Hip Resurfacing Questions and Answers
What is hip resurfacing?
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.
How does hip resurfacing differ from 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 further 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.
Am I a candidate for hip resurfacing?
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 are likely going to have a revision operation on their lifetime.
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, there is more bone for surgeons to work with in any subsequent procedures.
What steps should I take if I believe I'm a candidate for hip resurfacing?
If you know you have significant hip arthritis and non-operative care has failed for you, you may be a candidate for hip resurfacing. If you'd like to find out more about this procedure, please call (608) 263-4069 to schedule an appointment with a UW Health orthopedic surgeon.
What number should I call to schedule an appointment with a UW Health orthopedic specialist?
Please call (608) 263-4069.
Besides hip resurfacing, what other options are available to me?
It should be emphasized that standard total hip replacement is an outstanding operation with a long-term record of success. For the majority of patients, standard total hip replacement will remain the primary operation offered to treat severe hip arthritis. However, for young and active patients with healthy bones, total hip resurfacing may be offered as an alternative to traditional total hip replacement.
What are the risks and complications associated with hip resurfacing?
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 experience 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 components that are cementless. There have been no studies yet to determine how durable the hip resurfacing components will remain in patients more than 10 years after surgery.
- 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.