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Overview

 


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.

Hip Resurfacing epitomizes medical achievements in arthroplasty. Hip Resurfacing is a new conservative surgical technique of arthroplasty of the hip. In this, only the diseased surface of the head of femur is replaced with a cobalt chromium cap , retaining all the bone in the hip joint. The lining of the socket (acetabulam) is also replaced with the cobalt chromium cup .This mimics the natural hip closely and has near normal bio-mechanics, load transfer and range of movement.



The indications for hip resurfacing include:


  1. Osteo Arthritis.
  2. Avascular Necrosis.
  3. Secondary Osteo Arthritis.
  4. Arthritis following fractures.
  5. Ankylosing spondylitis.
  6. Old perthes disease.
  7. Old SUFE.
  8. Dysplastic Hip.


Who Needs Hip Resurfacing?

Conventional Hip Replacement

Birmingham Hip Resurfacing

Suitable for Elderly Patients Suitable for Younger Patients
Head of femur (thigh bone) removed Bone not removed
Wears out rapidly in young and active patients Birmingham of Metal on Metal Articulation
Activity restriction required after surgery for fear of dislocation Activity restriction not required after surgery as there is hardly any risk of dislocation (can sit on floor ,squat, use Indian toilet ,etc)
Sport not advised as the usage is inversly proportional the life of the hip replacement Sport and High demand activities encouraged as usage is not related to life of resurfacing implant
Revision surgery invariably necessary in younger patients Revision surgery not Required for younger patients



Advantages of Hip Resurfacing


  • Femoral head is preserved.
  • Femoral canal is preserved and no associated femoral bone loss with future revision. Also, the risk of microfracture of femur with uncemented stem implantation is eliminated.
  • Larger size of implant "ball" reduces the risk of dislocation significantly.
  • Resurfacing patients are more likely than total hip replacement patients to recover a natural gait.
  • Stress is transferred in a natural way along the femoral canal and through the head and neck of the femur. With the standard THR, some patients experience thigh pain as the bone has to respond and reform to less natural stress loading.
  • Use of metal rather than plastic reduces osteolysis and associated early loosening risk.
  • Use of metal has low wear rate with expected long implant lifetime.
  • Allows the patient to squat and sit on the floor safely
  • Allows a normal range of movement and sporting activities after operation
  • Sacrifices only the diseased bone and preserves normal bone
  • Restores the normal structures of the hip
  • More natural feel after surgery
  • Early rehabilitation
  • Easy to revise if needed
  • Less risk of dislocation
  • No leg length alteration


Special Risks of Hip Resurfacing



  • There is some risk of the femoral neck breaking. This risk can be nearly eliminated by proper patient selection, correct angle of implantation of the device and avoiding notching the neck when preparing the femoral head in surgery.
  • Lack of long-term track record. Current device has only been used for about 10 years.
  • Despite known low wear rate, longevity and longterm effects of wear debris are unknown.
  • For some surgeons, the procedure has a longer surgical time. The procedure requires somewhat more skill of surgeon. Because of this, a learning curve" has been documented where it is common for a surgeon to have more complications in his first series of patients.













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