TOTAL HIP-REPLACEMENT

Objective.-To provide physicians with a current consensus on total hip replacement. Participants.-A nonfederal, nonadvocate, 13-member conse nsus panel representing the fields of orthopedic surgery, rehabilitati on and physical medicine, biomechanics and biomaterials, internal medi cine, public health, geriatrics, biostatistics, and a public represent ative. In addition, 27 experts in orthopedic surgery, rehabilitation a nd physical medicine, biomechanics and biomaterials, rheumatology, ger iatrics, and epidemiology presented data to the consensus panel and a conference audience of 425. Evidence.-The literature was searched thro ugh MEDLINE and an extensive bibliography of references was provided t o the panel and the conference audience. Experts prepared abstracts wi th relevant citations from the literature. Scientific evidence was giv en precedence over clinical anecdotal experience. Consensus.-The panel , answering predefined consensus questions, developed their conclusion s based on the scientific evidence presented in open forum and the sci entific literature. Consensus Statement.-The panel composed a draft st atement that was read in its entirety and circulated to the experts an d the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the co nference. The panel finalized the revisions within a few weeks after t he conference. Conclusions.-Total hip replacement is an option for nea rly all patients with diseases of the hip that cause chronic discomfor t and significant functional impairment. Most patients have an excelle nt prognosis for long-term improvement in symptoms and physical functi on. At this time, a cemented femoral component using modern cementing techniques, paired with a porous-coated acetabular component, can give excellent long-term results. Revision of a total hip replacement is i ndicated when mechanical failure occurs. Continued periodic follow-up is necessary to identify early evidence of impending failure so as to permit remedial action before a catastrophic event.