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Hip Resurfacing

Other popular names

Who does it affect?

Patients with advanced arthritis of the hip may be candidates for either traditional total hip replacement (arthroplasty) or hip resurfacing (hip resurfacing arthroplasty).  Each of these procedures is a type of hip replacement, but there are important differences. Your orthopaedic consultant will talk with you about the different procedures and which operation would be best for you.

Unlike hip replacement, hip resurfacing is not suitable for all patients. Generally speaking, the best candidates for hip resurfacing are younger (less than 55years), usually 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.

What is Hip Resurfacing?

The hip is a ball-and-socket joint. In a healthy hip, the bones are covered with smooth cartilage that enables the femoral head and acetabulum to glide painlessly against each other.

In a traditional total hip replacement, the head of the thighbone (femoral head) and the damaged socket (acetabulum) are both removed and replaced with metal, plastic, or ceramic components.

In hip resurfacing, the femoral head is not removed, but is instead trimmed and capped with a smooth metal covering. The damaged bone and cartilage within the socket is removed and replaced with a metal shell, just as in a traditional total hip replacement.

Revision or redo hip surgery is required when hips fail. Hips can fail for a variety of reasons. The most common include:

Revision or redo hip surgery is technically demanding and complex surgery.

The result following a redo or revision hip surgery will never be as good as after a primary operation.  This is because there is increased risk of infection, dislocation, nerve damage together with prolonged recovery due to scarring.

There are a number of implants and methods available to surgeon.  It is my preference to use revision implants from Stryker along with their uncemented or Trabecular MetalTM cup together with the Restoration uncemented modular stem. This implant allows me the flexibility and versatility required to treat this condition.

Advantages of Hip Resurfacing

The advantage of hip resurfacing over traditional total hip replacement is an area of controversy and continued discussion amongst orthopaedic surgeons and a great deal of research is currently being done on this topic.

Disadvantages of Hip Resurfacing

Hip Resurfacing v Traditional Hip Replacement

Symptoms

Hip arthritis typically causes pain that is dull and aching. The pain may be constant or it may come and go. Pain may be felt in the groin, thigh, and buttock, or there may be referred pain to the knee. Walking, especially for longer distances, may cause a limp.

Some patients may need a cane, crutch, or walker to help them get around. Pain usually starts slowly and worsens with time and higher activity levels.

Patients with hip arthritis may have difficulty climbing stairs. Dressing, tying shoes, and clipping toenails can be difficult or impossible. Pain may also interfere with sleep.

Diagnosis

Your consultant will readily be able to diagnose hip arthritis.  This will be done through a physical examination, supported by X-ray.  The x-ray may show loss of the cartilage space in the hip socket and a "bone-on-bone" appearance. Bone spurs and bone cysts are common.

Depending upon the extent of your condition, you may be referred for an MRI, which will provide a greater level of detail to your consultant.

Non-surgical treatment

Hip arthritis is never life threatening, the main aim of treatment is therefore symptomatic for pain and to try to keep mobility and range of movement of the joint. Treatment follows a progression from simple measures to major surgical intervention.  There are a range of non-surgical approaches to be exhausted prior to the need for surgical intervention:

Once all non-surgical means have been exhausted, a comprehensive evaluation by your orthopaedic surgeon will help you determine if you are a good candidate for hip resurfacing.

Surgical Procedure

Before your procedure, the Anaesthetist evaluate you, review your medical history and discuss anesthesia choices with you. You should also have discussed anesthesia choices with your surgeon during your preoperative clinic visits. Anesthesia can be either general (you are put to sleep) or spinal (you are awake but your body is numb from the waist down).  Your surgeon will also see you before surgery and sign your hip to verify the surgical site.

A hip resurfacing operation is complex and typically lasts between 1 1/2 and 3 hours.

Your surgeon will make an incision 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 the 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.

Post-surgery rehabilitation

Most patients are able to return home 1-4 days following surgery.  All patients will need someone to take them home and be with them on the night following return home.

The anaesthetic will wear off after approximately 6 hours.  Simple analgesia (pain killers) usually controls the pain and should be started before the anaesthetic has worn off.

You may begin putting weight on your leg immediately after surgery, depending on your consultant’s preferences and the strength of your bone. You may need a walker, cane, or crutches for the first few days or weeks until you become comfortable enough to walk without assistance.

A physical therapist will give you exercises to help maintain your range of motion and restore your strength. You will continue to see your orthopaedic surgeon for follow-up visits in his clinic at regular intervals.

You will most likely resume your regular activities of daily living by 6 weeks after surgery

Dressings

The large bandage is normally removed 24-48 hours after surgery.

The non-stick sterile dressings on the wounds are replaced with clean waterproof dressings.  The larger incision is closed using sutures, which are removed after 10 days.

Return to normal routine

Bathing and showering

The wounds should be kept clean and dry until the wound has sealed. Showering is fine and the waterproof dressings can be changed afterwards. Bathing is best avoided until the wounds are sealed, typically 10 days after surgery.
In summary, whilst the wounds are wet - keep them dry and when the wounds are dry, you can get them wet!
 
Rehabilitation

Surgery is followed by a prolonged course of physiotherapy. This requires a commitment to undertake this rehabilitation in order to achieve the best possible result (at least half an hour per day for 6 months).  It is vitally important to stay within the post-operative activity restrictions an physiotherapy guidelines to avoid damaging stretching your reconstructed ligament.
 
Return to work

The timing of your return to work depends on the type of work and your access, however, the following is a general guide:
 

Driving

When you can walk without crutches or a limp and be in control of your vehicle (about 4-6 weeks).

Risks

As with any surgical procedure, there are risks involved with hip resurfacing. Your surgeon 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:

All these risks are uncommon and in total, the chance of you or your knee being worse off in the long term is about or less than 1%.

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