Hip Resurfacing vs Hip Surface Replacement
Hip resurfacing involves replacing damaged surfaces in the hip joint with metal surfaces. This procedure can be useful for patients under 65 with advanced hip disease
 
Hip resurfacing surgery is an alternative to standard hip replacements for patients with severe arthritis. In hip resurfacing surgery, the implant is smaller, and less normal bone is removed. Hip resurfacing is gaining interest, especially in younger patients
 
Mr Hugh Blackley was the first to pioneer modern hip resurfacing in New Zealand in 2003. He was trained by the designers and remains a strong advocate for the technique. He has done the most hip resurfacings of any surgeon in New Zealand and currently does 2-3 per week. He remains the most experienced surgeon in New Zealand in the procedure and is on the Australiasian Surgical Advisory Panel for Birmingham Hip Resurfacing.
 
Hip Resurfacing Complications

Before having a hip resurfacing there are certain things you should understand regarding the surgery. This information is not intended to be a comprehensive list, but our aim is to make you aware of the more severe and more common complications seen in Orthopaedic surgery.

 

As with all surgery, there are certain risks and complications. Orthopaedic surgery is surgery related to bones and joints. It often requires prolonged anaesthesia and occasionally requires blood transfusion. As with any surgery there is always a possibility of major complications and complications can be life threatening. Although the incidence of these risk factors is low, each patient needs to be informed of the possible complications prior to surgery.

 

Hip Resurfacing surgery is approximately 2 hours of set up and operating time. There is approximately 1 hour in the recovery room after surgery. You are in hospital between 5 and 7 days. Crutches are usually required for the first 6 weeks. These are provided by the hospital.

 

No operation can be guaranteed 100% successful but in the main hip resurfacing are very successful and over 95% of patients are very pleased with the result. However, specific problems may arise and these include:

 
Infection

Infection is uncommon, occurring in less than 0.5% of cases. It is usual for each patient to be given intravenous antibiotics at the time of their joint surgery and afterwards. Infection in the post-operative period in most patients is treatable. It may require longer hospitalisation, treatment with antibiotics for a longer period than normal and wash out of the joint. In some cases, the implant will be removed to treat the infection before re-implanting a new joint. In rare cases when the infection cannot be treated successfully, a patient may need to have the artificial joint removed permanently and have the joint is left to scar up. Infection is uncommon and we take detailed precautions to avoid this problem including special joint replacement theatres (laminar flow) and spacesuits. Our deep infection rate is lower than public hospitals.

Delayed infection has been reported years after joint replacement, and appears to be related to the ability of the implants, in general, to harbor bacteria transported by the blood stream from other sites of the body. Bladder or kidney infections are the most common source of these delayed infections, but dental abscesses, infected ingrown toenails, bacterial sinus infections or skin infections may also be a significant danger to a joint implant. Please call the office if infection is suspected in any area. If dental surgery, bladder surgery, bowel surgery or rectal surgery is planned, the physician or dentist should be informed that you have had a joint replacement.

 
Dislocation

Dislocation of the hip is a potential risk of joint replacement. Approximately 4% of total hip replacements dislocate in the immediate post-operative period (first 6-12 weeks). In the vast majority of these cases treatment of this problem requires a short operation to reduce the joint. In about 1% a second open surgical procedure may be necessary to correct the situation. In hip resurfacing this risk is less than 1 in 500 (0.2%) as the hip is far more stable and hence the quick recovery.

 

Thrombosis

Another potential risk is the occurrence of blood clot or thrombosis after a joint replacement. Because our patients are mobilised very soon after surgery and we use epidural pain relief, this potential risk is small. Post surgery TED stockings are available and low doses of aspirin or other anti-coagulation (blood thinners) medications are prescribed depending on the patient’s medical history. These measures are in place to reduce the risk of forming a clot. In the event the patient is diagnosed with a blood clot, intravenous or subcutaneous anti-coagulation therapy is required. This means a longer stay in hospital for the patient. There is no perfect treatment and while trying to decrease the significant risk of deep vein thrombosis and the possibility of more serious complications, such as pulmonary embolism, other potential side effects (such as bleeding) can occur with the drugs used to decrease this complication. These powerful medications (Warfarin, Clexane) require extreme care in their use.

 
Death
The risk of death is present in any major procedure requiring anaesthesia and blood transfusion. The specific risk for each patient differs depending on their age, medical condition and the difficulty of the operation. The risk factor is very small.
 
Loosening

Loosening or wearing of the components is a consequence of all joint replacement surgery. Loosening can occur in one or all components, this may increase in rate and volume with inappropriate use of the prosthesis. The younger you are and the more active you are the increased rate of wear. The potential risk is approximately 1% per year. This means, it is a gradual process, characterized by increasing discomfort. In most cases if the components become loose, it can be corrected by another surgical procedure, replacing the worn or loose component.

The advantage of Birmingham Hip resurfacing is the rate of wear and failure appears less than that of the more conventional total hip replacement in young people, however these results are only out to 10 years. When a resurfacing fails it can be converted to a total hip replacement with relative ease.

 

Hip Fracture and Avascular Necrosis (AVN)

Because there is no stem down the thigh bone with hip resurfacing there is a small risk of fracturing of the hip in the first 12 weeks after surgery. In one study this was less than 0.5% and is more common in people over the age of 70 or with brittle bones (osteoporosis). Most are breaks are associated with injury. If this occurs then a stem is placed down the thigh bone in a second operation. You should avoid activities that put you at risk of falling or injury for 12 weeks after surgery.

Avascular necrosis is the loss of blood supply to the head of the hip bone. This can occur with any hip but is extremely rare, it maybe associated with some diseases and medications. If it occurs before surgery then it means a hip resurfacing is not possible and a total hip is required. If it occurs after surgery then it will cause the resurfacing to slowly loosen and it may need to be replaced with a stem (total hip conversion)

Loss of Motion (Stiffness)
A decrease in motion of a joint is also a potential risk. The joint condition prior to surgery will have some bearing on the movement post surgery. Physiotherapy and exercise are encouraged prior to surgery. If the joint remains stiff in the post surgery period, physiotherapy or manipulation can improve the range of motion in the joint.
 
Nerve Damage
Nerve damage is another potential risk factor when considering any joint replacement surgery. The nerves can be traumatized at the time of the operation through stretching and occasionally due to post-operative swelling. Precautions are in place to protect the nerves. The risk factors are small and are dependent on the age and prior medical condition of the patient. Diabetes, smoking, previous nerve problems including sciatica and peripheral vascular diseases are risk factors. If nerve damage occurs it may take years to recover and in some cases can be permanent (usually less than 1 in a 1000).
 
Other Complications

Other complications that can occur include instrument failure, muscle wasting, artery or vein trauma, drug reactions, instrument or implant breakage and loss of income. These complications are extremely rare. It is important to be aware of complications when considering joint surgery.

Medical

Medical risks are varied. They can range from minor to more serious complications. These may include cardiovascular, (Heart attack), respiratory, gastrointestinal, neurological (stroke) and genitourinary systems in the body. Each concurrent of medical complication is addressed on an individual basis.

While orthopaedic surgery carries with it certain risks, it would be safe to say that these risks can be encountered with any surgical procedure. Careful pre-surgical screening and education, a superior surgical technique and a closely monitored post-operative period all add up to minimizing the occurrence of these complications. It is our conscientious effort to adhere to these criteria whenever a patient is under our care. With this in mind, the potential risks are reduced.

 
Long Term Results

The concept of hip resurfacing has been around for decades but previously they have not been successful because of materials and design issues. The Birmingham hip resurfacing has been in use since 1993. It has been the most successful and now is copied by others. However it only has published 10 year results. While many new total hip designs have less than 10 year results we have been using similar designs for over 30 years and so know their results and problems. We do not know this about the hip resurfacing and while successful now we can only assume they will continue to be successful for many decades.

 
Metal Ion Levels

The device is a metal on metal surface. The metal that is currently used in Birmingham hip resurfacing has been used for over 30 years and worldwide for some 40 years. Metal on plastic total hips produce plastic particles that can irritate the hip over years and cause bone loss (osteolysis) and loosening of the hip. There are far less wear particles with metal on metal hips and osteolysis is rare. These implants (prostheses) have been thought to offer a good solution to the problem of arthritis and pain and wear. Any metal in the body release ions (chromium and cobalt).

Metal on metal hips produce these ions and can be measured in the body. There has been no problem associated with the use of this metal in patients despite them probably having high ion levels associated with the watery environment of the body (some metal dissolves in the salt water environment of the body). There have been no adverse effects seen by these ions, but some people have speculated they may cause allergy or even disease over decades of exposure. This has not been shown but continues to be studied scientifically.

 
IMPORTANT NOTICE
It is important not to have any infections at the time of surgery, including teeth problems, bladder or skin infections. We suggest that you have a dental check up within 6 months prior to surgery as it is important not to have any major dental work for 6 months after the surgery. Please let me know if you have any infections prior to surgery.
 

Modern day anaesthetics are very efficient and safe but when dealing with older patients there is always the possibility, although small, of heart or chest complications. Blood clots can occur as a complication of any operation and these may be fatal in less than one patient per thousand. This is reduced further by taking 100mg of Aspirin (Cartia) daily for 6 weeks after surgery.

 
This information is given to you so that you are fully aware of the small risks associated with knee surgery. Overall the procedure is very successful and the incidence of complications is very small.
 
Further Information on Hip Resurfacing :

 

 

 
If you have any queries on Birmingham Hip Resurfacing Surgery please do not hesitate to contact Dr Hugh Blackley's practice rooms during office hours on 09 522 2980