Unlike a total hip replacement, hip resurfacing effectively relines the hip joint rather than completely replacing it. It is viewed as a bone-preserving alternative procedure for qualified patients that can delay (usually by several years) the need for a total hip replacement. In these cases the hip has been compromised by localized arthritis, wear and tear, inflammation, or prior injury. The goal of hip resurfacing is to restore the best possible function to the hip by replacing damaged joint surfaces with artificial ones while preserving as much natural bone as possible.
During the procedure, the upper end of the thigh bone (femur) is not removed, but is instead trimmed and capped with a rounded metal implant component which restores integrity to the femoral head (“ball”) of the hip joint. Damaged bone and cartilage within the acetabulum (“socket”) is removed and replaced with a metal prosthesis, similar to what is used in a traditional hip replacement.
Are you a candidate for Hip Resurfacing?
Generally speaking, the best candidates for hip resurfacing are younger (under 60), larger-framed patients with strong, healthy bones.1 However, there are many surgeons who consider hip resurfacing to be appropriate for patients of all ages and lifestyles. But hip resurfacing might be a better choice for younger people because the procedure leaves more bone intact, which can make it easier to perform a total hip replacement if needed later.2 Therefore, total hip resurfacing could be viewed as a time-buying procedure to delay the need for a total hip replacement.
Advantages of Hip Resurfacing
Hip resurfacing has been the subject of substantial on-going research across the world. The main advantage of hip resurfacing compared to total hip replacement is the preservation of the femoral neck (upper thigh bone) and femoral canal, thus facilitating revision or conversion to a total hip replacement in the future if necessary.3 In addition, the resurfaced head (ball) is more similar in size to the natural femoral head, and many surgeons feel that the larger head size decreases risk of dislocation and provides greater stability of the joint in general.3
Several studies have shown that a post-operative hip resurfacing patient’s walking patterns are slightly more natural than those of a total hip replacement patient. And, hip resurfacing patients are usually able to move their hips in a greater range of motion than total hip patients. However, certain total hip replacement implants can allow the same range of motion as a hip resurfacing implant.1
Disadvantages of Hip Resurfacing
Hip resurfacing procedures are more difficult than total hip replacements for surgeons to perform. As such, a larger incision is usually required for a hip resurfacing.1 The large size of the head/socket requires very accurate alignment in order to avoid micro-misalignment and run the risk of wear problems. The larger heads used in resurfacing are much less forgiving than the smaller ones used in total hip replacement. In other words, the larger the head, the less ‘wiggle room’ there is in placement. Hip resurfacing results in a metal ball on a metal socket, and in a small number of people, these metallic moving parts may cause problems such as pain, immune system reaction (hypersensitivity) or, rarely, tissue destruction.2
Additionally, a small percentage of hip resurfacing patients may experience weakening or softening of the bone, leading to collapse or fracture of the femoral neck, especially if there are inflammatory processes, osteonecrosis (reduced blood flow to the bone), or progressive osteoporosis (arthritis) present. If this occurs, it is usually necessary to convert the hip resurfacing into a traditional hip replacement.1
Hip Resurfacing Complications
As with any surgical procedure, there are risks involved with hip resurfacing. You should discuss each of the risks with your surgeon and take specific measures to help avoid potential complications. Although rare, the most common complications of hip resurfacing are blood clots in the leg veins, infection, injury to the nerves or blood vessels, femoral neck fracture due to osteoporosis, and dislocation of the hip joint.
Although many surgeons will consider performing hip resurfacing before total hip replacement, the decision must be made on an individual case basis. Only a qualified surgeon can provide an assessment of your condition and make appropriate recommendations to meet your specific needs. Use the information here to help you intelligently discuss the options with your surgeon and to better understand his or her recommendations for your treatment.
- American Academy of Orthopaedic Surgeons, “Hip Resurfacing” (http://orthoinfo.aaos.org/topic.cfm?topic=A00586)
- Spangehl, Mark M.D., The Mayo Clinic, “What are the pros and cons of hip resurfacing as an alternative to hip replacement?” (http://www.mayoclinic.com/health/hip-resurfacing/AN01550)
- Blue Cross Blue Shield Association, “Hip Resurfacing” (http://www.bcbsms.com/com/bcbsms/apps/PolicySearch/views/ViewPolicy.php?&blank&action=viewPolicy&noprint=yes&path=%2Fpolicy%2Femed%2FTotal_Hip_Resurfacing.html&keywords=%3C!123-321!%3E&source=emed&page=id=200&me=index.php)
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