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 Frequently Asked Questions (FAQ)
 
 
Commonly Asked Questions Post Hip Surgery
 

What is Hip Resurfacing Surgery?

Hip Resurfacing Surgery, Surface Hip Replacement or Double Shell Arthroplasty is a new alternative to traditional Hip Replacement Surgery. Hip Resurfacing is a particularly attractive option an alternative to total hip replacement for younger arthritic and active patients as the design permits a greater range of movement and a lower risk of dislocation.

 
Why Undergo Hip Resurfacing Surgery?

Hip Resurfacing is a particularly attractive option an alternative to total hip replacement for younger arthritic and active patients as the design permits a greater range of movement and a lower risk of dislocation.

  • Unlike Total leg Hip Replacement you can expect no substantial leg lengthening as the hip musculature remains unchanged.
  • Rehabilitation after Hip Resurfacing Surgery is quicker and easier compared to Total Hip Replacement.
  • The Hip Joint feels normal.
  • In the Birmingham Hip Resurfacing procedure the implants are available in different sizes to best suit individual hip sizes. This helps prevent prosthetic hip dislocations.
  • Hip Resurfacing procedure is very bone conserving as the femoral head is simply reshaped and resurfaced with a metal cap. If there are any problems after the Hip Replacing Surgery, the prosthesis can be removed and a Total Hip Replacement Surgery is performed.
  • The Metal on Metal (MoM) joint used eliminates the wearing away of the prosthetic joint.
  • The Metal prosthetic is expected to have a longer life.

 

Are you a candidates for Hip Resurfacing Surgery?

This operation is primarily intended for use in people who are in need of a hip placement at an earlier age A typical hip resurfacing surgery candidate is an individual suffering from advanced hip disease like osteoarthritis and rheumatoid arthritis.

Candidates Activity Level

When considering hip resurfacing surgery the activity level of the candidate is taken into account. The prosthetics used in MOM hip resurfacing are harder wearing ( not made of plastic) and are not expected to wear down because of activity. In the off chance that the joint malfunctions, a " revision" surgery ( surgery where loose, worn or broken joint parts are replaced) can be easily carried out.

Candidates Age

Studies indicate that an individual 65 years of age and younger would benefit from this procedure. Hip Resurfacing Surgery is not recommended in older patients due to risks associated with femoral neck fracture. It was with younger more active patients that the hip resurfacing technology was pioneered.

Candidates Health Status

Hip Resurfacing Surgery is rarely performed on patients with severely deformed hips or patients with skeletons that are undergoing osteoporosis ( diminishing bone disease). If the patient has had previous hip joint surgery with some resulting deformity; Hip Resurfacing Surgery is not recommended.

 
What are the Alternatives to Hip Resurfacing Surgery?

Total Hip Replacement: In Total Hip Replacement a prosthetic Plastic on Metal joint is inserted. The new joint is anchored into the femur bone using bone cements. This procedure removes a good bit of bone which may destabilise the integrity of the hip joint.

Resection Arthroplasty: The diseased or damaged bone is removed and the remaining space is allowed to fill with scar tissue. A patient that goes through procedure can barely walk.

 
How is Hip Resurfacing Operation performed?

Hip Resurfacing surgery is approximately 2 hours of set up and operating time. There is approximately 1 hour in the recovery room after surgery. Hip resurfacing surgery requires the removal of the diseased bone only. This means, the bone removed is minimized to 4-5mm from the head of the femur and approx 4-5mm from the acetabulum.

The incision is approximately 15-20cm in length and it runs over the outer edge of your hip joint. The scar line may not be completely flat immediately after surgery. This will settle down a few weeks after surgery. The operation itself is performed with the patient of their side. The surgical wound is closed with absorbable sutures.

Most surgery is carried out under an epidural spinal injection with sedation. It is safer way with a quicker recovery. You will not feel anything and can be fully asleep with an epidural. The epidural is removed 1-2 days after surgery. Post operative pain is well controlled with the epidural and oral medications. We try to avoid strong painkillers such as morphine because of side effects and they are not usually necessary. For most people the pain is less than that which they experience most days prior to surgery.

 
What to expect during Birmingham Hip Resurfacing Surgery?
Using Birmingham Hip Resurfacing Surgery as an example; The Birmingham Hip Resurfacing Surgery can be performed under general, spinal or epidural anaesthesia. The patient is usually asleep during the surgery. A ventilator is not required. The diseased or damaged surface of the acetabulum is shaped into a hemisphere using a special instrument. A new cup coated with hydroxyapatite ( a chemical that stimulates bone growth) is then inserted into the hemisphere. The femoral bone is then reshaped to a cone-like head which is then fitted with a new metal ball.
 
What to expect after Birmingham Hip Resurfacing Surgery?

Using Birmingham Hip Resurfacing Surgery as an example; Post Birmingham Hip Resurfacing Surgery rehabilitation starts the days after surgery. Most patients are able to sit or stand the day after surgery. Patients can move around bearing weight on crutches as early as two days after the surgery. The hospital staff helps the patients learn to negotiate stairs on crutches. Typical hospital stay is averagely 4 - 7 days. For the first week or so, you will need crutches to get around. Your physical therapy normally starts averagely 6 weeks after the surgery.

In about three months you will be free of walking stick or crutches. Your improvement continues over the next few years. You will be able to return to relatively normal levels of activities.

 
Tips for preparing for Birmingham Hip Resurfacing Surgery
Preparing Your Body
  • Increase your upper body strength to enable you to use mostly your arms after surgery.
  • Lose weight reducing the weight strain on your new hip.
  • Stop taking any anti-inflammatory medications or aspirins at least 10 days prior to surgery.
  • Stop smoking as early as you can before Birmingham Hip Resurfacing surgery.
Preparing Your Home

Rent or purchase special equipment to make your home life comfortable when you return from your surgery: some long-handled devices to avoid bending more than 90 degrees, elevated toilet seat, good chair cushions, and a shower chair.

 
Preparing to Travel
It is generally safe to travel within a week of your surgery. Discuss this with your doctors. Take advantage of the wheelchair services offered at the airports.
 
What is the Recovery Period following a Hip Resurfacing?
The recovery period following Hip Resurfacing surgery will vary depending on the patient. In general, the orthopaedic surgeon will encourage the patient to use the new joint soon after the operation. Usually the patient will be standing and beginning to walk within several days. The patient will normally use crutches or cane for a period of time. The patient will also learn to do appropriate exercises to move and strengthen the joint.
 
What are the Benefits of Hip Resurfacing Surgery?

With the development of Birmingham hip resurfacing surgery, many advantages exist for hip resurfacing surgery compared to the traditional full hip replacement.

Smaller Device: Birmingham device is chrome cobalt, metal combination. It is smaller than a traditional total hip device. With a smaller device the recovery is quicker.

Reduction in the Bone removed: Birmingham hip resurfacing literally means retreading the bone with a metal prosthesis. Therefore, there is a significant decrease in the amount of bone removed. Only a very small amount of bone needs to be removed. The femur (thigh) bone does not need to be damaged.

Decrease in Complication Rates: Birmingham hip surgery greatly reduces the disruption of the joint, therefore providing a shorter recovery period and a decrease in some complications. There is dramatic reduction of dislocation rates and a reduction to the problem of lengthening or shortening of the leg.

Shorter Recovery Time: Most Birmingham hip patients are walking 4 hours after surgery. Total time spent in hospital is approximately 2 days. Within 2 weeks, most patients are back driving, resuming most of their normal activities. Birmingham hip resurfacing dramatically improves quality of life. For total hip replacement most people remain in hospital for 5-6 days and remain off driving for 6 weeks.

More stable hip: Because hip replacements use a smaller ball (to allow thicker plastic for longer wear) the range of movement is less and the dislocation rate greater (up to 1 in a 25) than a BHR. The hip resurfacing has a dislocation rate of less than 1 in 500 because the ball is not removed and remains the same size as the patient’s original hip. The range of movement is greater. Because the hip is more stable and feels more normal, the recovery is quicker and the function generally better.

Ease of Revision: Because hip resurfacing does not damage the thigh bone, when they fail they can be more easily converted to a total hip replacement. This is important in young patients who wear out total hip replacements, because it saves this procedure as a later option when they are older.

 
What are the Risks of Hip Resurfacing Surgery?
There are risks with any surgical procedure. Hip Resurfacing Surgery being a relative new procedure there is long term use data available. Hip Resurfacing surgery requires a well trained orthopaedic surgery.The person considering Hip Resurfacing surgery should tell the orthopaedic surgeon about any additional medical conditions that might complicate the surgery. The patient's regular doctor should be told of the proposed surgery. Before the operation, the patient should discuss with the anesthetists the type of anaesthetic and possible risks involved.
 
What are the Possible Complications of Hip Resurfacing?

With ANY operation there are risks to nerves, blood vessels, bone, tendons, ligaments, muscle, skin and structures which are not intentionally injured but occasionally are so. The more common complications include:

  • INFECTION: The major potential complication of total joint replacement is infection. It may occur during the hospital stay or after the patient goes home. It may occur even years after the operation. Infections in the wound are generally treated with antibiotics. Deep infections may require further surgery and removal of prosthesis. Spread of infection from another part of the body to a joint replacement has been known to occur. To prevent such infection, persons with total joint replacements are generally given antibiotics before dental cleaning and more extensive dental procedures, as well as before some other types of surgery. If an infection occurs, elsewhere in the body, it must be treated promptly with antibiotics.
  • LOOSENING: Loosening of the prosthesis is the most common mechanical problem occurring after total hip joint replacement. Loosening causes pain, and if loosening is significant a second total hip joint replacement may need to be performed. New methods of fixing the prosthesis to bone may minimize or eliminate this problem.
  • DISLOCATION: This complication sometimes occurs after total hip joint replacement, generally in the first few weeks after the operation. In most cases the orthopaedic surgeon can relocate the dislocated hip manually. Only rarely is another operation necessary. A brace may need to be worn for a period of time after a dislocation.
  • WEAR: Although some wear can be measured in artificial joints, it occurs slowly. Wear may contribute to loosening, bit it is rarely necessary to do corrective surgery because of wear alone.
  • BREAKAGE: Breakage of an implanted joint is rare. A second operation is necessary if this occurs.
  • IMPAIRED NERVE FUNCTION: On rare occasions, a nerve in the vicinity of the total hip joint replacement is damaged during the operation. This generally occurs when the orthopaedic surgery must correct considerable joint deformity in order to implant the prosthesis. With time, the nerves usually begin to function normally again
 
What are the Results of Hip Resurfacing Surgery ?

Long term results of hip resurfacing surgery are not yet know as it has only been in clinical usage in its current form for 6 years, however, the results over this period have been very good and all at least as good as conventional hip replacement. The long term reliability of the implant will not be known until it has been in widespread usage for 15 to 20 years.

The historical metal on metal (MoM) which share their metallurgical heritage with the BIRMINGHAM HIP Resurfacing have been shown to last in excess of 30 years. Only a small number of these historical devices have survived however, due to the inconsistencies in manufacturing at that time. With modern manufacturing and quality control techniques we are confident in the BIRMINGHAM HIP Resurfacing Product.

 
Is Hip Resurfacing Permanent?

Being a relative new procedure there is long term use data available. Hip Resurfacing surgery requires a well trained orthopaedic surgery.

Materials and surgical techniques are improving rapidly because of the efforts of orthopaedic surgeons working with engineers and other scientists.

 
How long does a Hip Resurfacing Operation take?
Hip Resurfacing surgery is approximately 2 hours of set up and operating time. There is approximately 1 hour in the recovery room after surgery. Hip resurfacing surgery requires the removal of the diseased bone only.
 

How long will my leg continue to swell and hurt after hip surgery?

The pain usually decreases rapidly during the first few weeks, but the hip continues to improve for 12 months or even longer. The swelling is due to alterations in fluid return up the limb and will gradually diminish but may take many months. Mobilisation helps, as does elevation when not exercising.

 

How much exercise should I do and how can I tell if I have done too much?

Mild and moderate exercise is beneficial but over-exercise is painful. Be guided by the hip symptoms. Generally the more active you are the better, but within your tolerance.

 

When should I drive after hip surgery?

Driving is an individual matter. Some people regain their co-ordination and reflexes quickly and others take longer. Following hip surgery, you should avoid driving for at least 2-3 weeks, depending on your progress.

 

When should I go up and down stairs after hip surgery?

During the first days after surgery you should learn to walk stairs with a physiotherapist at the hospital. The pace at which you regain agility on stairs depends on individual traits.
 

What kind of shoes should I wear after hip surgery?

High heels should be avoided for the first few months. Otherwise there are no rules regarding shoes.

 

Should I use a heating pad or ice packs after hip surgery?

Both ice and heat can be used to help relieve pain but both can be harmful if left on too long. Never sleep with a heating pad on your hip. It can damage the skin and even cause a severe burn. Ice can be used several times a day. 20 minutes on, 20 minutes off, is the usual regime.

 

For how long should I continue taking my medications after hip surgery ?

Blood thinning medications (Aspirin, Cartia) should be taken for 1 month. All pain medications may be taken as directed for pain. We suggest you use these pain medications regularly for the first 10 days after surgery to prevent pain, after this they can be used just as necessary. If you have any questions about your medications, please ask.

 

Is it normal for the hip to click ?

It is common to have clicking of the artificial joint. It is caused by the movement of the hard joint surfaces or tendons moving across them. As your hip recovers and strengthens it tends to go away.

 

Why do I have trouble sleeping at night after hip surgery?

Sleeping trouble is the most common question. You need patience. Surgical healing takes approximately 6-8 weeks. Therefore you may be slightly uncomfortable for this time. When you sleep your own natural body produced pain killers (endorphins) reduced so the leg and hip can ache. Taking prescribed medication at night (Paracetamol, Tramadol and Gabapentin) will help and heat packs can also help. Also getting out of bed and moving the joint sometimes helps. Keep active during the day and avoid napping during the day as this makes night sleep more difficult. Normal sleep will return as the hip heals. This can take 6 -12 weeks.

 
When can I have a Dental Check Up if I have a Hip Resurfacing?
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.
 
Further Information on Hip Resurfacing Surgery :

 

 
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