Hip Resurfacing – Is It Right for Everyone?
Hip resurfacing is an advanced surgical procedure that offers a bone-preserving alternative to total hip replacement for younger individuals dealing with pain caused by hip arthritis. This technique involves removing the arthritic bone and reshaping the head of the femur (ball) and the acetabulum (socket) to place new surface replacement components.
Image credit – Sydney Orthopaedic Trauma and Reconstructive Surgery
Hip resurfacing is not suitable for everyone, and determining whether you’re a candidate involves several factors. This blog covers the essentials of hip resurfacing, including who is an ideal candidate, the potential risks, and the long-term results of the procedure. By the end, you’ll have a clear understanding of this option and whether it might be right for you.
Who is a Candidate for Hip Resurfacing?
While hip resurfacing may offer compelling advantages, not everyone is a suitable candidate for this procedure. This technique is typically reserved for younger patients with good bone, a large femoral head, minimal leg length difference and pain caused by osteoarthritis.
Patients with arthritis from paediatric hip conditions such as hip dysplasia, Perthes disease or those with collapse of the femoral head and severe acetabular wear are not candidates for this surgery. Because you are simply placing a new surface on the bone, there is little ability to correct leg length or other anatomical parameters.
Younger Adults with Active Lifestyles
Individuals under the age of 55-60 who maintain an active lifestyle often benefit most. The bone preservation element of this surgery enables placement of a stable implant with an improved range of motion suitable for an active and more physically demanding lifestyle. Several professional athletes have undergone this procedure and been able to return to professional sport.
Patients with Strong Bone Quality
Those with healthy, strong bone structures are better equipped to handle the demands of a resurfaced hip. Strong and healthy bones enable better outcomes and reduce the risk of complications related to the implant.
Those Seeking Bone Preservation
Unlike a total hip replacement, which involves removing the entire femoral head, hip resurfacing preserves more natural bone. This is ideal for those wishing to delay or avoid the need for future revision surgeries.
Who Might Not Be Suitable
Patients with the following conditions may not be suitable for hip resurfacing.
- Severe Osteoporosis or Bone Weakness
- Chronic Kidney Disease or Metal Sensitivities
Metal implants used in hip resurfacing may release ions over time. Individuals with sensitivities or kidney disease face an increased risk.
- Women of Post-Menopausal Age
Due to the higher risk of osteoporosis in post-menopausal women, the durability and success rate for this group can vary.
- Advanced Arthritis or Joint Deformation
Patients with significant joint damage may derive greater benefits from a total hip replacement, particularly when extensive reconstruction is required. This includes arthritis secondary to paediatric hip pathology such as hip dysplasia, Perthes disease and osteonecrosis of the femoral head.
If you’re unsure whether you’re a candidate, discussing your medical history and lifestyle with a qualified orthopaedic surgeon, like Dr. Dan Cohen, is a critical first step.
What Are the Risks of Hip Resurfacing?
No surgical procedure is without its risks, and hip resurfacing comes with its own set of considerations and specific risks, in addition to the standard risks of hip replacement. Understanding these potential complications ensures that you can make an informed decision and weigh the benefits against the challenges.
- Metal Ion Release
Hip resurfacing implants are typically made from cobalt-chrome metal alloys. Over time, friction at the joint may release small amounts of metal ions into the bloodstream. While rare, excessive levels can lead to a condition called metallosis, which may require further treatment. Metal allergies or sensitivities should be discussed with your surgeon before surgery.
- Risk of Implant Failure
Although the success rate of hip resurfacing is high, there is still potential for implant loosening or failure. This is most often associated with inadequate bone strength in the femoral head, underscoring the importance of careful pre-surgical screening.
- Fracture of the Femoral Neck
One complication unique to hip resurfacing is the risk of a femoral neck fracture. This can relate to several factors, including the quality of the supporting bone and the technical demands of the operation. This occurs when the preserved portion of the femoral head is unable to support the resurfacing implant. The femoral neck can sometimes be damaged at the time of surgery or can wear away from a reaction to the metal ions. Several strategies are used to reduce this risk, including intra-operative imaging and 3-D printed patient-specific guides.
Recovery and Rehabilitation Challenges
Post-operative recovery can be demanding, requiring a period of protected weight bearing with crutches, intensive physical therapy and strict adherence to activity restrictions. Disregarding your rehabilitation plan can lead to complications, including ligament strain or implant instability.
By working closely with an experienced surgeon and healthcare team, the majority of these risks can be managed effectively.
Long-Term Results of Hip Resurfacing
Hip resurfacing is designed to deliver durable, long-term results for the right candidates. Many patients maintain an active lifestyle for decades with minimal restrictions; however, it’s essential to understand what to expect. The outcomes of hip replacement are equivalent to those of hip replacement in the correctly selected patient.
Bone Preservation for Future Options
The younger you are when undergoing hip replacement or hip resurfacing, the more likely you are to require revision surgery in future. One of the most significant benefits of hip resurfacing is the preservation of bone around the hip joint. Should a revision procedure be needed later in life, transitioning to a full hip replacement is typically easier when compared to revising an original total hip replacement.
Enhanced Durability and Activity Levels
Studies have shown that patients who undergo hip resurfacing typically return to higher levels of activity compared to those with total hip replacements. Sports, hiking, and other moderate-impact activities can often be resumed after recovery.
For suitable candidates, the lifespan of a hip resurfacing implant is comparable to that of a total hip replacement, with many patients maintaining joint functionality for 10 to 20 years or more. Factors such as bone health, adherence to rehabilitation, and overall physical activity impact longevity.
Hip Resurfacing vs Total Hip Replacement
When deciding between hip resurfacing and total hip replacement, it’s essential to understand the differences between them.
- Bone Preservation
Hip resurfacing is designed to save more of the natural bone, making it an excellent choice for younger patients. Total hip replacement, by contrast, removes more of the femoral head but may be better suited for older adults or those with more advanced joint damage.
- Range of Motion
The preserved bone and larger femoral head used in hip resurfacing replicate natural joint movement, which can improve range of motion and stability.
- Candidate Suitability
Total hip replacement is a more widely applicable solution, accommodating patients with varying degrees of bone quality and joint damage. Hip resurfacing requires rigorous candidate screening to ensure successful outcomes.
Consulting with an experienced orthopaedic surgeon will allow you to weigh these factors and make the best choice for your individual needs.
Pain-Free Movement
Deciding on the right surgical option for your hip can be a daunting process, but you don’t have to make it alone. Hip resurfacing offers significant benefits for specific individuals, particularly those who are younger, active, or looking to preserve their natural bone structure. However, understanding the risks and long-term results is essential before moving forward.
Dr. Dan Cohen and his dedicated team bring experience, care, and personalised advice to every patient. If you’re considering hip resurfacing, book a consultation today to determine whether it’s the best choice for your lifestyle and health needs.