Unlike traditional hip replacement, hip resurfacing doesn't replace the "ball" of the hip with a metal or ceramic ball. Instead, the damaged hip ball is reshaped and capped with a metal prosthesis. The damaged hip socket is fitted with a metal prosthesis — similar to what is used in a conventional hip replacement.

With newer materials, the artificial joint implants used for total hip replacement last about 15 years. This isn't an issue for older people who receive a hip replacement late in life. But hip resurfacing might be a better choice for younger people because the procedure leaves more bone intact, which can make it easier to perform a total hip replacement if needed later.

Resurfacing generally results in a bigger hip ball than what is typically used in a conventional hip replacement, which may reduce the risk of dislocation. But newer implants used for conventional hip replacement now offer the option of a larger hip ball, similar in size to what results from hip resurfacing procedures.

Hip resurfacing is technically more difficult and generally requires a larger incision than what is used for a conventional hip replacement. And the risk of complications is slightly higher with hip resurfacing — even when controlling for factors such as your age, sex and activity levels.

Hip Resurfacing Candidates

Patient suitability for hip resurfacing is decided by the patient's anatomy and the patient's surgeon. Hip resurfacing is intended for younger patients who are not morbidly obese, are clinically qualified for a hip replacement (determined by the doctor), have been diagnosed with noninflammatory degenerative joint disease, do not have an infection, and are not allergic to the metals used in the implant.

Hip resurfacing should not be used on patients who have severe bone loss in their femoral head, those with large femoral neck cysts present (typically found at surgery), or patients who have poor bone stock in the acetabulum.

Caution should be used for patients who have rheumatoid arthritis, are tall, thin, or small boned, those with osteonecrosis (poor blood supply) to the femoral head, or those with femoral head cysts > 1 cm on an x-ray taken before surgery.

Patients with any of these conditions may not be suitable candidates for hip resurfacing.

Hip resurfacing isn't recommended for people who have:

• Osteoporosis
• Impaired kidney function
• Known metal hypersensitivities
• Diabetes
• Large areas of dead bone (avascular necrosis)

Hip Resurfacing Alternatives

Surgery is usually recommended only if non-surgical treatments, such as taking painkillers (eg paracetamol) or anti-inflammatories (eg ibuprofen), or using physical aids like a walking stick, no longer help to reduce your pain or improve your mobility.

Depending on how badly your hip joint is damaged, your surgeon may recommend a total hip replacement. Your surgeon will explain your options to you.

Total hip replacement is an alternative to hip resurfacing. Hip replacement is a surgical procedure in which the hip joint is replaced by a prosthetic implant. Hip replacement surgery can be performed as a total replacement or a hemi (half) replacement. Such joint replacement orthopaedic surgery generally is conducted to relieve arthritis pain or fix severe physical joint damage as part of hip fracture treatment. A total hip replacement (total hip arthroplasty) consists of replacing both the acetabulum and the femoral head while hemiarthroplasty generally only replaces the femoral head. Hip replacement is currently the most successful and reliable orthopaedic operation.

Hip Resurfacing Outcome & Benifits

The potential advantages of hip resurfacing compared to Total Hip Replacement (THR) include less bone removal (bone preservation), a reduced chance of hip dislocation due to a relatively larger femoral head size, and easier revision surgery for any subsequent revision to a THR device because a surgeon will have more original bone stock available. The potential disadvantages of hip resurfacing are femoral neck fractures, aseptic loosening, and metal wear.

Prepare for Hip Resurfacing

Your surgeon will explain how to prepare for your operation. For example, if you smoke you will be asked to stop, as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.

The operation is usually done under general anaesthesia. This means you will be asleep during the operation. Alternatively, you may have the surgery under spinal or epidural anaesthesia. This completely blocks feeling from below your waist and you stay awake during the operation. Your surgeon will advise you which type of anaesthesia is most suitable for you.

If you're having a general anaesthetic, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it's important to follow your anaesthetist's advice.

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

You will be asked to give your consent to have your name on the National Joint Register, which is used to follow up the safety, durability and effectiveness of joint replacements and implants.

You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs (deep vein thrombosis, DVT). You may need to have an injection of an anticlotting medicine called heparin as well as, or instead of, wearing compression stockings.

Hip Resurfacing Surgery Overview

Surgeons perform this operation using several different incisions, or approaches, to the hip joint. The anterior approach from the front of the hip and the posterior approach from the back of the hip. There is no one right approach. Many surgeons prefer the posterior approach because it keeps the joint capsule intact. Keeping the joint capsule intact may reduce the risk of dislocation after the surgery and damage the blood supply less. Either approach is commonly used depending on the training and experience of the surgeon.

The operation begins by making an incision in the side of the thigh. This allows the surgeon to see both the femoral head and the acetabulum (or socket). The femoral head is then dislocated out of the socket. Special powered instruments are used to shape the bone of the femoral head so that the new metal surface will fit snugly on top of the bone.

The cap is placed over the smoothed head like a tooth capped by the dentist. The cap is held in place with a small peg that fits down into the bone. The patient must have enough healthy bone to support the cap.

The hip socket may remain unchanged but more often it is replaced with a thin metal cup. A special tool called a reamer is used to remove the cartilage from the acetabulum and shape the socket to fit the acetabular component. Once the shape is correct, the acetabular component is pressed into place in the socket. Friction holds the metal liner in place until bone grows into the holes in the surface and attaches the metal to the bone.

Birmingham Hip Resurfacing

Birmingham Hip Resurfacing Resurfacing System surgery has helped more hip pain patients around the world than any other hip resurfacing surgery available.

The Birmingham Hip Resurfacing (BHR) device consists of a socket in the shape of a shallow cup (acetabular component), and a cap in the form of a ball head (femoral resurfacing component). See Figures 1a and 1b.

• The cup replaces the damaged surface of your hip socket (acetabulum).
• The cap covers the ball-shaped bone at the top of your thigh (femoral head), and the cap has a small stem that is inserted into the top of your thighbone.

The cap moves within the cup. The surfaces that rub against each other (the bearing couple) are made from highly-polished metal. This type of bearing couple is called a metal-on-metal bearing couple.

The cup (acetabular component) is available in two styles: a one-piece cup or a two-piece cup. The one-piece cup is a single component. The two-piece cup has a metal outer shell and a separate metal liner that locks into the shell.

The Birmingham Hip Resurfacing System relieves hip pain and improves hip function by replacing the parts of your hip that have been severely damaged by degenerative joint diseases. The names of such diseases include osteoarthritis, rheumatoid arthritis, traumatic arthritis, dysplasia, or avascular necrosis.

The Birmingham Hip Resurfacing System is intended for patients who, due to their relatively younger age or increased activity level, may not be suitable for traditional total hip replacement due to an increased possibility of requiring future hip joint revision.

Hip Resurfacing Recovery

You will need to rest until the effects of the anaesthetic have passed. You may not be able to feel or move your legs for several hours after a spinal or epidural anaesthetic. You may need pain relief to help with any discomfort as the anaesthetic wears off.

A special pillow may be placed between your legs to hold your hip joint still and stop it from dislocating.

You may have to wear special pads, attached to an intermittent compression pump, on your lower legs. The pump inflates the pads and encourages healthy blood flow in your legs and helps to prevent DVT. You will be encouraged to get out of bed and move around as this helps prevent chest infections and blood clots in your legs.

A physiotherapist (a health professional who specialises in maintaining and improving movement and mobility) will usually visit you each day to guide you through exercises that are designed to help your recovery.

You will stay in hospital until you're able to walk safely with the aid of sticks or crutches. This is usually about five days. However, if you're generally fit and well, your surgeon may suggest you do an accelerated rehabilitation programme, where you start walking on the day of the operation and are discharged within one to three days.

When you're ready to go home, you will need to arrange for someone to drive you home.

Your nurse will give you some advice about caring for your hip and a date for a follow-up appointment before you go home.

Your stitches or clips will usually be removed after 12 to 14 days.

Hip Resurfacing After Care

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

The exercises recommended by your physiotherapist are a crucial part of your recovery, so it's essential that you continue to do them.

There are certain movements that you shouldn't do in the first eight weeks. For example, you shouldn't cross your legs or twist your hip inwards and outwards. Your physiotherapist will give you further advice and tips to protect your hip.

You should be able to move around your home and manage stairs. You will find some routine activities, such as shopping, difficult for a few weeks and will need to ask for help. You will need to use crutches for about four to six weeks.

You may be asked to continue wearing your compression stockings for a few weeks at home.

You can usually return to light work after about six weeks. But if your work involves a lot of standing or lifting, you may need to stay off for longer.

Follow your surgeon's advice about driving, as the length of time before you are fit to drive will depend on several factors, including which leg has been operated on and whether your car is automatic.

Hip Resurfacing Possible Risks

Hip resurfacing is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications.

Side-effects

These are the unwanted but mostly temporary effects of a successful procedure, for example feeling sick as a result of the general anaesthetic.

Your hip joint will feel sore for several weeks and you may have some pain and swelling.

Complications

This is when problems occur during or after the operation. Most people are not affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, infection, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).

Complications specific to hip resurfacing are listed below:

• Joint dislocation - this is rare but if your hip comes out of joint you may need another operation to correct this.
• Difference in length - your leg may be slightly shorter or longer, and you may need to wear a raised shoe on the shorter side to correct your balance.
• Hip fracture - tiny cracks can occur in your bone while fitting the new surfaces. These usually heal, but sometimes the bone can fracture and require further surgery.
• Loosening - the metal surfaces may become loose from your bone and you may need further surgery to correct this.

The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.