Quite unlike the conventional hip replacement, Hip resurfacing surgery will not completely replace “ball” of hip with ceramic or metal ball. Instead, hip resurfacing reshapes bone & caps with a metal prosthesis. Hip socket is subsequently fitted with a metallic cup. However, as these metal surfaces eventually rubbing together will cause potential wearing & release metal ions as a result. Lower levels of these metal ions usually do not cause any problem, but higher levels are definitely risky. Socket prosthesis for conventional hip replacement is generally lined with thick layer of hard plastic without any metal-on-metal contacts. These artificial hip components will wear out, but most patients undergoing hip replacement can expect them to last for at least 15 years. While hip resurfacing was originally seen as stop-gap arrangement for younger people with serious hip problems since it would leave more availability of bone for future hip replacement surgery, in the present circumstances it is generally recommended only in instances of severe deformity only allowing few other options. Nevertheless, best candidates for hip resurfacing appear to be younger folks with good quality of bone.
Healthy hip is basically a ball & socket joint where bones are covered with smooth cartilage enabling acetabulum & femoral head to painlessly glide against each other. While head of the thigh bone & damaged socket are both removed & replaced with ceramic, plastic or metal components in conventional total hip replacement, hip resurfacing procedure will not involve removing femoral head but will instead only trim & cap it with a smooth metal covering. Damaged cartilage & bone within the socket is then removed & replaced with a metal shell just like it is done in conventional total hip replacement surgery.
Doctors usually recommend surgery for patients having more advanced osteoarthritis when they have failed to effectively address through nonsurgical treatment options. Surgery therefore is only considered when the hip joint is significantly affecting quality of life & interfering with normal day-to-day activities. Unlike hip replacement surgery, hip resurfacing procedure is not suitable for all patients. Best candidates for hip resurfacing surgery generally are much younger (usually less than 60 years of age), large framed which are always often males with healthy & strong bones. Older, female & small framed patients with weak or damaged bone pose higher risk of complications including femoral neck fractures. Therefore, a comprehensive evaluation of orthopedic surgeons is required so as to help determine who is a good candidate for hip resurfacing surgery.
Patients will most likely be admitted to the hospital on the day of hip resurfacing surgery. Surgeons will evaluate patient’s health including medical history & choice of anesthesia which could have also been previously discussed during initial consultation. Choices for anesthesia can either be general which will put patients to sleep or spinal where the patient will be awake but lower body will be numb waist down. Surgeons will also examine & sign hip prior to surgery so as to verify surgical site.
Hip resurfacing operation will typically last anywhere between 90 – 180 minutes of time. Surgeons will make an incision in thigh so as to reach the hip joint. Femoral head is subsequently dislocated from the socket & trimmed using specially designed power instruments. A metal cap is then cemented over the newly prepared femoral head. Cartilage lining the socket is now removed with help of a power tool called reamer. Metal cup is then pushed into socket & held in place by using friction between bone & metal. Once metal cup is in place, femoral head is relocated back into the socket. Incisions are finally closed on completion of the procedure. Patients are taken to a recovery room after hip resurfacing surgery where they will be closely monitored by nurses as they recover from effects of anesthesia. Following this they will be shifted to a hospital room for overall observation & recovery.
There are risks involved with hip resurfacing surgery as with any other surgical procedure. Surgeons will discuss every risk with patients & take specific measures so as to avoid any potential complications.
These are however rare –
Patients go home within 1 – 4 days after hip resurfacing surgery in most cases. They may however begin putting weight on legs immediately after surgery depending upon strength of bone & surgeon’s preferences. Patients may require canes, walkers or crutches for the first few days or weeks until the time they become comfortable to walk without any assistance. Physical therapists will provide a menu of exercises so as to help maintain range of motion & restoration of strength. Patients must make it a point to continue seeing the orthopedic medical surgeon for follow up evaluation at prescribed intervals. Most patients are likely to resume daily normal activities by 6 weeks following hip resurfacing surgery.
Great deal of research is currently being done to find out advantages of hip resurfacing surgery over conventional total hip replacement procedure.
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