results of operations by the doctor performing the surgery using that implant. Based on the answers you can judge whether to seek the operation elsewhere.