Total hip replacement

Ranking in the 2020 list of Hospitals and Clinics published by the Point newspaper:

1st National Clinic for hip replacement
2nd National and 1st Regional Clinic for Knee Replacement
4th Regional Clinic for Knee Ligaments

Osteoarthritis and necrosis of the hip are the two main causes of painful deterioration of thehip joint.
In both cases, the friction surface between the thigh bone and the pelvic bone is worn away. This causes disabling pain and/or stiffness. There is currently no effective way of repairing this friction surface, which is made up of cartilage.

The journey of a patient suffering from osteoarthritis of the hip from the consultation to the organisation of the operation.

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Ranking 2016 - 2017 Le Point:

In 2017, Clinique Arago remains No. 1 for hip replacement surgery in France

Hip replacement surgery

Before the operation:

For the surgeon to decide to fit a total hip replacement, there must be both significant, prolonged pain or discomfort that is resistant to medical treatment and an X-ray of the hip confirming advanced wear.
A full pre-operative check-up will be required, including: a consultation with an anaesthetist and a cardiologist; a blood test; and a specific X-ray to measure the dimensions of the prosthesis required.

During the operation:

The skin incision is made on the edge of the hip.
The operation lasts an average of 1 hour 30 minutes, from the time the operating drapes are put in place to the time the patient leaves the operating theatre.

A blood recovery system enables the volume of blood lost during the operation to be reinjected into the patient.

The total hip prosthesis is made up of 3 or 4 parts, some of which are fixed to the bone in the femur and pelvis, while others are assembled together. Metal (various possible alloys based on chrome-cobalt, titanium or oxinium), polyethylene (a special industrial plastic) and ceramic are the three most common materials used in a hip prosthesis.
There are also dozens of types of prosthesis, from which the surgeon chooses according to each individual case.

After the operation :

From the second day after the operation, the patient can sit in a chair.
The redon drains (small tubes placed under the scar to draw out blood and prevent haematoma) are removed on the third day.
Walking is started with crutches as soon as possible in the days following the operation to prevent phlebitis (a blood clot in a leg vein).
The average length of stay at the clinic is one week, but this is tending to decrease with recent progress.
Rehabilitation is then necessary, starting in hospital and continuing in a centre or at home with the help of a physiotherapist for around 2 to 4 weeks.
Certain rules for living and positioning the leg must be observed, especially during the first few months, to avoid dislocation of the prosthesis. Such dislocation is much rarer once all the tissue around the prosthesis has healed, which takes 2 to 3 months. For example, car use should be avoided for the first few weeks after the operation.

Recent progress:

The latest materials developed aim to limit the progressive wear of the prosthesis (Metasul® or Ceramic), improve fixation to the bone (Titanium or Hydroxyapatite) and prevent dislocation (dual mobility cup).
These innovations mean that the prosthesis can be expected to last longer than the usual 15 years.
These prostheses can now also be fitted with or without cement; each of these two options has its advantages and disadvantages.
New fitting techniques, with or without computer assistance, mean that these modern prostheses can be fitted in a minimally invasive way, i.e. by limiting the incision, cutting no muscle, reducing bleeding, and therefore theoretically allowing much faster recovery of function and walking.