What is a Hip Resurfacing Procedure?
A total hip replacement is a surgical procedure during which a degenerated hip joint is resurfaced or reworked to receive an artificial implant. The hip joint primarily works as a junction between the hip and the thighbone, through a ball and socket arrangement. The hip resurfacing procedure is a relatively conservative procedure that preserves the ball (femoral head). The surface of the femoral head is prepared to receive a metallic cap and this helps to protect the cartilage. A matching metallic cup is placed in the socket. During hip movement the cartilage in the hip joint is protected by the metal implants.
About the hip joint
The hip structure comprises of a ball and socket and is one of the largest joints in the body. In this arrangement, the acetabulum constitutes the socket, while the upper end of the thighbone forms the ball.
A healthy hip has a smooth cartilage surface across the bone surface. The cartilage has a cushioning effect when the bones are in motion. The other bone surfaces of the hip are lined by a tissue called the synovial membrane which releases a lubricating fluid. It is this fluid that completes the mechanism for smooth functioning of the hip joint. The ball and socket are held together by ligaments which also provide stability to the hip joint.
What medical conditions cause hip pain and degeneration?
The primary cause of constant hip pain and malfunction of the hip joint is arthritis.
The most common forms of arthritis which affect the hip joint are the following:
- Osteoarthritis: This condition is primarily age-related and generally occurs in individuals over the age of 50, who have a family history of this condition. Osteoarthritis causes the cartilage cushion in the hip to wear away, leading to bone friction and hip pain
- Rheumatoid arthritis: This condition causes inflammation of the synovial membrane, which produces the lubricating fluid for the hip joint. The inflammation of this membrane causes excessive production of the lubricating fluid which fills the hip joint and damages the cartilage, resulting in pain and stiffness in the hip joint.
- Arthritis caused by hip fracture/trauma: Fracture of the hip or severe damage to the ligaments in the hip joint can cause degeneration of the cartilage, resulting in hip pain.
- Avascular necrosis: Damage to the hip joint cost by trauma or by some diseases can result in reduced blood supply to the femoral head, resulting in the wearing away of the bone surface of the ' ball'. This results in arthritis.
- Hip disease during childhood: Some hip diseases suffered during infancy or childhood can result in arthritis in adult life even if the diseases were treated and cured during childhood
Do I actually need a major procedure like Hip Replacement or Hip Resurfacing?
Hip replacement or resurfacing is not necessary if:
- Pain is not acute
- Pain during movement is only intermittent and not constant
- Pain during rest is tolerable
- Pain is tolerable with mild, intermittent medication
Hip replacement or resurfacing is advisable if:
- Pain is chronic and intense during movement
- Pain is present even during periods of non-activity
- You have been on painkillers for a long time and are therefore at risk of side-effects
Your surgeon will evaluate you to correlate your symptoms with x-ray images of your hip to confirm degeneration of the hip joint and to verify that you will benefit from the surgery.
Is Hip Resurfacing a better option for me compared to Total Hip Replacement ?
Hip Resurfacing is a better option for you if:
- You are relatively young (below 60)
- You are not very overweight
- You have a confirmed diagnosis of non-inflammatory degenerative joint disease
- You do not have an infection in the hip joint
- You do not have allergies to the metals used in the implants
Hip Resurfacing MAY not be for you if:
- The femoral head is not strong
- You have weak bones or suffer from osteoporosis
- Blood supply to the femoral head is inadequate
- You suffer from rheumatoid arthritis
- You are over 60
Advantages of hip resurfacing surgery
- Conservative surgical approach
- Minimal removal of bone mass from the hip joint, providing stronger support to the implant
- Smaller risk of dislocation of hip joint
- If the implant wears out after, say, 15 years then the new implant can be put in with a simple hip replacement procedure, instead of a complex hip revision procedure.
- Ideal for younger patients (below 60 years) with an active lifestyle
How is the implant type selected?
Selecting the right implant is important for a successful hip resurfacing surgery. Some of the factors that will come into play while picking your implant will be the following: your age, lifestyle, nature of activity, the specific condition of your hip and other medical factors
What is the life of the implant?
Implants are available in a wide range of designs and materials of construction. The average life of an implant is approximately 10 to 15 years. With progress in technology, there are many patients whose implants have lasted more than 25 years.
Preparing for your Hip Resurfacing procedure
In preparation for your hip resurfacing:
- might affect the results of the hip resurfacing surgery,
- You will also undergo cardiac screening to confirm that you are fit enough to sustain the stress of the surgery
- Your current medication list will be reviewed and all contraindicated drugs will be suspended before surgery
How exactly is the hip resurfacing procedure performed?
Hip resurfacing surgeries can be performed either under:
- General Anaesthesia (you will be asleep for the duration of your procedure)\
- Spinal / Epidural/ Regional Nerve Block Anaesthesia: While you will be awake during the procedure, your waist and lower limbs will be completely insensitive to pain. This method is preferred by many surgeons because it provides relief from pain for about 72 hours following the surgery)
The total duration of the surgery will be approximately two hours.
There are many approaches to hip resurfacing. The incision can be made on the back, the front or the side of the hip depending on the nature of the problem and the technique favoured by your surgeon.
During standard hip replacement surgery, the surgeon would remove the entire ball of the ' ball and socket joint' of the hip. In the case of hip resurfacing surgery, the ball would be left intact and a metal cap is placed around the cartilage section that has worn away. The top of the femoral head is re-shaped so that its profile is closely matched to the underside of the cap of the implant. This metallic cap protects the cartilage from further deterioration. This approach leaves a large amount of bone which supports the metal cap. The other component of the implant is a metal cup that becomes the socket of the joint. This component surface is designed to allow natural bone growth extends into the component, does integrating it into the hip bone structure and providing stability to the joint. The implant used in hip resurfacing surgery is much smaller than the implant used in hip replacement surgery.
After the surgery
You will be shifted from the operating theatre to a recovery room where your vitals will be monitored for a few hours. Generally speaking, most patients will be shifted to the hospital room after this monitoring period. A physiotherapist will visit you the day following surgery and commence gentle exercises. An important exercise involves your lungs to clear it of post-surgery congestion.
Stitches placed during surgery will be removed 10 days later. You should be free to fly home to your country after this.
At the time of your discharge, the hospital will provide you with a folder containing records of all investigations and a discharge summary which will describe your condition on admission to the hospital, the course of investigations and treatment as well as the doctor's advice to you upon discharge. In addition, you will receive dietary advice as well as prescriptions for medication to be taken after your discharge from hospital.
You will also be provided with the surgeon's certificate that you are fit to fly - a requirement with most international airlines.
What will be the duration of my stay in India?
The total duration of your stay in India would be approximately 2 weeks, including five to seven days in the hospital. If you wish to have a recuperative holiday after your surgery, we will be happy to assist you with your plans.