Thursday, March 23, 2023

Hip Resurfacing Vs Hip Replacement

Disadvantages Of Hip Resurfacing

Hip resurfacing or hip replacement?
  • Femoral neck fracture. A small percentage of hip resurfacing patients will eventually break the thighbone at the femoral neck. If this occurs, it is usually necessary to convert the hip resurfacing into a traditional hip replacement. A femoral neck fracture is not possible with a traditional hip replacement because the femoral neck is removed during this procedure. However, fractures around the implants can still occur with a traditional hip replacement.
  • Metal ion risk. In hip resurfacing, a metal ball moves within a metal socket. Over time, the friction between the two surfaces can lead to the release of tiny metal molecules called ions. The ions can cause a reaction in the bone and soft tissues surrounding the joint called an adverse local tissue reaction. This can cause pain and swelling and may lead to the need for revision surgery. The ions may also enter the bloodstream and have systemic effects. For this reason, hip resurfacing is now performed less frequently than in the past.Some types of traditional hip replacements also consist of a metal ball and a metal socket and these replacements run the same potential risks. Ask your doctor for more information about metal-on-metal implants.

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What You Need To Know

  • Hip replacement can address hip pain and stiffness for people with arthritis, avascular necrosis or other forms of hip joint damage.
  • During a hip replacement surgery, an orthopaedic surgeon replaces both ends or one end of the damaged hip joint with artificial parts.
  • There are various surgical approaches to hip replacement surgery, including minimally invasive options that may be appropriate for some patients.
  • Recovery and rehabilitation help you restore mobility and return to activities with less pain.

The Risks Of Hip Replacement Surgery

Hip replacement surgery can cause a variety of complications, including infection and blood clots. According to experts, one out of every five patients who undergo surgery dies within 90 days. It is important to remember that this is a serious complication, but it is critical to remember that hip replacement is extremely successful, with approximately 95 percent of patients experiencing no pain or discomfort after surgery.

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After A Hip Replacement

Hip replacement recovery starts right away. You will be encouraged to get up and move around as soon as possible after surgery. Patients who dont have other health conditions can go home as soon as they demonstrate that they can walk, climb stairs, and get in and out of a car.

Some patients might spend time in an inpatient rehabilitation unit to prepare for independent living at home. Whether you go home or to a rehabilitation unit after surgery, you will need physical therapy for several weeks until you regain muscle strength and good range of motion.

The surgeon, physical therapist or occupational therapist can advise you on when you are ready to walk with or without assistance, and how to manage your pain. The provider will discuss your rehabilitation needs, what to expect in the days and weeks ahead, and how to make the most of your recovery. Your motivation and cooperation in completing the physical therapy is critical for an effective recovery process and overall success of the surgery.

While you recover, be sure to:

  • Keep the surgical area clean and dry. Your doctor will give you specific bathing instructions.
  • Take all medications as directed.
  • Keep all the follow-up appointments with your surgeon.
  • Attend physical therapy and complete home exercises.
  • Resume your normal diet unless otherwise instructed.
  • Elevate the leg and use ice to control swelling.
  • Do not drive until your doctor says it is safe to do so.

Surface Replacement Of The Hip

Hip Resurfacing

Surface replacement of the hip is an alternative to traditional hip replacement for the treatment of conditions such as osteoarthritis, avascular necrosis, and post-traumatic arthritis. It provides a bone-conserving artificial hip joint, and is designed to preserve bone for younger, active patients.

The gold standard of the treatment of end-stage hip arthritis for the last 30 years has been a total hip replacement in which the upper part of the femur are replaced with a stemmed device and prosthetic head . The socket is replaced with a hemispherical shaped cup which usually contains a bearing surface of either metal, ceramic or polyethylene . Total hip replacement is an extremely successful operation that allows patients to return to pain-free activity and improve their quality of life. Unfortunately, over time prosthetic hip implants can wear-out as well as loosen. When this occurs, patients encounter pain, a loss of functional ability and possibly even loss of bone.

Traditional Total Hip

Hip Resurfacing

An x-ray of a patient with a total hip replacement on one side, and a hip resurfacing on the other. This clearly demonstrates the bone-preservation as well as the larger ball size achieved by a hip resurfacing.

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Outcomes Of Hip Replacement

Like resurfacing, hip replacement can greatly improve pain and mobilityand make everyday tasks possible once more.

However, even if hip replacement makes it easier to get around the house, patients shouldnt participate in certain activities, such as running, basketball, or soccer.

Its also important to avoid movements like crossing your legs or bending more than 90-degrees at the waist if you have a posterior approach, however, Dr. Raterman has performed thousands of minimally invasive anterior approach for hip replacements. This improves the early recovery and minimizes the dislocation risk of the posterior approach. There is no need for restrictions in sleeping, leg crossing, or the height of your chairs. Since the anterior hip replacement patients have no internal muscular releases, the early recovery is faster and the usual dislocation precautions do not apply.

Finally, hip replacements may require future revision surgery. New developments in replacement technology mean that many hip replacement implants last up to 20 years or even longer. Some patients may require an earlier revision in cases of infection or injury that compromises the stability of the joint.

What About Return To Sex After Surgery

Research that included our patients showed that patients have sex more frequently and of better quality after hip replacement surgery.

In general, you should avoid extreme positions for the first 6 weeks after surgery and it is safest for you as the patient to be on the bottom during this time period.

This patient has a hip resurfacing on the right hip and a total hip replacement on the left.

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When Is Total Hip Replacement A Better Choice

Hip resurfacing is not recommended for patients with the following conditions:

  • Active or suspected infection in or about the hip joint
  • Poor bone quality which your surgeon feels could not support the implant
  • Multiple cysts
  • Any known allergy to metal
  • Extreme overweight
  • Skeletal immaturity
  • Weak immune system due to disease or certain medications
  • Kidney failure.

When To Seek Treatment For Your Arthritis

Hip Resurfacing or Replacement Pritchett

Arthritis doesnt have to spell the end of an active life. If you are experiencing worrisome symptoms or persistent pain, the renowned arthritis specialists at Summit Orthopedics can help. We work with you to confirm a diagnosis and develop an appropriate conservative treatment plan. If nonsurgical treatments fail to support your lifestyle goals, highly skilled orthopedic surgeons will consult with you and discuss appropriate surgical options. Summit is home to innovative joint replacement options. Our Vadnais Heights Surgery Center is one of only two surgery centers nationally to receive The Joint Commissions Advanced Certification for Total Hip and Total Knee Replacement.

Start your journey to healthier joints. Find your arthritis expert, request an appointment online, or call us at to schedule a consultation.

Summit has convenient locations across the Minneapolis-St. Paul metro area, serving Minnesota and western Wisconsin. We have state-of-the-art centers for comprehensive orthopedic care in Eagan, MN, Plymouth, MN, Vadnais Heights, MN, and Woodbury, MN, as well as additional community clinics throughout the metro and southern Minnesota.

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Advantages Of Hip Resurfacing

The advantages of hip resurfacing over traditional total hip replacements is an area of controversy among orthopaedic surgeons. Research is currently being done on this topic.

  • Hip resurfacings may be easier to revise. Because the components used in hip replacements and hip resurfacings are mechanical parts, they can and do wear out or loosen over time. This typically occurs between 15 and 20 years after the procedure, although implants may last longer or shorter periods of time. If an implant fails, an additional operation may be necessary. This second procedure is called a revision and it can be more complicated than the initial operation. Because hip resurfacing removes less bone from the femur than a traditional hip replacement, many surgeons believe it is easier to exchange implants that fail after hip resurfacing.
  • In hip resurfacing, the size of the ball is larger than in a traditional hip replacement, and it is closer to the size of the natural ball of your hip. Because of this, it may be harder to dislocate. This stance is controversial because several factors can affect the risk of dislocation, such as surgical approach, and the type and size of the implants used.
  • More normal walking pattern. Some studies have shown that walking patterns are more natural following hip resurfacing compared to traditional hip replacement. These differences in walking are quite subtle, however, and special instruments are needed to measure them.

Hip Resurfacing Vs Standard Total Hip Replacement By Dr Thomas Gross

Dislocations are the most common cause for revision surgery after THR. They account for over 20% of all revisions. Dislocations occur in about 5% of all THR. About half of these cases become recurrent requiring revision surgery. They can even occur for the first time many years after the THR was done.

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What Is Already Known On This Topic

  • Total hip replacement is a successful treatment for older patients with severe arthritis of the hip
  • However, in younger and more active patients, traditional hip replacements might not provide the best function and could wear out
  • Hip resurfacing is an alternative form of replacement designed specifically to cope with the high functional demands of more active patients

Strengths And Limitations Of Study

Hip resurfacing

The main strength of this trial is that it was entirely pragmatic, with a relatively large number of surgeons using different hip implants and their own preferred surgical technique. Although we recruited patients from only one centre, the large number of surgeons involved and the variety of implants used probably reflects practice in the wider surgical community. Other strengths included the use of validated, patient reported outcome tools, which were assessed by researchers who were blinded to the type of hip arthroplasty, and the very high levels of complete follow-up data at the primary endpoint .

The key limitation of this trial was that the patients themselves were not blinded to their type of hip arthroplasty. Patients undergoing resurfacing arthroplasty in the UK generally receive a preoperative information sheet and surgical consent form that is different from documents given to those undergoing a total hip arthroplasty. This information details the existing evidence regarding the different risk-benefit profiles of the two procedures. Therefore, in our clinical setting and after discussion with our institutional review board, we did not consider it ethical to blind the patients to their treatment allocation within the trial.

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Increased Interest In Hip Resurfacing Is Inevitable

Nevertheless, the publicity associated with a high-profile sports star like Andy Murray choosing this treatment for his hip osteoarthritis means that awareness of hip resurfacing will grow again. If you are weighing up the decision of a hip replacement versus hip resurfacing, you can expect to find a plethora of information about Andy Murrays experience and his decision to opt for hip resurfacing. We would strongly recommend speaking with a hip surgeon before making the final decision.

Risks Specific To Surface Replacement

Metal ion dispersal

The current generation of surface replacements are metal-on-metal bearings. That means both the ball and the socket are made entirely of metal. Although this cuts down dramatically on wearing out of the components, it has been shown to cause metal ions to be dispersed through the body. Cobalt and chromium ions are measurable in the blood stream, but have not been shown to cause cancer or any other disease in humans. Although the metal ions are measurable, no one knows what a safe level is. Generally, people with functioning kidneys are able to excrete the ions in their urine. There is also a rare possibility of developing a reaction to the metal particles that could result in pain or joint swelling.

Femur fracture

Because the bone of the femur is retained, it is possible to fracture it after surface replacement. Most of the fractures occur early in the post-operative period if too much weight is put on the leg too early. The body needs time to adapt to the new prosthesis. Post-operatively, crutches are used for 3-4 weeks to protect the amount of weight put on the leg. With current techniques and rehabilitation protocol, the risk of fracture is less than 2%.

Nerve injury

Working around the bone of the femur may cause extra pressure to be put on the nerves in the hip area, specifically the sciatic nerve. This may cause a transient weakness of some of the muscles of the leg in less than 1% of cases.

Heterotopic ossification

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Resurfacing Vs Total Hip Replacement By Mr Mark Bloomfield Orthopaedic Surgeon Uk

The first point I want to make is I have done hundreds or thousands of total hip replacements on all sorts of people at all sorts of ages and activity levels. Some of this experience pre-dates hip resurfacing, but I still often do THR as well. There were many very happy THR patients, but quite a few with a host of problems. My patients and colleagues’ patients referred to me for a second, third or more opinion! Dislocation , infection, leg length differences and completely inexplicable pain. Another frequent problem was limping or muscle weakness as a result of using the direct lateral or Hardinge approach to the hip in an effort to avoid the higher dislocation rate associated with the posterior approach – which more rarely has muscle weakness or limp associated with it.

Resurfacing Of The Hip

Hip Replacement vs. Hip Resurfacing

Hip resurfacing is a specialised kind of hip replacement where the minimal amount of bone is removed from the head of the femur.

Benefits of hip resurfacing:
  • Easy revision after femoral failure.
  • Benefits of MoM:
  • > 20 years experience of modern MoM bearings
  • Allows use of very large heads.
  • Problems of hip resurfacing:
  • Metal allergy, and ALVAL/ARMD, especially in young females
  • Unexplained pain, especially in young females
  • Worries over cancer risk
  • Wear particles cross the placenta
  • Sensitive to surgical error in placement.
  • The procedure

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    What Are The Risks Of Hip Replacement Surgery

    Most patients do well with hip replacement. As with any surgical procedure, there are some risks during and after a hip replacement:

    • Blood clots in the legs or lungs
    • Leg length discrepancy
    • Loosening or wearing out of the prosthesis
    • Unrelieved joint pain

    In very, very rare cases of bone surgery, particularly procedures using cement, an embolism can occur if fat from the bone marrow enters the bloodstream. A fat embolism can raise the risk of a heart attack or stroke.

    There may be other risks depending on your medical condition. Be sure to discuss any concerns with your doctor before the procedure and ask which risks are highest for you.

    After the surgery, notify your doctor if you notice any of the following:

    • Redness, swelling, or bleeding or other drainage from the incision site that doesnt stop after a few days
    • Increased pain around the incision site
    • Pain in the lower leg that is unrelated to the incision
    • New or increased swelling of the lower leg
    • Shortness of breath

    Talk With A Tampa Hip Surgeon

    Advances in medical technology have made hip surgery, both replacement and resurfacing procedures, safer and more effective than ever before. If your hip pain is getting in the way of your everyday activities, you may be a good candidate for surgery.

    An expert in minimally invasive hip surgeries, Dr. Stephen Raterman has helped countless patients in the Tampa Bay area regain their mobility and get back to living a pain-free life. To learn more, schedule an appointment with Dr. Raterman at a Florida Medical Clinic location in North Tampa, Zephyrhills, or Wiregrass. Virtual telemedicine appointments are also available.

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    The Difference Between Hip Resurfacing And Hip Replacement

    March 30, 2021 by Herman Botero, MD

    Pain in the hip joints can make every step a grueling process, and if your joints arent responding well to conservative care, you may think that a joint replacement operation is your only option. For the right patient, they may benefit from a less invasive operation known as hip joint resurfacing. In todays blog, we examine the differences between hip resurfacing and hip replacement and explain which procedure may be right for your.

    The Benefits Of Hip Resurfacing

    Outcomes of Hip Resurfacing vs Standard Primary THA in Men

    Traditional hip replacement involves removing all of your natural hip joints and replacing it with a prosthetic joint made from metal, ceramic, or plastic. In contrast, hip resurfacing is a procedure that retains most of your natural bone while repairing damage within the joint.

    With hip resurfacing, Dr. Boone removes a portion of the femoral ball the rounded end of the thigh bone and reshapes the remaining bone, placing a metal cap on it. He removes damaged bone and cartilage in the joint socket and inserts a metal cup, similar to a traditional hip replacement.

    Hip resurfacing means you retain the larger natural ball in your hip joint. This can reduce your risk of suffering a hip dislocation, and you may have a more natural walking pattern following surgery with hip resurfacing.

    Another benefit of hip resurfacing is that revision surgery may be easier, making it a good option for younger patients. Joint replacements generally last 15-20 years and require revision surgery when they begin to wear out.

    Hip resurfacing can be effective for long-term pain relief, particularly for young, active patients. If your hip arthritis is keeping you from enjoying life, book a consultation with Dr. Boone.

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