Hip Resurfacing

What is Hip Resurfacing?

Hip Resurfacing or Surface Replacement Arthroplasty is a bone-conserving alternative to conventional Total Hip Replacement (THR). Unlike Total Hip Replacement, hip Resurfacing does not involve the removal of the femoral head and neck nor removal of bone from the femur. Rather, the head, neck and femur bone is preserved in an effort to facilitate future surgery should it be necessary and to enable the patient to take advantage of newer technology or treatments in the future.

The current generation of hip Resurfacing devices utilize a metal bearings have demonstrated a much higher level of wear resistance as well as reduced bone loss and inflammatory tissue reaction about the hip joint as compared to metal-polyethylene bearings.

Hip Resurfacing is anatomically and biomechanically more similar to the natural hip joint resulting in increased stability, flexibility and range of motion. Further, dislocation risk is virtually eliminated. Higher activity levels are typically achieved with less risk. These benefits are realized because the head diameter that results from Resurfacing is very similar to the patient's normal head diameter and these larger head sizes are typically much larger than the femoral balls utilized in conventional THR.

Advantages of Hip Resurfacing :

1. Allows the patient to squat and sit on the floor safely
2. Allows a normal range of movement and sporting activities after operation
3. Sacrifices only the diseased bone and preserves normal bone
4. Restores the normal structures of the hip
5. More natural feel after surgery
6. Early rehabilitation
7. Easy to revise if needed
8. Less risk of dislocation
9. No leg length alteration

Know the physiology of Human Hip

The normal hip joint consists of a ball rotating inside a socket. The ball is called the head of the femur and the socket in the pelvis is called the Acetabulum. The surface of the femoral head and the acetabulum (i.e. the ball and the socket) is covered by a protective layer of cartilage. This makes the joint smooth and reduces friction during movements. It covers and protects the bone like the rubber of a car tyre.

Any condition that damages the Cartilage will lead to pain, dysfunction and eventually arthritis. Cartilage can get damaged due to a number of reasons including Injury, Infection, Ankylosing Spondylitis, Avascular Necrosis ( loss of blood supply to bone), Rheumatoid Arthritis, Osteoarthritis, Developmental problem like bone Dysplasias, slipped upper femoral epiphyses etc.

Frequently Asked Questions about Hip Resurfacing

• Is this a minimally invasive?

This operation can be done by a minimally invasive approach and the invasion can be kept to less than 10cms.The operation also involves minimal damage to bone.

• Do I need blood transfusion during the surgery?

We generally do not need blood transfusions during the operation.

• Is it a very painful operation?

Pain control techniques and minimal injury to soft tissue and bone during surgery help to keep the patients comfortable in the post operative period.

• When do we remove the stitches and is it very painful?

Absorbable sutures are used. These need not to be removed. The patient does not have to follow up for up to 60 years after discharge from hospital.

• How long do I have to stay in hospital?

Local patients are discharged four days after the operation, but overseas patients may have to stay for 8-10 days after surgery.

• When can I start walking and climbing stairs after the operation?

Most patients start walking with support on the second postoperative day after removal of the drain. Our team of physiotherapist takes you through a standardized protocol of mobilization and stair climbing is achieved before discharge.

• Do I need lots of physiotherapy after surgery?

The amount of physiotherapy needed depends on the condition of your joint and muscles before the operation. Most patients do not need much suppressed physiotherapy.

• Will I be able to sit on the floor after surgery?

Yes, this surgery will allow you to do that safely unless another problem prevents it.

• What is the ASR/BHR?

Hip resurfacing or surface replacement arthroplasty uses specialized implants that are fixed into the bone .Two international companies sell such implants in India at present.

a)Smith and Nephew (MMT) - (BHR) Birmingham Hip Resurfacing.
b)Johnson and Johnson - (ASR) Articular Surface Replacement.

• What is the advantage of Hip Resurfacing over conventional total hip replacement?

Conventional Total Hip Replacements usually consist of a long metal component that is fixed into the femur (thigh bone) articulating with a polyethylene cup cemented into the pelvis.

Conventional hip replacements sacrifice a large quantity of normal bone. The very nature of fixation of these implants causes progressive bone loss due to stress shielding. The problem of bone loss gets compounded by osteolysis due to polyethylene debris from the cup. All these reduce the bone stock and make any future revision procedures difficult. The polyethylene cups gradually thin down due to wear and need replacing. The head of the femoral component is small in diameter, so as to reduce friction at the cost of stability. This increases the risk of hip dislocation i.e. hip coming out of joint.

Problems with Conventional Total Hip Replacement:

1. Bone loss

2. Increased risk of dislocation

3. Cannot squat or sit on the floor without the risk of dislocating the hip

4. Range of movement is less

5. Cannot safely indulge in sporting activities

6. Revision Surgery difficult

7. Feels less like a normal natural hip

8. Possibility of change in leg length after surgery

Are there any implants used?

Modern techniques allow us to replace the diseased human hip with artificial implants which ensure near normal movements and function.

Huge advances have been made in terms of the materials, the method of fixation and structure of these implants. The purpose of all these changes is to increase the longevity, reduce complication rate and improved function after surgery. Hip Resurfacing (bone conserving hip replacement (BHR), surface replacement ) with a metal-on-metal articulation is another step in this direction.