Hip replacement: clinical perspectives

Technological advances in hip replacement have reduced many of the problems that faced the arthroplasty surgeon. Modularity, larger femoral heads and bone conservation are the present trends in implant design as the mechanics and engineering have advanced. It is likely that the next generation of implants will move towards a deeper appreciation of the biological environment in which the implant performs. It is also likely that the main battlegrounds in the prevention of implant failure will remain similar; technical surgical issues, loosening and wear. It is likely that advances would be matched by an escalation of patient expectation. At each stage along the patient's clinical journey, innovation and advances in technology promise incrementally to help improve performance. At the same time, expectations from joint replacement are rising. Patients require more choices and more information. Widened indications for joint arthroplasty give rise to new challenges in selecting patients, assessing the best time for operating and preparing the patient for surgery. Digital radiographs are commonplace and digital templating software allows detailed planning and sizing of components in a way not feasible a few years ago. Although less widely available, three-dimensional reconstructions from computerized tomograms bridge the interface between operative planning and the surgery itself; commercial platforms now provide navigated placement of implants from these images.