title: The modern, hybrid total hip arthroplasty for primary osteoarthritis at the Hospital for Special Surgery.
abstract: We describe our technique and rationale using hybrid fixation for primary total hip arthroplasty (THA) at the Hospital for Special Surgery. Modern uncemented acetabular components have few screw holes, or no holes, polished inner surfaces, improved locking mechanisms, and maximised thickness and shell-liner conformity. Uncemented sockets can be combined with highly cross-linked polyethylene liners, which have demonstrated very low wear and osteolysis rates after ten to 15 years of implantation. The results of cement fixation with a smooth or polished surface finished stem have been excellent, virtually eliminating complications seen with cementless fixation like peri-operative femoral fractures and thigh pain. Although mid-term results of modern cementless stems are encouraging, the long-term data do not show reduced revision rates for cementless stems compared with cemented smooth stems. In this paper we review the conduct of a hybrid THA, with emphasis on pre-operative planning, surgical technique, hypotensive epidural anaesthesia, and intra-operative physiology.
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, 20012, USA.
authors.forename: A
authors.initials: A
authors.lastname: González Della Valle
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, 20012, USA.
authors.forename: N
authors.initials: N
authors.lastname: Sharrock
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, 20012, USA.
authors.forename: M
authors.initials: M
authors.lastname: Barlow
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, 20012, USA.
authors.forename: L
authors.initials: L
authors.lastname: Caceres
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, 20012, USA.
authors.forename: G
authors.initials: G
authors.lastname: Go
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, 20012, USA.
authors.forename: E A
authors.initials: EA
authors.lastname: Salvati
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D006622:Hip Prosthesis; D006761:Hospitals; D006801:Humans; D007430:Intraoperative Care; D015207:Osteoarthritis, Hip / Q000601:surgery*; D011300:Preoperative Care; D011474:Prosthesis Design; D017755:Prosthesis Fitting
keywords: hybrid fixation; surgical technique; total hip arthroplasty