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NICE has been notified about this procedure and it is part of its work programme. The Interventional Procedures Advisory Committee (IPAC) will consider this procedure and NICE will issue an interventional procedures consultation document about its safety and efficacy for 4 weeks’ public consultation. IPAC will then review the consultation document in the light of comments received and produce a final interventional procedures document, which will be considered by NICE before guidance is issued to the NHS in England, Wales, Scotland and Northern Ireland.
 
Status In progress
Decision Selected
Process IPG
ID number 1842
Description Osteoarthritis is a disorder of synovial joints which occurs when damage triggers repair processes leading to structural changes within a joint. When it affects the hip, symptoms include joint stiffness, pain and reduced function, such as difficulty walking. This procedure aims to precisely reconstruct the hip with less damage to surrounding structures that are important to hip function, and without dislocating the hip joint. Under general anaesthesia, the patient is usually positioned on their side in the standard lateral decubitus position with the hip in 450 of flexion and 100 to 150 of internal rotation. An incision is made superior to the greater trochanter. The gluteal fascia is incised and the gluteus maximus muscle is split. The gluteus medius and minimus are retracted anteriorly and the piriformis tendon is retracted posteriorly. Once the joint capsule is exposed, it is incised from the base of the greater trochanter to 1 cm proximal to the acetabular rim. The femoral canal is then reamed and broached without dislocation. The femoral neck osteotomy is performed and the femoral head is removed. The implant trial cup is placed into the acetabulum to allow access of instruments for acetabular preparation. Once acetabular is reamed, the definitive acetabular component and polyethylene liner are inserted and secured. Trial femoral components are reduced and tested for stability and tissue tension. Once satisfied, the definitive femoral head is inserted and femoral prosthesis is implanted. Cement is not used. The hip joint capsule is preserved and closed with a suture. Then the gluteal fascia and skin are closed with sutures. The procedure usually takes about 120 minutes to complete, and a specific implant and various specialised instruments are used. Postoperative rehabilitation is recommended for muscle strengthening and mobility. This procedure aims to reconstruct the hip to reduce symptoms and improve hip function, with a smaller incision and reduced tissue damage compared to the standard posterior or direct lateral approaches.

For further information on how we develop interventional procedures guidance, please see our interventional procedures programme manual