Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.
The prostheses for a total hip replacement (total hip arthroplasty) can be inserted into the pelvis and femur with or without cement. The options are customized for each patient by the orthopedic surgeon.
Chronic pain and impairment of daily function of patients with severe hip arthritis are reasons for considering treatment with total hip replacement.
Complications and risks of total hip replacement surgery have been identified.
Preoperative banking of the blood of patients planning total hip replacement is considered when possible. This blood can be used for transfusion if needed (autologous transfusion).
Physical therapy is an essential part of rehabilitation after a total hip replacement.
Patients with artificial joints are generally recommended to take antibiotics before, during, and after any elective invasive procedures (including dental work).
A total hip replacement is a surgical procedure whereby the diseased cartilage and bone of the hip joint is surgically replaced with artificial materials. The normal hip joint is a ball and socket joint. The socket is a "cup-shaped" component of the pelvis called the acetabulum. The ball is the head of the thighbone (femur). Total hip joint replacement involves surgical removal of the diseased ball and socket and replacing them with a metal (or ceramic) ball and stem inserted into the femur bone and an artificial plastic (or ceramic) cup socket. The metallic artificial ball and stem are referred to as the "femoral prosthesis" and the plastic cup socket is the "acetabular prosthesis." Upon inserting the prosthesis into the central core of the femur, it is fixed with a bony cement called methylmethacrylate. Alternatively, a "cementless" prosthesis is used that has microscopic pores which allow bony ingrowth from the normal femur into the prosthesis stem. This "cementless" hip is felt to have a longer duration and is considered especially for younger patients. Total hip replacement is also referred to as total hip arthroplasty.
The progressively intense chronic pain, together with impairment of daily function including walking, climbing stairs, and even arising from a sitting position, eventually become reasons to consider a total hip replacement. Because replaced hip joints can fail with time, whether and when to perform total hip replacement are not easy decisions, especially in younger patients. Replacement is generally considered after pain becomes so severe that it impedes normal function despite use of anti-inflammatory and/or pain medications. A total hip joint replacement is usually an elective procedure, which means that it is an option selected among other alternatives and can be scheduled on a routine basis. It is a decision that is made with an understanding of the potential risks and benefits. A thorough understanding of both the procedure and anticipated outcome is an important part of the decision-making process with the orthopedic surgeon.
Surgery is generally reserved for those patients with osteoarthritis that is particularly severe and unresponsive to the conservative treatments. In some cases, severely degenerated joints are best treated by fusion (arthrodesis) or replacement with an artificial joint (arthroplasty). Total hip and total knee replacements are now commonly performed in community hospitals throughout the United States. These can bring dramatic pain relief and improved function.