The goals of total hip replacement (arthroplasty) are to provide relief of pain and discomfort, improve function and enhance stability in patients suffering from arthritis or any disabling orthopedic hip problem. This goal was originally met in the late 1960’s and has been improved over the past several decades.

Joint replacement is a common surgical procedure with a high success rate. In an arthritic hip, the damaged ball (the upper end of the femur) is replaced by a metal or ceramic ball attached to a metal stem fitted into the femur (with or without cement), and a plastic or ceramic socket (fitted into a metal socket) that is implanted into the pelvis, replacing the damaged socket.

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The increasing number of total hip replacements in young patients in recent years, is accompanied by an increased number of revision operations due to excessive wear of the polyethylene in the young active patient, leading to osteolysis and loosening of the prosthesis. For this reason, there has been extensive research to find alternative bearings with better wear properties to cope with this tremendous devastating problem. At this moment, ceramic-on-ceramic and metal-on-metal seem to be the most suited alternatives for the metal-on-polyethylene bearing in the young active patient.

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Ceramic-on-ceramic prostheses

New in our clinic is the use of DELTA ceramic-on-ceramic prostheses (figure 4 and 5). The Ceramtec Biolox®delta is a prosthesis which has a new ceramic mixture. Due to the adding of zirconium and chromiumoxide (pink colour), the couple is now even better than the previous ones (Biolox®Forte).

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Metal-on-metal prosthesis (figure 1 and 2)

Today there is a new type of metal-on-metal prosthesis used in the ANCA medical centre. ( en These are fabricated from a harder cobalt-chromium alloy, and thus consist of a metal-on-metal couple. This new combination creates a differential hardness between the two moving parts. This differential makes that the metal is likely to release less particles into the body and wear less over time. (figure 3 and 4) In all hip prostheses the femoral head wears quicker than the acetabular shell (except the metal-on-polythylene ones (hard-on-soft)). The difference in hardness is a major advantage over the previous metal-on-metal prostheses and even more over the metal-on-polyethylene prostheses.

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Revision Total Hip Arthroplasty

When 1 or both components of the prosthesis are loosened, a replacement will be mandatory. This is called a revision arthroplasty. There are several reasons for loosening of the prosthesis:

  • osteolysis (bone resorption), induced by polyethylene wear particles (aseptic)
  • infection (septic)
  • fracture (e.g. caused by a fall… )

Revision arthroplasty implicate more extensive surgery with less chance for excellent clinical results. 

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Alternatives For Total Hip Replacement

Conservative treatment

One alternative is not to have an operation. If your pain can be controlled with medication (pain killers: such as paracetamol, or non steroidal anti-inflammatory drugs; or disease management medication: like glucosamine-sulfate), physiotherapy, and adapting your physical activities, so that you are sufficiently comfortable and you are content with your present activity level and motion in your hip, then you may decide to wait (AKA watchful waiting).

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