What is Hip Resurfacing?
Patients with advanced arthritis of the hip may be candidates for a total hip replacement or hip resurfacing
Hip resurfacing is a type of surgery to replace a damaged hip joint. When there is damage to this joint, moving the femoral head may cause pain as the bones scrape together abnormally.
Patients with advanced arthritis of the hip may be candidates for either traditional total hip replacement or hip resurfacing. Each of these procedures is a type of hip replacement, but there are important differences. We will talk with you about the different procedures and which operation would be best for you.
When do I need Hip Resurfacing?
You might need hip resurfacing if you have significant damage to your hip joint. Different types of medical conditions can damage this joint, like:
- Osteoarthritis (most common)
- Rheumatoid arthritis
- Injury or fracture of the hip joint
- Bone tumor in the hip joint
The damage to your hip joint, if significant, eventually causes pain and can interfere with your activities of daily life. Hip resurfacing may help decrease your pain, improve your joint mobility, and result in a better quality of life.
The advantages of hip resurfacing over traditional total hip replacements is an area of controversy among orthopaedic surgeons. Research is currently being done on this topic.
Hip resurfacings may be easier to revise
Because the components (called implants) used in hip replacements and hip resurfacings are mechanical parts, they can — and do — wear out or loosen over time. This typically occurs between 15 and 20 years after the procedure, although implants may last longer or shorter periods of time.
If an implant fails, an additional operation may be necessary. This second procedure is called a revision and it can be more complicated than the initial operation. Because hip resurfacing removes less bone from the femur (thighbone) than a traditional hip replacement, many surgeons believe it is easier to exchange implants that fail after hip resurfacing.
Decreased risk of hip dislocation
In hip resurfacing, the size of the ball is larger than in a traditional hip replacement, and it is closer to the size of the natural ball of your hip. Because of this, it may be harder to dislocate. This stance is controversial because several factors can affect the risk of dislocation, such as surgical approach, and the type and size of the implants used.
More normal walking pattern
Some studies have shown that walking patterns are more natural following hip resurfacing compared to traditional hip replacement. These differences in walking are quite subtle, however, and special instruments are needed to measure them.
The disadvantages of hip resurfacing are mainly in not knowing the long term results.
Femoral neck fracture
A small percentage of hip resurfacing patients will eventually break (fracture) the thigh bone at the femoral neck. If this occurs, it is usually necessary to convert the hip resurfacing into a traditional hip replacement.
A femoral neck fracture is not possible with a traditional hip replacement because the femoral neck is removed during this procedure. However, fractures around the implants can still occur with a traditional hip replacement.
Metal ion risk
In hip resurfacing, a metal ball moves within a metal socket. Over time, the friction between the two surfaces can lead to the release of tiny metal molecules called ions. The ions can cause a reaction in the bone and soft tissues surrounding the joint called an adverse local tissue reaction. This can cause pain and swelling and may lead to the need for revision surgery. The ions may also enter the bloodstream and have systemic effects. For this reason, hip resurfacing is now performed less frequently than in the past.
Some types of traditional hip replacements also consist of a metal ball and a metal socket and these replacements run the same potential risks.
Use of cane or crutches
You might need to use a cane or crutches for a few days or weeks.
You may need to work with a physiotherapist, who can help you maintain range of motion and strength.
You will probably be able to resume many of your regular activities within 6 weeks of the surgery.
May loosen or wear out over time
The mechanical components of your hip may wear out or loosen over time. Because of this, you may need a revision surgery 10 to 20 years after your original hip resurfacing surgery.
Candidates for surgery
We may recommend surgery if you have more advanced osteoarthritis and have exhausted the nonsurgical treatment options. Surgery should only be considered if your hip is significantly affecting the quality of your life and interfering with your normal activities.
Unlike hip replacement, hip resurfacing is not suitable for all patients. Generally speaking, the best candidates for hip resurfacing are younger (less than 60), larger-framed patients (often, but not always male) with strong, healthy bone. Patients that are older, female, smaller-framed, with weaker or damaged bone are at higher risk of complications, such as femoral neck fracture.
You will be admitted to hospital the same day of surgery.
Before your procedure, a doctor from the anesthesia department will evaluate you. They will review your medical history and discuss anesthesia choices with you. You will have discussed these during your preoperative clinic visits.
Anesthesia can be either general (you are put to sleep) or regional (you are awake, but your body is numb from the waist down).
Dr Al-Khateeb will also see you before surgery and sign your hip to verify the surgical site.
A hip resurfacing operation typically lasts from 1-1.5 to 3 hours.
An incision will be made in your thigh in order to reach the hip joint. The femoral head is then dislocated out of the socket. Next, the head is trimmed with specially designed power instruments. A metal cap is cemented over the prepared femoral head. The cartilage that lines the socket is removed with a power tool called a reamer. A metal cup is then pushed into the socket and held in place by friction between the bone and the metal. Once the cup is in place, the femoral head is relocated back into the socket and the incision is closed.
After surgery you will be taken to the recovery room, where you will be closely monitored by nurses as you recover from the anesthesia. You will then be taken to your hospital room.
As with any surgical procedure, there are risks involved with hip resurfacing. Dr Al-Khateeb will discuss each of the risks with you and will take specific measures to help avoid potential complications.
Although rare, the most common complications of hip resurfacing are:
- Infection. You will be given antibiotics before the start of your surgery and these will be continued for 24 hours to prevent infection
- Blood clots. Blood thinners, such as rivaroxaban (Xarelto), enoxaparin (Lovenox) or warfarin (Coumadin); aspirin; or other drugs can help prevent this problem
- Injury to nerves or vessels. On rare occasions, nerves or blood vessels may be injured or stretched during surgery
- Femoral neck fracture
- Risks of anesthesia
Many hip resurfacing patients are back walking just 4 hours after surgery. Patients stay in hospital from 1 to 4 days following hip resurfacing surgery, but then can return home to recover.
You may begin putting weight on your leg immediately after surgery. You may need a walker, cane, or crutches for the first few days or weeks until you become comfortable enough to walk without assistance.
We will recommend physiotherapy after surgery. The physiotherapist will give you exercises to help maintain your range of motion and restore your strength. You will continue to see us for follow-up visits in clinic at regular intervals.
You will most likely resume your regular activities of daily living by about 6 weeks after surgery.
Many types of pain medication are available to help control pain, including opioids, nonsteroidal anti-inflammatory drugs (NSAIDs) and local anesthetics. Treating pain with medications can help you feel more comfortable, which will help your body heal faster and recover from surgery faster.
You can expect some pain and discomfort for several weeks after surgery. You will be prescribed pain medicine, if needed.
Clemenceau Medical Center Hospital, Dubai