Surgeon/patient understanding
Review of the literature
Standard prostheses
Custom prostheses

Factors that make A difference

1. Fixing

Modern fixation involves fixation without cement. Cement was a type of fixation that gave prostheses good results initially. The technique of fixation without cement is more respectful of bone biology, and it appears to enable the prosthesis to support greater stresses over a longer period of time.

2. Wear

Wear is the principle cause of prosthesis failure. The characteristics of the materials used for friction couples are critical. Polyethylene should be avoided at all costs for active patients, as it produces wear debris that can cause an inflammatory reaction of the tissues leading to the disappearance (resorption) of the bone around the prosthesis. This situation may require a revision operation.

3. Dislocation

This is a debilitating complication of hip replacement and, if it recurs several times, it may be necessary to revise the prosthesis. Dislocation represents the second most common cause of a revision procedure. There are several solutions for minimising the risk of dislocation, and they can be applied simultaneously:

- implants designed to reduce dislocation
- good geometrical surgical reconstruction
- correct positioning of implants
- operative technique 

4. Legs of unequal length

Legs of unequal length cause limping and possibly back pain. The problem can be compensated for by a heel raise placed in each pair of shoes. This problem can be avoided however through:

- pre-operative planning
- good geometrical surgical reconstruction of the joint
- use of a modular neck stem or, in some cases,
  a custom prosthesis