Is Hip Resurfacing Right for You?
MADISON - A possible alternative to total hip replacement, a surgical technique called Hip Resurfacing
has been generating a lot of media buzz since its approval in 2006 by the FDA.
But just as with any major surgery, UW Health orthopedic surgeons urge potential patients to educate themselves about the new procedure - which shows promise for some patients, but is not a cure-all for every person with hip problems.
Hip resurfacing - also known as surface replacement arthroplasty (SRA) - has been performed on patients in Europe and Australia for about the past decade. Compared with traditional Total Hip Replacement
surgery, hip resurfacing involves the removal of less bone from the hip joint. For young, more active patients with healthy bones, this bone-conserving approach results in better range of motion and less risk of dislocation than traditional total hip replacement.
What's driving the use of this new technique? A new generation of patients with higher expectations for their health and quality of life. Having learned about new hip procedures through the Internet and exposure to direct-to-consumer marketing, these patients are changing the face of the traditional hip-replacement demographic.
Traditionally, patients seeking total hip replacement surgery have been older, generally less active people over 60 who have sought hip replacement primarily to relieve pain due to hip arthritis and related problems.
"We're dealing with very different patients than we were dealing with 30 years ago," says UW Health orthopedic surgeon Richard Illgen, MD. "The fact of the matter is, people want to be able to do things that add quality to their lives."
Whether it's yoga, kayaking, golf or hiking, today's generation of hip-replacement patients want to do more with their hips. For these people, hip resurfacing can be a particularly attractive option if they meet certain criteria.
"Probably the best candidates for hip resurfacing are the people who are going to put the most demands on their hip - young, active people with good bone quality who may need a revision operation in their lifetime," says Dr. Illgen.
Revision surgery is an additional surgical procedure that's performed several years after the initial hip resurfacing. Because hip resurfacing preserves more bone than traditional hip replacement does, there is more bone for surgeons to work with in any subsequent procedures.
Traditional and Large Head Total Hip Replacement
In traditional total hip replacement, the patient's hip socket (acetabulum) is replaced with a metal socket and a plastic liner. The neck of the femur (thigh bone) is cut, and this neck and the femoral head are removed.
In traditional total hip replacement, a metal device (prosthesis) is then placed down the femoral shaft, and a metal ball is attached. The metal ball sits in the plastic liner of the socket and serves as the newly reconstructed hip joint. Traditional total hip replacement involves a socket that can be fixed with surgical screws, which can be particularly beneficial for patients who have bad bone quality or a deformity in the acetabular socket.
Another form of total hip replacement is performed with a metal socket and a metal ball. This type of large head "metal-on-metal" total hip replacement typically results in improved function of the hip, including better range of motion and less risk of dislocation than the traditional metal on plastic technique. The larger the head, the less risk of dislocation because the head would need to move farther away from the socket in order to "pop out."
The device approved by the FDA for hip resurfacing is also metal-on-metal. While the neck of the femur and the femoral head are completely removed in total hip replacement, hip resurfacing involves capping the surface of the femoral head with a metal ball. The metal ball is then inserted into a metal socket and cemented in place.
But because metal components result in elevated levels of metal ions in the bloodstream, any type of metal-on-metal device carries its own risks.
"There has never been a documented case of cancer related to a joint replacement. That being said, there are some theoretical concerns," Dr. Illgen says.
The following factors may make you a poor candidate for any metal-on-metal procedure, which includes both large head total hip replacement and hip resurfacing:
- Kidney problems
- Being a woman of childbearing age (due to risk to the developing fetus in pregnancy)
- Bad bone, either on the socket or the femur
- Documented metal sensitivity
Hip Resurfacing - Potential Complications
While there are several advantages to hip resurfacing for certain types of patients, the technique also carries a unique set of complications:
- Because traditional total hip replacement involves the removal of the femoral head and neck, patients will not have problems related to early failure due to loosening of the femoral head. Because the femoral head and neck are preserved in hip resurfacing, these patients may experience such problems.
- There is currently not enough long-term study of hip resurfacing patients to determine whether they will experience problems over time with the cemented components of the hip resurfacing design. With most other types of implants, cemented components don't last as long in young, active patients as cementless components do.
"The question remains - will the cemented femoral components of hip resurfacing remain durable in these young, active patients over time? We don't have any documented results beyond 10 years for hip resurfacing patients, and it often takes more than 10 years for these types of implants to fail," Dr. Illgen says.
- In hip resurfacing, surgeons must pop the hip out during the procedure, thereby disrupting the blood supply to the femoral head. This can result in dead bone in the femoral head (also known as avascular necrosis), which can lead to loosening of the components, and ultimately, the need for revision surgery. This is not a problem with total hip replacement, because the femoral head and neck are completely removed.
Recovery and Rehabilitation
Though hip resurfacing does involve less bone removal, it is still a major operation. Several factors will determine how quickly a patient recovers, including whether the patient has other medical issues or problems with other joints.
In hip resurfacing, more soft tissue is removed compared to total hip replacement.
"The net effect is, there's still going to be time required for recovery," says Dr. Illgen. "There can be a fair bit of variability in terms of how quickly a person recovers. Patients should discuss the choice between hip resurfacing or total hip replacement in detail with their treating surgeon."
"We really have to help educate patients - hip resurfacing is a big operation," Dr. Illgen added. "And the information about long-term outcome is somewhat limited."
No matter which option a patient pursues, long-term recovery goals include regaining hip function and reducing the pain you experienced before surgery. UW Health physical therapists will work with you to create a comprehensive rehabilitation plan that will help you return to normal activities with relatively few limitations.
How to Learn More About Hip Resurfacing
If you're interested in learning more about hip resurfacing, please call 608-263-4069 to schedule an appointment with a UW Health orthopedic surgeon.
Date Published: 06/06/2007