So you think you need . . . A total hip replacement:Safer surgery

* First, avoid surgery by treating your osteoarthritis holistically (see box, p 10).

* Think twice if you are under 60. It’s likely that you’ll need a revision in your lifetime.

* Use the cementless variety if your bones are strong.

* Insist on a hospital and a surgeon with a long and successful track record in performing this particular operation.

* Opt for tried-and-tested materials. At the last count, there were more than 60 brands of artificial hips. In one study, two-thirds of Charnley prostheses, among the oldest and best-tested models, were still operational after 25 years (J Bone Joint Surg, 1997; 79: 1599-617).

In a 1998 health-technology assessment of all research on the various hip brands, the lowest revision rates were seen with the Exeter, Lubinus and Charnley prostheses. Another good performer is the Stanmore (J Bone Joint Surg, 1995; 77-B: 520-7).

Among the cementless varieties, the AML Total Hip Replacement is the most widely used model in the world. The lowest wear rate is with metal-on-metal (alumina-on-alumina) (Clin Orthop, 1996; 329 Suppl: S78-88; Clin Orthop, 2000; 379: 123-33).

* Avoid these products: hip prostheses made from zirconia ceramic, hydroxyapatite (HA)-coated total hip replacements with a thin polyethylene inlay, and the W Hex Loc cementless hip socket (J Bone Joint Surg, 1999; 81 [B]: 835-42; Acta Orthop Scand, 1998; 69: 253-8; Clin Orthop, 2001; 393: 112-20).

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