Hip Replacement, Hip Arthroplasty, Hip Arthroscopy — What’s the Difference?

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According to a 2020 report by the National Health Service (NHS), the UK’s publicly funded healthcare system, nearly 94% of hip replacement procedures performed between April 2018 and March 2019 were on patients aged 50 years and up. Of these patients, the majority were female (almost 60%).

Meanwhile, the Organisation for Economic Co-operation and Development (OECD) Library’s “Health at a Glance 2021 : OECD Indicators” ranks Germany, Switzerland, Austria, Finland, and Belgium with the most number of people who have had hip replacement procedures in 2019.

The prevalence of hip replacement surgery adds weight to claims that it is among the most common and most accepted joint replacement procedures globally. But how does Hip Replacement differ from Hip Arthroplasty or Hip Arthroscopy, and who is a good candidate for such an operation?

LEARN MORE: Patient’s Guide When Seeking Orthopaedic Care in Singapore

HIP REPLACEMENT a.k.a. HIP ARTHROPLASTY

In order to repair a damaged hip joint, the surgeon takes out the parts that have been worn out and replaces them with prosthetic components, usually made from metal and/or plastic material. This medical procedure is called a total hip replacement, which is the same as a total hip arthroplasty.

The hip is a joint composed of a ball and socket, the surface of which is covered by articular cartilage, a substance that acts like both a lubricant and a protective layer. The ball is part of the upper thigh bone and is called the femoral head  while the socket, part of the large pelvis bone, is the acetabulum.

A total hip arthroplasty entails surgically removing the damaged femoral head and replacing it with a prosthetic stem and ball. The acetabulum is likewise taken out and replaced with a metal socket. In place of the articular cartilage, an artificial spacer is placed between the new ball and the socket.

How long a hip arthroplasty surgery takes ultimately depends on the condition of the patient’s hip. Typically, the procedure lasts about an hour or two, in which the surgeon removes the damaged ball and joint and puts in the implants. Hospitalisation is required post-op.

Meanwhile, in a revision (redo) hip replacement, the prostheses themselves are replaced with another set of artificial parts. One or more parts, such as the stem, cup or the socket may be replaced, but there are cases where the entire replacement hip has to be changed.

A revision or a redo is performed when the replacement hip stops functioning the way it’s supposed to, causing significant pain or discomfort. It usually happens when the prosthesis has started to wear out or has loosened over time and, in some cases, when it becomes dislocated.

For a revision hip replacement necessitated by an infection, one or two procedures may be performed depending on the severity of the condition. One procedure entails the hip itself to be cleaned out and for the infected tissue and prostheses to be removed and replaced accordingly.

LEARN MORE: 7 Signs That A Hip Replacement Surgery Might Be Needed

HIP ARTHROSCOPY a.k.a. KEYHOLE SURGERY

In a standard hip replacement surgery, the surgeon makes a relatively large incision of about 20.32cm (8in) to 25.4cm (10in) on the side of the hip. A hip arthroscopy, on the other hand, is a minimally invasive procedure requiring one or two incisions measuring 5.08cm to 12.7cm (2in to 5in).

Inserted into one of these incisions is an arthroscope, a miniscule fibre-optic tube to which a video camera, light, and lenses are attached. The arthroscope lets the surgeon see inside the knee through a magnified image that is displayed on a monitor.

Guided by the arthroscope, the surgeon performs the same hip replacement procedure using miniature surgical instruments that are inserted through the other incision, to probe, grasp, and cut. Because the incisions are smaller, a hip arthroscopy results in less blood loss, pain, joint stiffness, and scarring.

Moreover, hip arthroscopy results in a faster recovery time as compared to a standard hip replacement surgery. In fact, hip arthroscopy surgery is usually an outpatient procedure that takes between 30 minutes to 2 hours, depending on the assessment of the surgeon on the patient’s condition.

Additionally, hip arthroscopy is also used to repair a torn or damaged labrum—the cartilage around the socket of the hip, which keeps the hip stable. A torn labrum can cause the centre of the hip’s rotation to shift. This results in faster wear-and-tear on the hip and causes various injuries and damage.

LEARN MORE: What It’s Like To Recover From A Total Hip Replacement [Timeline]

BONUS INFO on BIRMINGHAM HIP RESURFACING

Since it was first used in July of 1997, there have been almost 200,000 Birmingham hip resurfacing (BHR) implantations worldwide. The Journal of Bone and Joint Surgery reports that those who have had BHR showed a higher chance of staying active post-op and had “demonstrated excellent survivorship” as well.

In total hip replacement, the femoral head is removed and replaced with a prosthesis, leaving very little of the femur. However, in a BHR procedure, only a few millimetres are removed from the joint, leaving much of the ball and socket intact.

Also known as metal-on-metal (MoM) hip implantation, the BHR entails attaching a metal sphere to the femoral head and fitting the acetabular socket (cup joint) with a corresponding metal cup. The entire procedure may take 1-1/2 hours to 3 hours, but patients may be hospitalised for up to four days.

While total hip replacement showed mostly positive effects in elderly patients, the hip replacement joints wear out faster in younger patients who tend to be more active. As such, more instances of complications and revision or redo hip replacement have been noted.

LEARN MORE: 7 Ways to Relieve Hip Socket Pain

Keep in mind that the only way to determine if your hip problems warrant the medical procedures we mentioned is by consulting with a board-certified orthopaedic surgeon. The information we provide, however medically factual and vetted by a doctor, should never replace a medical consultation.

Dr Andrew Quoc Dutton Orthopaedic & Sports Clinic Insurance


The Dr Andrew Quoc Dutton Orthopaedic & Sports Clinic offers minimally invasive and surgical treatments for sports-related injuries and orthopaedic conditions.

To aid in the expenses that you may incur, we accept a number of corporate and international insurance. If you have any of the insurance plans below, please let us know when you book an appointment with us. If you need further assistance, you may drop us an e-mail at info@eliteortho.com.sg or call us at (+65) 6836 8000.

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About Dr Andrew Quoc Dutton

Dr. Dutton has been in clinical practice since 1996 after graduating from Marist College, Canberra and the University of New South Wales, Sydney, Australia. Dr. Dutton has worked at the Prince of Wales Hospital, Sydney and the St. George Hospital, Sydney before completing his orthopaedic surgery training in Singapore.

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