Hip resurfacing surgery is a bone conserving revolutionary alternative to traditional hip replacement surgery for few selected patients particularly young and active with strong bones, who are suffering from hip arthritis to an extent that the patient is unable to carry out day to day activities and none of the non surgical modalities prove beneficial.
Q1 What is a hip joint?
A1 Hip joint is a type of ball and socket joint. Under normal conditions, the contact surfaces of the bones, in this case, head of the femur and the socket in the pelvic bone(acetabulum) are covered with smooth cartilage that ensures smooth gliding of bones against each other.
Q2 What is the difference between Hip resurfacing surgery and Total hip replacement surgery?
A2 Birmingham Hip resurfacing surgery(BHR) is bone conserving alternative to traditional Total Hip replacement surgery.
Total hip replacement surgery involves the removal and replacement of the whole hip joint with metal,plastic or ceramic parts. THR calls for the removal of the upper portion of the femur to accommodate the stem portion of the implant. Hip resurfacing does not remove the head of the thigh bone, the contact(articulating) surface of the head(Ball) of the Femur is trimmed and shaped and eventually a smooth metal cap is closely fitted over it. The damaged bone and cartilage in the the socket (acetabulum) in the hip bone are removed and metal shell is positioned well inside the socket in both Total hip replacement arthroplasty and Hip resurfacing arthroplasty.
It is also referred to as Metal-on-Metal implant. These implants are more bone conserving devices and also preserve the natural geometry.
Hip resurfacing is invariably recommended for young and active patients with strong bones as it offers greater stability, reduced risk of complications such as dislocation of the hip joint and unequal length of the lower limb and easy revision surgery,if need be.
Q3 What is done during hip resurfacing surgery?
A3 During Hip resurfacing surgery, an incision is made in the thigh to access the arthritic hip joint. The head of the femur is positioned out of the socket, trimmed, shaped and eventually covered with a smooth metal cap.
This mushroom shaped hollow metal cap is made up of Cobalt chrome and snugs the head of the femur well.
The damaged cartilage lining the socket of the hip bone, where the head of the femur resides,is removed and replaced with metal cup.
Once the metal cup is in place, the femoral head now covered with smooth metal cap is replaced back into original position and the incision is closed.
Here, the head of the thigh bone is intact unlike that in conventional Total hip replacement surgery.
Successful outcome of the surgery depends upon the surgeon's level of experience with the resurfacing technique, careful selection of the implant and its proper positioning.
Q4 What type of anesthesia is required in Hip resurfacing surgery?
A4 Hip resurfacng surgery can be carried out under General anesthesia(Patient is put to sleep) or Spinal anesthesia(Patient is awake while the lower part of the body down the waist is numb).
Q5 What is the duration of the Hip resurfacing surgery?
A5 The Hip resurfacing surgery typically lasts between 1.5 to 3 hrs.
Q6 Who is the right candidate for Hip resurfacing surgery?
A6 Hip resurfacing surgery is generally recommended for young(<60yrs of age) and active patients with strong bones and large body built, often but not invariably males, who are suffering from advanced arthritis.
Older patients,people with small body built, with weaker and damaged bones and females are not considered good candidates for hip resurfacing because of the fear of developing complications like Femur neck fracture.
However, your orthopedic surgeon will determine the best treatment option for you after your thorough clinical examination and comprehensive evaluation of your medical reports.
Q7 What are the advantages of Hip resurfacing surgery?
A7 Although a great deal of research is being carried out on this subject. Diferent orthopedic surgeons hold different perspectives regarding the advantages of Hip resurfacing surgery over conventional Total hip replacement surgery. Your specialist will determine the best treatment protocol for you after weighing the pros and cons of each procedure.
Apparently, the advantages can be broadly listed as follows:
Bone conserving surgery.
In nutshell, the quality of life of the patient is significantly improved and patient is satisfied after Hip resurfacting arthroplasty.
Q8 What are the disadvantages of Hip resurfacing surgery?
A8 The following are the disadvantages that may be associated with the hip resurfacing surgery:
Q9 When do I need hip surgery in case of arthritis?
A9 If you have an advanced hip arthritis to an extent where normal daily activities seem impossible, your quality of life is severly compromised and you have exhausted all non surgical treatment modalities without any benefit, then your specialist may consider surgery as a viable treatment option for you.
Q10 How long would the hospital stay be for Hip resurfacing surgery?
A10 Generally, the hospital stay would be around 4 to 5 days after surgery.
Q11 When can I resume my daily activities after Hip resurfacing surgery?
A11. You will probably resume your daily activities by 6 weeks post surgery.
Q12 What are the contraindications for Hip resurfacing surgery?
A12 Under the following conditions, hip resurfacing surgery is absolutely advised against:
Postmenopausal women with Osteoporosis
Compromised renal function
Other conditions such as femoral head or neck cysts, hip dysplasia of severe intensity or deficient bone stock of femoral head or neck and small acetabulum.
Q13 What do you mean by revision surgery?
A13 The components or implants used in both conventional Total hip replacement surgery and Hip resurfacing surgery are after all mechanical parts. They can wear out or loosen over time, although that duration is around 10 to 20 yrs generally, post surgery. Under such scenario, an additional surgery is required, also referred to as Revision surgery.
Q14 What are the complications of Hip resurfacing surgery?
A14 Though rare, the most common complications of Hip resurfacing are:
Blood clot formation in the leg veins
Injury to nerve or vessels
Femoral neck fracture
Anesthesia related perils.
Dr Kaushal Malhan
MBBS,MS(Ortho),FRCS(Orth) U.K, Dip. Sports Medicine, UK
Consultant,Knee and Hip surgeon
Fortis Hospital, Mulund,Mumbai
Dr S.K.S Marya
MBBS, MS(Ortho), DNB, MCh(Ortho),FRCS,FICS
Chairman-Medanta Bone and Joint Institute
Medanta The medicity,Gurgaon,Delhi-NCR
Saket, New Delhi
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