| Summary: | Over the past 30 years, total hip replacement (THR) surgery, also known as total hip arthroplasty (THA), has become commonplace in the United States and throughout the world. It has been described as the greatest achievement in orthopedic surgery in the twentieth century. Although no surgery is without risk, the utility of THR to relieve pain and restore function among patients with damaged or degenerated hips and chronic pain is well-accepted as indicated by the large number of procedures that take place in the United States each year. In 2003 alone, 201,545 THR procedures and 34,688 revisions of THR were performed in the United States. From 1990 through 2002, the number of THR procedures per 100,000 individuals in the United States increased by 46%, from approximately 45 to 66 per 100,000 individuals. The same study reported a 60% increase in revisions of THR during the same time period. The rates of both primary and revision THR are expected to continue to increase. A recent report estimates that the annual number of THR revision surgeries will increase 137% by 2030. This horizon scan looks at some of the important issues facing orthopedic surgeons and other healthcare providers as they plan for the increasing utilization of THR. Areas of concern include: the selection of operative approaches (standard vs. minimally invasive or computer/robotic assisted); the design of the replacement prosthesis (metal-on-plastic, metal-on-metal, ceramic-on-ceramic, or some other combination); the surface coating of the prosthesis (untreated vs. treated); and cemented vs. uncemented fixation of the prosthesis
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