The hip joint is also known as a ball and socket joint, where the ball (femoral head) of the thigh bone fits into the socket (acetabulum) of the pelvis bone.
Damage to the hip bones can be treated by hip resurfacing, which is a surgical procedure in which the damaged parts of the femoral head are trimmed, and the socket is removed and replaced with metal caps.
Hip resurfacing is an alternative to total hip replacement surgery where both the ball and socket of the hip joint are completely removed and replaced with plastic, metal, or ceramic prosthetics.
Indications and contraindications
Your surgeon may recommend hip resurfacing surgery if you suffer from severe hip arthritis affecting your quality of life and the symptoms have not been relieved with conservative treatment options such as medications, injections, and physical therapy.
In addition, younger, larger-framed patients with strong and healthy bone are more suitable candidates for hip resurfacing surgery.
Hip resurfacing surgery is not recommended in patients with known metal hypersensitivities, osteoporosis, diabetes, impaired kidney function, and large areas of dead bone (avascular necrosis).
Hip resurfacing surgery is performed with the patient under spinal or general anesthesia.
Your surgeon makes an incision over your thigh to locate the hip joint. The femoral head is displaced from its socket, trimmed of the damage using special instruments, and fitted with a metal cap. The damaged bone and cartilage lining the socket is removed and a metal cup is fixed. Finally, the femoral head is repositioned into the socket, and the incision is closed.
Advantages of hip resurfacing
The advantages of hip resurfacing over total hip replacement include:
- Easier to revise: Components used in both procedures usually wear out, loosen or fail after a period of 10 to 20 years, requiring revision surgery. As hip resurfacing involves less removal of bone, the revision surgery should be easier to perform.
- Lower risk of hip dislocation: As the ball size in hip resurfacing is larger and closer to the normal size, the risk of hip dislocation is less.
- More natural walking pattern
- Greater range of hip motion
Disadvantages of hip resurfacing
The disadvantages of hip resurfacing are:
- Femoral neck fracture: There is a likelihood of femoral neck fracture with hip resurfacing, which eventually necessitates a total hip replacement.
- Metal ion risk: Tiny metal particles or ions produced by the movement of the metal ball against the metal socket may produce an allergic reaction causing pain and swelling.
- Difficulty: Hip resurfacing is a more difficult procedure to perform, requiring a larger incision.
Risks and complications
As with any surgery, complications are rare but can occur. Hip resurfacing patients may have complications including:
- Formation of blood clots in the leg veins
- Injury to nerves or blood vessels
- Femoral neck fracture
Birmingham Hip Resurfacing
The Birmingham Hip Resurfacing (BHR) is a metal-on-metal prosthesis used in hip resurfacing procedure. Hip Resurfacing is a bone conserving procedure where the acetabulum (hip socket) is replaced and femoral head is resurfaced. Hip resurfacing is indicated in all the individuals with arthritis where conservative treatment was a failure. Advantage of hip resurfacing procedure is that the little bone is removed from femoral head and this spares the femoral canal.
The conventional method of total hip replacement offers poor long-term outcomes for young and active patients leading to the further complications such as revision surgery and associated problems.
In hip resurfacing, the articular surfaces of the femur and acetabulum are replaced. The procedure is bone conserving as most of the head of the femur is retained. Instead of removing the head completely as with a total hip replacement, it is shaped to accept a low-wear metal sphere. This sphere matches the patient's own anatomy that confers low risk of dislocation, a broad range of movement and excellent stability. A comprehensive range of sizes is offered to address the needs of almost all patients, and those with acetabular deficiencies.
The BHR offers a bone conserving, less invasive alternative to total hip replacement, with the potential for higher levels of patient activity. The BHR device is designed to suit cemented fixation or cement-less press-fit fixation. The resurfacing femoral head and acetabular cups are available in various sizes to suit everyone’s needs. The BHR system has allowed many young and active patients, athletes, and sports personalities with arthritic hip to perform their normal activities with no or minimal pain. It can be used in all individuals aged <60 years and in individuals aged>60 years with bone quality strong enough to support the implant.