Hip Resurfacing FAQ’s
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Hip resurfacing specific questions
Why should I have a hip resurfacing vs. a traditional total hip replacement?
A hip resurfacing and hip replacement are both designed to improve your activity, function, and decrease your pain. The difference lies in the way this is accomplished. For some patients, there is a large difference between a hip resurfacing and a hip replacement because of your age and activity level. For others, there is not such a large difference. For example, a young patient who may outlive his/her first hip replacement may more willing to have a hip resurfacing because of the preservation of bone. A patient who participates in activities requiring a high range of motion will have a greater benefit from a hip resurfacing. On the other hand, a low-demand patient for whom a total hip replacement can last the rest of his/her life would be a better candidate for a traditional total hip replacement.
What are the specific risks of hip resurfacing?
The general risks of hip resurfacing are the same as with traditional total hip replacement. These include infection, dislocation, blood clots, nerve injury, and extra bone formation around the hip that could make the hip stiff. The risk of infection with hip resurfacing is no different than with total hip replacement. The risk of dislocation is 10x lower, because of the larger diameter ball. The risk of nerve injury and extra bone formation around the hip are slightly higher with a hip resurfacing because of the need to work around your bone in an enclosed space.
A risk unique to hip resurfacing that is not present in traditional hip replacement is that of femoral neck fracture. The femoral neck is a vulnerable area of bone that connects the ball of your hip joint to the rest of your thighbone. When elderly people fall and “break their hip”, this is the area that breaks. With a traditional hip replacement is done, this bone is removed, so it cannot break. With a hip resurfacing, the femoral neck is preserved, so there is a risk of fracture. We believe the risk of fracture in this area is between 1-2%. It is because the surgical exposure, preparation of bone, and placement of the component with cement may cause this bone to be more vulnerable.
The risk of femoral neck fracture is why crutches are necessary for 3-4 weeks post-operative and impact activities are not recommended for 6 months. If you have a femoral neck fracture after hip resurfacing, you will need another operation to convert it to a traditional total hip replacement.
What will happen when the hip resurfacing wears out?
When a hip resurfacing wears out, it is generally because the femoral cap loosens from the underlying bone. If this happens, it can be converted to a traditional total hip replacement with a stem in the thigh bone, utilizing a big metal ball to match your socket. Generally, the socket is firmly attached to your bone and will not need to be revised. The end result is a metal-on-metal hip replacement with a big metal ball.
What are the major benefits of hip resurfacing?
The major benefit to resurfacing compared to traditional replacement is the preservation of bone. For patients who may outlive their implant, I see this as the largest advantage. Since bone is preserved at the initial operation, more bone is available for the next operation.
A hip resurfacing also has a larger diameter ball, which gives a greater theoretical range of motion. It is also more stable, so the dislocation rate is lower. Additionally, a hip resurfacing loads the bone of the femur the way it is in your own hip, so we believe you can return to more impact activity.
Should I be concerned about the metal ions that are released into the blood?
This is a controversial topic. There have been many studies looking at this issue, and none have been conclusive. People with healthy kidneys seem to excrete the metal ions in the urine. Metal/metal hip replacements have been around since the 1970’s, and they have never been linked to an increase in cancer or other diseases. We do not know “safe levels” of these metal ions in the blood, nor is it likely that we will be able to determine “safe levels” in the near future. It is not advisable to perform metal/metal hip resurfacing in patients on dialysis, kidney transplants, or with renal failure.
What kind of activity can I do after resurfacing?
I am often asked by patients what sorts of activities they may expect to do after a hip resurfacing. To this, I am happy to respond, “EVERYTHING!” Of course, each patient and each hip situation is different, but the entire purpose of going through with the operation is to get back to doing the activities that you love doing. Once the healing process has occurred and the bone around the implants has strengthened, I release you from all restrictions.
I have many patients who are martial artists, dancers, yoga practioners, swimmers, cyclists and weight lifters. Many patients play competitive tennis, soccer, squash, racquetball, basketball, and volleyball. My most active patients are triathletes and marathoners. I also have patients who simply love to walk, garden, and play with their kids.