Dr Engela is a fellowship-trained specialist hip replacement surgeon and a founder member of the Constantia Joint Replacement Unit (CJRU) and has been performing total hip replacements since 1993. He utilizes a minimally invasive surgical technique through a posterior approach.
Dr Martin is a fellowship trained specialist hip replacement surgeon and a member of the CJRU. He operates through a minimally invasive, muscle-sparing anterior approach.
A total hip replacement is a very successful procedure for patients with arthritis of the hip. Arthritis of the hip can be caused by osteoarthritis, inflammatory arthritis, or secondary arthritis due to an injury or deformity. Hip fractures are often treated with a hip replacement if screw and plate fixation can not be done.
The accepted survivorship 
period of a total hip replacement after replacement is 98% at 10 years and this criterion is used when selecting an implant in our practice.
There are various implants available for total hip replacement with combinations of bearing surfaces being metal-on-polyethylene, metal-on-metal, ceramic-on-ceramic and metal-on-ceramic. The material that the hip replacement component is manufactured from could range from cobalt chrome, stainless steel to titanium, with or without hydroxyappertite coating. The implant selection should be left up to the surgeon, as there are various combinations and permutations available which may have to be ultimately selected only during surgery, based on the particular anatomical requirements of the patient.
Dr Engela and Dr Martin attend- and present papers regularly at international meetings and follow published literature closely in order to determine which implant is best for which patient. We do not follow a principle of one implant could or should be used on all patients. Each patient has a different geometry and different circumstances and therefore each patient in our practice will be assessed individually and a suitable implant selected to match the patient.
Dr Engela's experience was gained whilst he was involved in designing custom implants for each patient and supervising manufacturing of the custom implants during the years 1993 – 1995. These custom implants were part of a research project and did not become commercially viable due to the cost of manufacturing inidiviual implants. The design of more than 1000 custom implants and implantation of more than 500 implants at the time gave him a good understanding of how to select an implant for each patient individually.
At present most patients in our practice will have a cementless total hip replacement with the option of metal-on-metal, ceramic-on-ceramic, or metal-on-polyethylene articulation surfaces. Implant selection and procedure of choice are based on several factors. We have to consult with the patient in order to determine the needs of the patient in terms of joint utilization, severity of disease and deformity and assess the X-rays.
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