Wednesday, September 18, 2013

Hip Resurfacing - An Alternative to Total Hip Replacement

Total hip replacement is a very successful operation for hip arthritis. The purpose is to remove the two damaged and worn parts of the hip joint- the "ball and socket" and replace them with smooth artificial implants.

However for younger patients, there is a high chance that a traditional hip replacement will wear out during their lifetime and need to be replaced. A second replacement is more difficult and tends not to last as long. in addition high impact activities are not generally recommended after total hip replacement.

Hip resurfacing is a procedure which replaces the two surfaces of the hip joint. This conserves bone as the femoral head is retained. Instead of removing the femoral head, it is reshaped to accept an anatomically shaped metal sphere. This results in lower risk of dislocation compared to traditional total hip replacement and the potential for higher activity level.

Who is a candidate for resurfacing?

Generally people who require a hip replacement under age 55 yrs are candidates unless they have certain types of arthritis which has deformed the femoral head. Hip resurfacing is rarely considered for people over the age of 65yrs.

Results of Hip Resurfacing

Long term results are not known as this procedure has only been in clinical use for just over 10 years- however the results to date have been very good with success rate better than conventional total hip replacement over the first 5-10years.

4 common conditions that may indicate the need for hip resurfacing:


This is a disease which wears away the cartilage between the femoral head and the acetabulum ( the ball and socket) causing the 2 bones to scrape against each other. This results in pain, stiffness and instability. Some patients even develop bone spurs.

Symptoms include pain in the hip or groin area during weight bearing resulting in limping. As it worsens the pain may be present all the time even at night.

Rheumatoid arthritis

RA is a chronic inflammatory disease that results in pain, stiffness and swelling. It is commonly thought to be an autoimmune disease perhaps triggered by virus or bacteria in those with a genetic predisposition.

Developmental Dysplasia

One in 10,000 people are born with this altered hip anatomy leading to early wear and tear. There is often a family history.

Avascular necrosis

This occurs when poor blood circulation starve the bones that form the hip joint. Over time the starved bone dies and the hip collapses.

Alcoholism and corticosteroids are by far the leading causes of this.

Post op recovery

Most patients walk the day after surgery usually with crutches or walking sticks. You will then commence an intensive physiotherapy programme. This is critical to strengthen the muscles around the hip correctly to protect the new hip and give it the best chance of lasting as long as possible. Also many patients had months of pain and were limping before the operation so the hip muscles were often very weak prior to the operation.

Your surgeon will tell you how much weight you are allowed to take initially. For many patients full weight bearing is allowed within the first week and normal walking is usually achieved by 4-6 weeks.

During the first 6 months post op impact activities should be avoided as the bone initially remodels to "grip" the new implant.

In the weeks after surgery it is important to gradually build up your activity under the guidance of a physiotherapist to strengthen the hip muscles and ensure normal walking gait.

It is normal to feel more tired than normal after surgery so allow yourself enough rest during your recovery period.

Further precautions:

* No heavy lifting

* Do not twist while lying or standing

* Avoid extreme movements of the new hip

* Do not cross your legs

* Do not lift your knee higher than your hip on the operated side

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