Hip Resurfacing

Who is a candidate for Hip Resurfacing?

Hip resurfacing is intended for young, active adults who are under 60 years of age and in need of a hip replacement. Adults over 60 who are living non-sedentary lifestyles may also be considered for this procedure. However, this can only be further determined by a review of your bone quality.

There are certain causes of hip arthritis that result in extreme deformity of either the head of the femur or the acetabulum (hip socket). These cases are usually not candidates for hip resurfacing.

Non-surgical Alternatives to Hip Resurfacing

Before deciding on hip resurfacing, your physician may try several non-surgical, conservative measures to relieve the pain and inflammation in your hip.

Lifestyle Modification

The first alternative to hip replacement involves such lifestyle modification measures as weight loss, avoiding activities involving long periods of standing or walking, and the use of a cane to decrease the stress on the painful hip.

Exercise and Physical Therapy

Exercise and physical therapy may be prescribed to improve the strength and flexibility of your hip and other lower extremity muscles. Your exercise program may include riding a stationary bike, light weight training and flexibility exercises. An aquatic therapy program is especially effective for the treatment of arthritis since it allows mild resistance while removing weight bearing stresses. For an appropriate exercise program, contact an experienced physical therapist.

Anti-inflammatory Medications

Arthritis pain is primarily caused by inflammation in the hip joint. Reducing the inflammation of the tissue in the hip can provide temporary relief from pain and may delay surgery.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs may be prescribed to decrease the inflammation associated with arthritis. A new classification of NSAIDs, called Cox-2 inhibitors are often very effective in decreasing pain.

In a small number of cases, the doctor may prescribe corticosteroids, such as prednisone or cortisone, if NSAIDs are not effective. However, due to the higher rate of side effects associated with corticosteroids, a physician must closely monitor their use.

Glucosamine/Chondroitin

Two dietary supplements, Glucosamine and Chondroitin (commonly available in a combined tablet), may decrease the symptoms of hip arthritis. Glucosamine and Chondroitin sulfate are both naturally occurring molecules, and issues associated with both remain under active research. However, it appears that many people taking these nutrition supplements on a regular basis note a decrease in their arthritis symptoms.

There exist a number of non-surgical alternatives to total hip replacement surgery. Such measures as lifestyle modification, exercise and physical therapy, and medication should be implemented before deciding on surgery. If all of these measures have been exhausted and your orthopedist recommends surgical intervention, BIRMINGHAM HIP Resurfacing can be very successful in decreasing pain and greatly improving function.

The Procedure

Until just recently, your orthopedist would likely be recommending total hip replacement surgery at this point of your disease state. While it is clearly a more bone-sacrificing procedure than hip resurfacing, total hip replacement is a safe and effective surgery, and is performed more than 300,000 times per year in the United States.

Implant components

As you may know, total hip replacement requires the removal of the femoral head and the insertion of a hip stem down the shaft of the femur. Hip resurfacing, on the other hand, preserves the femoral head and the femoral neck. During the procedure, your surgeon will only remove a few centimeters of bone around the femoral head, shaping it to fit tightly inside the BIRMINGHAM HIP Resurfacing implant.

Your surgeon will also prepare the acetabulum for the metal cup that will form the socket portion of the ball-and-socket joint. While the resurfacing component slides over the top of the femoral head like a tooth cap, the acetabular component is pressed into place much like a total hip replacement component would be.

The Implant

The BIRMINGHAM HIP Resurfacing implant is not brand new. It has been in use around the world since 1997 and has since been implanted more than 60,000 times. It is new to the United States, however, where it was approved for use by the Food and Drug Administration in May 2006.

Although hip resurfacing is not a new concept, the technology behind the ground-breaking BIRMINGHAM HIP was developed by British orthopedic surgeons Mr. Derek McMinn and Mr. Ronan Treacy. The two surgeons now train orthopedists from around the globe on behalf of London-based medical device manufacturer Smith & Nephew. US surgeons given access to this implant may travel to England for specialized training or may train at one of the few US centers capable of hosting these focused sessions.

Patient Benefits

The benefits to patients of the BIRMINGHAM HIP Resurfacing technique and implant are clear. The implant’s head size, its bearing surfaces, and its bone-sparing technique make it a preferred choice for young, active patients. While the implant’s rate of survivorship is comparable to standard total hip replacements after five years, these three key advantages set the resurfacing technique and implant apart from its total hip replacement counterparts.

View an animation comparing the BHR System to total hip replacement.

The most noticeable aspect of this implant is its size. While it closely matches the size of your natural femoral head, it is substantially larger than the femoral head of a total hip replacement. This increased size translates to greater stability in your new joint, and it decreases the chance of dislocation of your implant after surgery.

Healthy hip > BHR implant > Total hip

Dislocation is a leading cause of implant failure in total hip replacement. While total hip implants dislocate at a rate of one to three-percent over the lifetime of the implant, a study of 2,385 BIRMINGHAM HIP Resurfacing patients found that dislocation occurred in only 0.3-percent of cases five years after surgery.

Bearing Surfaces

BIRMINGHAM HIP Resurfacing takes advantage of one of the orthopaedic medical industry’s most technologically advanced bearing surfaces. That means that the surfaces of the ball and the socket are made from materials that dramatically reduce joint wear when compared to traditional hip implant materials.

In this case, both the ball and socket are made from tough, smooth cobalt chrome metal. Traditionally, only the ball is made from cobalt chrome, and the socket is lined with a plastic cup. While this plastic cup has some design advantages, it does wear out over the course of many years since it rubs against the metal ball at a rate of nearly two million footsteps per year in physically active adults.

The plastic particles released into the area around the joint as a result of this plastic wear can lead to a condition called osteolysis, which causes the bone around the implant to soften, become unstable, and ultimately a corrective surgery and new implant are required.

However, when both surfaces of a hip implant are made from cobalt chrome, wear particles are reduced by 97-percent1, thus potentially extending the life of the implant.

There may be risks associated with metal-on-metal hip implants, though. While no evidence has been established on the subject, some are concerned that the increased level of metal ions found in the blood of metal-on-metal hip recipients may have negative effects on the human body. For this reason, some surgeons may not implant such a device in a patient with kidney disease (since healthy kidneys filter ions from your body) or in women who are or may become pregnant.

Bone Conservation

Perhaps the greatest benefit of the BIRMINGHAM HIP Resurfacing implant is the fact that it conserves substantially more bone than a total hip replacement. This is important for two key reasons.

First, unlike a total hip replacement, the BIRMINGHAM HIP Resurfacing preserves your natural femoral neck. It is this neck length and angle that determines the natural length of your leg, and since it is not removed and replaced with an artificial device during a resurfacing procedure, concerns regarding leg length discrepancy are virtually non-existent.

BHR cuts > Total hip cuts

Second, if your surgeon should determine you need to have your BIRMINGHAM HIP implant replaced at some point in the future, you may undergo a regular total hip replacement surgery. If you had originally undergone total hip replacement instead of hip resurfacing, you would be dealing with a more traumatic and complex procedure and you would be receiving a more invasive implant.

 Preventing Hip Resurfacing Complications

As with any major surgical procedure, post-operative complications can occur following hip resurfacing surgery. Below is a list of some of the more common complications that can occur after hip resurfacing surgery. This list is not meant to be all-inclusive.

Thromboembolism

This condition, which includes two interrelated conditions—deep vein thrombosis and pulmonary embolism—occurs when blood clots are formed in the large veins of the legs. In some cases, these clots can become dislodged from the veins, travel through the circulatory system, and become stuck in the critical arteries of the lungs. This scenario, called a pulmonary embolism, is a serious medical condition.

The following steps may be taken by you and your physician to avoid or prevent thrombosis:

• Blood-thinning medication (anticoagulants, aspirin)
• Elastic stockings (TED hose)
• Foot elevation to prevent swelling
• Foot and ankle exercises to optimize blood flow.
• Pneumatic devices placed on the feet to improve circulation.
• IMPORTANT: If you develop swelling, redness, pain and/or tenderness in the calf muscle, report these symptoms immediately to your physician.

Infection

Infections occur in a small percentage of patients undergoing hip resurfacing surgery. Unfortunately, infections can occur even when every effort is made to prevent them.

The following steps may help to minimize the risk of post-operative infections:

• Closely monitor the incision and immediately report signs of redness, swelling, tenderness, drainage, foul odor, increasing pain or persistent fever.
• Always wash your hands before and after handling your incision site, especially when the sutures are still in place.
• Pneumonia
• A possible side effect of surgery is the development of pneumonia.

The following steps may help minimize this risk:

• Deep breathing exercises. A simple analogy to illustrate proper deep breathing is to: “smell the roses...and blow out the candles.” In other words, inhale slowly and deeply through your nose, and exhale slowly through your mouth at a slow and controlled rate. A simple rule of thumb may be to perform these deep breathing exercises 8-10 times every waking hour.
• Coughing. This activity helps to loosen the secretions in your lungs and excrete the from your pulmonary system.
• Incentive spirometer. This simple device provides visual feedback while performing deep breathing exercises. Your nurse or respiratory therapist will demonstrate the proper technique.

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