Surface Hip Replacement

Hip resurfacing has evolved in the last eight years. SR was FDA approved in 2006. The original hip resurfacing replacements were done 30 to 40 years ago and failed because of poor design and materials. The design, materials and techniques has significantly improved. Hip resurfacing is still a total hip replacement, however, it may be bone conserving leaving the femoral neck and head attached. If the hip fails then a revision standard total hip replacement can be performed without much difficulty. 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 these later procedures.

Resurfacing a hip is similar to a total hip replacement from a surgical perspective. Instead of resecting the arthritic femoral head, the head is reshaped and resurfaced with a metal cap. This is cemented in place. The socket is prepared in a similar fashion to a total hip replacement. The socket is press-fitted into the acetabular bone and bone grows into the socket.

Risks of hip resurfacing replacement are similar to total hip replacement. In addition to those standard risks a hip resurfacing replacement may fail due to a femoral neck fracture or softening of the bone (avascular necrosis).

The advantages of hip resurfacing replacement include reduced dislocation, restores leg lengths, restores “normal anatomy” and the hip appears to be more durable allowing one to perform higher impact activity. The metal on metal technology has been present for the past 30 years and has proved successful.

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.

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.

Minimally Invasive Procedure for Hip Resurfacing?

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."

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.

The following factors may make you a poor candidate for any metal-on-metal (M-O-M) 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 (osteoporosis)
  • 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.
  • 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.

No matter which option a patient pursues, long-term recovery goals include regaining hip function and reducing the pain you experienced before surgery.

Surface Replacement Handout

How to Learn More About Hip Resurfacing

If you're interested in learning more about hip resurfacing or your options for joint pain, please call 1-866-887-9300 to schedule an appointment with a Dr. Matthys.