HIP RESURFACING: BENEFITS, RISKS AND COST

Controversy aside, the truth is that hip resurfacing arthroplasty is a safe and effective alternative to conventional total hip arthroplasty.

Indeed, the cormet hip resurfacing system is especially recommended for younger and active patients. This surgery can diminish the risk of complications, such as hip dislocation.

However, it may increase the risk of femoral neck fracture. So, hip resurfacing surgery is a great alternative in the right hands and after careful patient selection.

WHAT IS HIP RESURFACING SURGERY?

Metal-on-metal hip resurfacing surgery is not the same as standard total hip arthroplasty. Each of these procedures is a type of hip replacement surgery, but there are important differences.

In a traditional total hip replacement, the round head of the thighbone (femoral head) and the damaged socket (acetabulum) are removed and replaced with metal, plastic, or ceramic implants.

In hip resurfacing, though, the femoral head is not removed. It is carefully cleaned and trimmed. Then, it is capped with a hollow, mushroom-shaped metal covering usually made of cobalt chrome. It is very similar to the capping of a tooth.

After that, the damaged bone and cartilage within the pelvis socket is replaced with a matching metal shell. Like a traditional total hip replacement, this metal socket is wedged directly into the bone.

Hence, this surgery replaces the surfaces of a patient’s hip joint while removing less bone compared to a total hip replacement.

AM I A GOOD CANDIDATE FOR HIP RESURFACING SURGERY?

Just as traditional hip arthroplasty, this procedure can decrease your hip pain, improving your mobility and quality of life.

However, invasive procedures such as hip replacement surgery are the last option after using more conservative treatments, including medication and assistive walking devices.

But, unlike hip replacement, resurfacing surgery is not suitable for everyone.  Ideal candidates are typically younger (less than 60) and larger-framed patients with strong, healthy bone.

Conversely, older female patients with weaker or damaged bones are less than ideal and prone to complications, such as femoral neck fracture.

In the end, your doctor’s decision whether to replace or resurface your hip will come after a comprehensive evaluation. It will depend on your age, weight, size, and any conditions that might make your bone softer than expected.

Hence, hip resurfacing surgery is not recommended in patients with:

  • Osteoporosis
  • Rheumatoid arthritis
  • Areas of dead bone in their femoral head (avascular necrosis)
  • Neck cysts close to the head-neck junction

These conditions are a synonym of soft, fragile bone and poor blood supply.

Additionally, metal-on-metal resurfacing systems are not recommended for patients with metal hypersensitivities and women of child-bearing age due to possible unknown effects of metal ion release.

WHAT ARE THE BENEFITS OF HIP RESURFACING SURGERY?

The advantages of hip resurfacing surgery include less bone resection, increased mobility, and decreased dislocation.

Also, this procedure shows excellent functionality on active patients and a potentially easier revision surgery in the future.

Many surgeons claim that most of the benefits of hip resurfacing surgery can be obtained with traditional arthroplasty using larger femoral heads. However, this remains a debate among surgeons.

In the meantime, many studies show great early results with the cormet hip resurfacing system compared to total hip arthroplasty.

Resurfaçage de hanche

TOP 5 BENEFITS

Less Bone Resection

The truth is that hip resurfacing surgery removes less bone from the thighbone. Hence, there is still a good portion of femur bone left to perform a future total arthroplasty, if needed. So, technically, it would be easier to exchange implants.

Indeed, when having a total arthroplasty, you may require revision surgery and the metal piece embedded in the femur has to be removed. During the removal and replacement with a larger diameter prosthesis, a lot of bone tissue can be lost.

Decreased Risk of Hip Dislocation

The size of the metal ball that replaces the femur’s head is larger than in a traditional hip replacement.

Also, it is closer to the real-life size of the natural ball of your hip joint. Because of this, a hip dislocation should be less likely to happen.

A More Natural Walking Pattern

Some studies have shown that hip resurfacing surgery offers a more natural walking gait compared to traditional hip replacement.

Though very subtle, walking differences are present and can impact the overall mechanics of the walking process.

Excellent Performance in Active Patients

Resurfacing systems are more resilient during high-impact activities like running or skiing. So, they may last longer in active, younger patients.

Other Benefits

The femoral neck and marrow remain intact. Hence, there is less risk of blood clots and no risk of introducing bacteria causing infection in the opened femoral canal.

There are other benefits of retaining the patients’ complete femoral neck:

  • Less chance of having surgeon induced discrepancies in leg length.
  • No foot direction defects, known as toe-in or toe-out faults.
  • Less “stress shielding” when compared to traditional hip arthroplasty. The femoral upper end retains its natural mechanics under load. This translates into less disruption of the processes taking place inside the bone.

Are There Any Disadvantages of Hip Resurfacing Surgery?

The main disadvantage of hip resurfacing surgery is a femoral neck fracture. So, appropriate patient selection is key when choosing this procedure. This can happen in a small percentage of patients (0–4%). If this occurs, you may need a traditional hip replacement.

A femoral neck fracture is not a complication with a traditional hip arthroplasty because the femoral neck is cut and removed. However, small fractures around the prosthesis can occur with a traditional hip replacement.

There have been some concerns due to cases of metal-on-metal (MoM) hip replacements wearing out earlier than expected or causing damage to the soft tissues around the hip.

For this reason, hip resurfacing systems are used less frequently. Also, the metal-on-metal constant friction produces metal debris, releasing metal (cobalt and chromium) to the bloodstream.

However, some companies have been working on novel components. They use a ceramic coating on the metal femoral head and cross-linked polyethylene plastic for the socket.

Finally, another limitation is that hip resurfacing surgery is a more complex procedure to perform. Also, proper positioning of main components is essential, and a larger incision is usually required.

How Is the Hip Resurfacing Procedure?

Hip resurfacing surgery can last between 1-1/2 to 3 hours. It is performed under general anaesthesia (you will be asleep), or you will receive an epidural (you will be awake but numb from the waist down.)

Your surgeon will make an incision in your thigh to expose the hip joint. Then, the femoral head is dislocated out of its socket and trimmed.

Next, the metal cap is fitted. The cartilage that lines the socket acetabulum is removed using a reamer and replaced with the metal cup. Finally, the femoral head is put back in place, and the incision is closed using stitches.

Precautions After Surgery

In most cases, hospital stay goes between 1 to 4 days. Depending on your doctor’s preferences, you may be encouraged to start putting weight on your leg immediately after surgery. But, you may need a cane, walker, or crutches during the first few days or weeks until you can walk without assistance.

You can expect pain and discomfort for several weeks after surgery. However, you will be prescribed pain killers and other medications if needed.

The physical therapist will be your best friend from now on. He will give you exercises to slowly restore your strength and improve your range of motion.

Also, you will have regular follow-up check-ups with your orthopaedic surgeon to monitor your progress. You will probably be able to resume most of your everyday activities within six weeks of the surgery. However, your recovery will last between four to six months.

Bear in mind that the main components of your hip resurfacing system may wear out sooner than expected or loosen over time. So, you may need revision surgery approximately 10 to 20 years after your original hip surgery.

What are Hip Resurfacing Surgery Risks?

Risks of hip resurfacing surgery include those common of a traditional hip replacement, including infection, blood clots, neck fracture, and dislocation (very rare).

To prevent infections, you will be given antibiotics before and after surgery. And for blood clots, you will have to wear compression stockings and receive blood thinners.

Can You Run After Hip Resurfacing?

Resurfacing patients should avoid stressing the new joint by jumping upon their hip, preferably during the first six months. Also, high-impact activities such as jogging and running should be avoided during this time to minimize the risk of a fracture.

Activities where deep bending of the hip is mandatory, such as some yoga positions, are best avoided. After three months, riding and golf are allowed.

Most patients can return to high-level activities following their hip surgery after clearance from the surgeon.

HOW MUCH DOES HIP RESURFACING SURGERY COST?

The cost of private hip resurfacing depends on many factors. We would be delighted to answer your query.

Please, fill in the contact form. If you have any medical reports from other centers, we would appreciate it if you could send these tests to us by email to offer you the solution that best suits your needs. You can be sure that this information will always be treated with maximum confidentiality.

Hip Specialists at Diagonal Clinic (Barcelona, Spain)

Doctor Martín Casola, Daniel

Doctor Martín Casola, Daniel

Hip replacement surgeon. Specialist in arthroplasty, hip and knee replacement, osteosynthesis, arthroscopy acromioplasty and stem cell transplantation
Doctor Aláez Penina, Jaume

Doctor Aláez Penina, Jaume

Hip replacement surgeon. Specialist in arthroplasty, hip, knee and shoulder replacement and treatment of scapulohumeral periarthritis
Doctor Norberto Bayona, Eduard

Doctor Norberto Bayona, Eduard

Hip replacement surgeon. Specialist in arthroplasty, hip and knee replacement and fracture surgery
Doctor Salvans Giralt, Xavier

Doctor Salvans Giralt, Xavier

Hip replacement surgeon. Specialist in arthroscopic surgery, arthroplasty, hip and knee replacement, osteosynthesis and sports orthopedics and traumatology
Doctor Valls Elias, Artur

Doctor Valls Elias, Artur

Hip replacement surgeon. Specialist in arthroscopic surgery, arthroplasty, hip, knee and shoulder replacements, osteosynthesis and sports orthopaedics and traumatology
Doctor Garcia Bonet, Jordi

Doctor Garcia Bonet, Jordi

Hip replacement surgeon. Specialist in arthroscopic surgery, arthroplasty, hip and knee replacement, foot surgery (halux valgus, finger deformities) and pediatric orthopedics
Doctor González Navarro, Albert

Doctor González Navarro, Albert

Hip replacement surgeon. Specialist in arthroscopic surgery, arthroplasty, hip and knee replacement and osteosynthesis
Doctor Sánchez Navés, Rubén

Doctor Sánchez Navés, Rubén

Hip replacement surgeon. Specialist in upper limb surgery, arthroscopy and hip, knee, shoulder and elbow replacement surgery
Doctor Rios Torondell, Joan

Doctor Rios Torondell, Joan

Hip replacement surgeon. Specialist in arthroscopic surgery, arthroplasty and knee replacement

Other articles that may interest you – External links – Bibliography

Cement penetration in Hip resurfacing 2008 Aufranc Award, Hip Society: Beaulé; Matar; Poitras, Smit, May. Clin Orthop Relat January 2009

Hip Resurfacing versus Total Hip Arthroplasty: A Systematic Review Comparing Standardized Outcomes Deborah A. Marshall, Karen Pykerman, Jason Werle, Diane Lorenzetti, Tracy Wasylak, Tom Noseworthy, Donald A. Dick, Greg O’Connor, Aish Sundaram, Sanne Heintzbergen, Cy Frank. Clin Orthop Relat Res. 2014

Eligibility for the hip-resurfacing arthroplasty procedure: an evaluation on 592 hips Roberto Dantas Queiroz, Rafael Salomon Silva Faria, David Marcelo Duarte, Marcelo Itiro Takano, Mauricio Morita Sugiyama. Rev Bras Ortop. 201

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