The hip joint structure is a typical ball –and-socket joint. In it, the femur (thigh bone) meets with the pelvis bones. Three bones make up the pelvis structure, the ilium (rear), ischium (lower front) & pubis. In this joint all three meet with the thigh bone.
Difference between total hip replacement and hip resurfacing is that in total arthroplasty femoral head and the damaged acetabulum is completely removed and replaced while in hip resurfacing arthroplasty the femoral head is not removed but it is scrapped and trimmed. In arthroplasty the removed structures are replaced with implant components made of ceramic/metal /plastic and in hip resurfacing the trimmed femoral head are covered with a metal cap and the other removed parts replaced similar to total arthroplasty.
Benefits of Hip Resurfacing are a debatable issue with surgeons but they include:
- This procedure involves limited implant insertion and thus when the implant fails the second additional procedure called revision is less complicated and easier to perform.
- Based on the surgical approach and the implant component and size, there is reduced risk of post operative hip dislocation. This is also possible as the metal capping in resurfacing the ball size is larger and is closer to the natural biological hip joint ball.
- Patients are able to regain their normal walking patterns post hip resurfacing.
Risks of Hip Resurfacing are:
- Femoral neck fracture or the thigh bone fracture is a miniscule possibility with resurfacing as in this surgery femoral head is not replaced.
- This is metal on metal implant and runs the risk of metal ion production over time which can cause pain and swelling.
- With larger incision it is relatively a more difficult procedure to perform.
Selection of patients for surgery: is done by the surgeon post a comprehensive evaluation.
– Advanced osteoarthritis patients with no relief from medication and injections
– Healthier patients of younger age with good strong bone structure are ideal candidates as weak boned old patients pose risk of femoral fracture post procedure.
Pre surgery Orthopaedic Evaluation consists of various steps to ensure a beneficial surgery which includes taking of detailed medical history, comprehensive physical examination, and diagnostic imaging tests.
Prior to surgery: commonly admission is done one day prior or same day for evaluations like – pre-anaesthetic check-up, routine fitness tests. Your surgeon will see you and confirm the operative spot.
Surgical process: the resurfacing procedure is usually 2 – 3 hours of duration. An incision is made in the thigh to gain access to the hip joint where firstly the femoral head is dislocated to come out of the socket. This head is then with the use of specialised instruments is trimmed and scrapped and subsequently covered with a metal cap secured with cement. Reamer – a power tool is used to remove the cartilage lining the socket and replaced with a metal cup. Then the dislocated femoral ahead is put back into place.
Post surgery: patient is moved to post op recovery room and kept under monitor.
Complications from the surgery are rare and may include clotting of blood in the veins for which patient is put on blood thinners, possible infection is prevented by antibiotic course post surgery. Also during surgery sometimes, there may be an injury to surrounding nerves or vessels. Other possible risks are continued pain and anaesthesia associated risks. Later in time femur neck fracture and dislocation are possible risks.
Recovery from surgery: Patient is commonly discharged within 2-3 days post this surgery and may use walker or crutches or cane to walk for few days. Routine daily activities can commonly be resumed within 6 weeks post surgery if the post operative medication, physical therapy schedule is followed.