Hip Resurfacing - An Alternative to Total Hip Replacement

Introduction

Hip resurfacing is a bone-preserving procedure that helps replace the damaged hips conservatively. This restores the function of the hips, and the patient can resume daily activities. Total hip replacement surgery involves more bone removal, replacing these areas with implants. Whereas, in hip resurfacing, bone removal is minimal and intended for patients where traditional hip surgery is considered a poor option.

What Is Hip Resurfacing?

The hip is a ball-and-socket type of joint. It consists of an acetabulum (hip socket) and the femoral head (a ball-shaped head at the upper part of the thigh bones). Hip resurfacing is also called surface replacement and helps conserve more bone rather than removing and replacing it with artificial ones. It is chosen as a treatment option only for certain patients. It is a type of hip replacement surgery that helps treat active young patients with damaged hips.

Who Are the Candidates Suitable for Hip Resurfacing?

The surgical option is selected only after all the non-surgical measures have failed to heal the damage caused to the hips. The candidates suitable for hip resurfacing are:

• Young and active patients less than sixty years of age.

• Males with strong and healthy bones.

In these candidates, the conditions that require a hip resurfacing surgery are:

• Osteoarthritis (inflammation of the joints).

• Rheumatoid arthritis (an autoimmune disease that causes inflammation of the joints).

• Osteonecrosis (death of the bone due to inadequate blood supply).

• Hip fractures.

• Tumors in the hip joint.

What Are the Advantages of Hip Resurfacing?

The advantages of performing a hip resurfacing surgery are:

• The normal walking of the patient is not affected after the surgery. The outcomes are more natural compared to traditional hip replacement surgery.

• There is less risk of the hip dislocating since the natural femoral head available after the surgery is more.

• The implants are used to replace the damaged parts of the hip joint. These implants may wear out over time and need to be replaced by a new one with additional surgery. The additional surgery is more complicated. Since hip resurfacing involves minimal bone removal, the procedure to replace the failed implants is easier to perform.

• The recovery time is faster, and the patients can resume normal activities in two to three weeks.

What Are the Disadvantages of Hip Resurfacing?

Any surgery is not fully beneficial to the patient. It also comes with a set of problems to deal with. The disadvantages of hip surfacing include:

• Fractures of the femoral neck (the part below the ball-shaped femoral head) occur commonly. This necessitates the need for additional surgery. These kinds of fractures do not appear in hip replacement surgery as the femoral head and neck are removed and replaced.

• In hip resurfacing surgery, a metal ball and socket are used. When these metal portions are moved during function, some metal ions leak into the blood and cause local or systemic adverse reactions.

How to Prepare a Patient for Hip Resurfacing Surgery?

• All investigations, such as blood count, urine analysis, an X-ray of the pelvis, and other tests for the patient, are completed for a proper diagnosis.

• The doctor will provide all the information regarding the purpose, benefits, and possible risks involved with the procedure. The patient should sign a consent form as approval for the surgery.

• If the patient is under medications such as Aspirin (blood thinner), it has to be stopped a week before the surgery.

• Allergies to anesthesia or medications are informed to the doctor to prevent complications.

• Avoid smoking one month before the surgery and several months after.

How Is Hip Resurfacing Performed?

• The procedure is done under spinal anesthesia and sedation or general anesthesia. The surgery takes about two to three hours.

• First, an incision or a cut of about 20 centimeters is made on the skin of the hip joint using a scalpel blade.

• The femoral head is visualized and dislocated. A portion of the bone and cartilage on the femoral head is trimmed, and a metal cap is cemented over it.

• Next, the cartilage on the socket is trimmed, and a metal portion is placed on the socket. The metal socket is roughened at one side to attach itself to the pelvic bone.

• Finally, the femoral head is moved back into the socket, and the incision is closed with sutures.

• A dressing is placed over the operated site and should remain for at least two days.

How Is the Recovery After Hip Resurfacing Surgery?

• The patient is usually discharged three to four days after the surgery.

• After discharge, the patient is advised not to put pressure on the operated leg. A walker, crutches, or cane can be used by the patient while walking to provide support.

• The patients must consume painkillers as prescribed by the doctor.

• Prolonged periods of non-functioning of the legs would have decreased bone strength. Hence, patients will require physiotherapy after the surgery to regain the normal function and strength of the bone.

• Patients can try normal walking in six weeks without support after consulting the surgeon.

• By the end of one year after surgery, the operated site will be completely healed, and the patient can fully function normally.

What Are the Complications Associated With Hip Resurfacing?

Some of the common complications associated with hip resurfacing are:

• Allergic reactions to anesthesia or medications. Hence, the doctor must take a proper history before the surgery. If the patient does not know about the allergy history, then a skin test to identify the presence of allergy to anesthesia is done.

• Infections can be managed by prescribing antibiotics before and a day after the surgery.

• Blood clots may form anywhere in the leg after surgery. This can be prevented by avoiding medications like blood thinners before the surgery.

• Injury to the adjacent nerves or blood vessels may occur.

• Fracture at the femoral neck.

• Metal implant failure.

If any of these complications are noticed, the patient has to consult with the doctor for immediate treatment. Sometimes, they may require further surgery to correct the problem.

What Is the Difference Between Hip Resurfacing and Hip Replacement?

Hip resurfacing surgery tries to conserve as much bone as possible. The femoral head and socket are slightly trimmed and replaced with a metal portion. In hip replacement surgery, the entire femur bone, including the head and the neck, is removed. The whole femur is replaced with a metal implant. Both procedures have benefits and also certain risks. The healing is faster in hip resurfacing compared to replacement surgery. But not all patients can undergo hip resurfacing. Only those who are physically active, have strong bones, and have no allergy to the metal can opt for hip resurfacing. Hence, proper patient selection and bone condition are considered important factors for selecting a suitable procedure.

Conclusion

Hip resurfacing surgery is considered a great alternative to total hip replacement surgery. It involves less bone removal, and the recovery rate is faster comparatively. Patient selection is the critical factor to be kept in mind before the doctor decides on hip resurfacing surgery. The long-term outcome is excellent if the patient satisfies all the required criteria and can lead an active and healthy life.