Resurfacing Arthroplasty

 

Overview

Patients with severe hip arthritis may be candidates for total hip replacement (arthroplasty) or hip resurfacing (hip resurfacing arthroplasty). Each of these operations is a sort of hip replacement, although they differ significantly. Your orthopedic surgeon will discuss the various techniques and which operation is best for you.

The femoral head (thighbone head) and the damaged socket (acetabulum) are both removed and replaced with metal, plastic, or ceramic components in a typical complete hip replacement.

The femoral head is not removed during hip resurfacing; instead, it is trimmed and covered with a smooth metal covering. As with a traditional total hip replacement, the damaged bone and cartilage within the socket are removed and replaced with a metal shell.

 

What’s the Difference Between Hip Resurfacing Arthroplasty& Hip Replacement?

It's the same as putting on a cap or cutting off your head.

Your surgeon will cut away small amounts of damaged cartilage and bone during hip resurfacing. You retain nearly all of the bone in your thigh and hip sockets.

A surgeon removes the whole head of the thighbone and replaces it with a metal stem that is put down into the thigh bone during hip replacement (femur). The top of the stem is secured by a metal or ceramic ball. This implant is normally inserted into a new metal hip socket with a plastic liner.

 

Advantages of Resurfacing Arthroplasty

The benefits of hip resurfacing over standard complete hip replacements remain controversial among orthopedic surgeons. This issue is actively being researched.

1. Hip resurfacings may be less difficult to amend. Because the implants used in hip replacements and resurfacings are mechanical parts, they may and do wear out or loosen over time. This usually happens between 15 and 20 years following the treatment, however implants can survive longer or shorter. If an implant fails, a second procedure may be required. This second treatment is known as a revision, and it might be more difficult than the first. Many surgeons feel that because hip resurfacing takes less bone from the femur (thighbone) than standard hip replacement, it is easier to repair implants that fail following hip resurfacing.
2. Hip dislocation risk is reduced. The ball size in hip resurfacing is greater than in typical hip replacement, and it is closer to the size of your natural hip ball. As a result, dislocating may be more difficult. This attitude is contentious since various factors, including as surgical method and implant type and size, might influence the likelihood of dislocation.
3. A more typical walking style. According to several research, walking patterns are more natural after hip resurfacing than after standard hip replacement. However, these changes in walking are relatively small, and specific devices are required to quantify them.

 

Disadvantages of Hip Resurfacing

1. Fracture of the femoral neck. A small percentage of individuals undergoing hip resurfacing will eventually break (fracture) the thighbone at the femoral neck. If this occurs, the hip resurfacing is generally converted into a standard hip replacement. Because the femoral neck is removed during the treatment, a femoral neck fracture is not conceivable with a standard hip replacement. However, with a typical hip replacement, fractures surrounding the implants are still possible.
2. Metal ion risk. A metal ball travels within a metal socket during hip resurfacing. Friction between the two surfaces can cause the release of microscopic metal molecules known as ions over time. The ions might trigger an unfavorable local tissue response in the bone and soft tissues around the joint. This can result in discomfort and edema, as well as the necessity for revision surgery. Ions can enter the circulation and have systemic effects. As a result, hip resurfacing is currently used less frequently than in the past. Some traditional hip replacements also use a metal ball and a metal socket, and these replacements have the same risks.

 

Who Benefits From Hip Resurfacing Arthroplasty?

Hip resurfacing can help relieve osteoarthritic hip discomfort. Hip pain is most commonly felt in the groin, buttock, or side of the hip. If nonsurgical therapies do not relieve your hip discomfort, your doctor may propose surgery.

Hip resurfacing is not for everyone. People above the age of 65 should not have the operation. Hip replacement is safe and effective in the elderly. This age group is more likely to have weaker bones (osteoporosis), which can make hip resurfacing and hip replacement more difficult.

Candidates for hip resurfacing typically are:

• Younger, active men, with strong, healthy bones.
• Women do not do as well as men, and are rarely resurfaced.
• The average age for hip resurfacing is the early 50’s.

 

How To Prepare for Surgery?

Several medical specialists will be involved in your care. One of your most critical responsibilities as an active part of the healthcare team is to ensure that each professional gets the knowledge they need to make sound decisions.

Another important task is to follow any directions provided to you in preparation for surgery. Your healthcare team will take the following actions to assure your readiness in the weeks leading up to your procedure:

• A general medical assessment will be performed several weeks before surgery by your primary care doctor or an internist. This checkup will evaluate your health as well as your risk of anesthesia. The results of this test, together with a surgical clearance, will be submitted to your orthopedic physician.
• Several preoperative procedures, including as blood tests, an electrocardiogram (EKG), and a chest X-ray, may be required. You may be requested to produce a urine sample as well.
• The anesthesiologist will meet with you on the day of your operation to discuss the type of anesthetic that will be used.
• If you need dental work done, such as an extraction or periodontal therapy, make sure you arrange it well in advance of your operation. Do not plan any dental care, including basic cleanings, for many weeks after your operation due to the risk of infection.
• Notify your doctor if you develop a fever, cold, or any other illness in the week leading up to the operation.
• One Day Before the Procedure:

The 24 hours leading up to your operation will be hectic, with many last-minute preparations. Use this checklist to ensure that you don't overlook anything:

• The night before your procedure, take a shower or bath. Your surgeon may advise you to use antibacterial soap or another type of medicinal wash. This will assist to lower the likelihood of infection.
• Do not shave the surgical region. If shaving is required, it will take place in the hospital.
• Before going to the hospital, remove any make-up, lipstick, or nail paint.
• After midnight the night before surgery, do not eat or drink anything.
• Pack a small bag to bring to the hospital. Some of the items you should include are: 
• A pair of comfortable, sturdy bedroom slippers with non-skid soles.
• A knee-length robe or gown.
• A lightweight camisole or cotton shirt to wear under your hospital gown.
• Something to read.
• Copies of your insurance cards, advance medical directives, and medical history.
• Any medications you take regularly.
• Personal care items such as a hair brush, denture case, eyeglass case, contact lens case. Be sure to leave your cash, credit cards and jewelry at home.
• A loose-fitting sweat suit or jogging suit and comfortable shoes to wear home.
• Ask a family member or friend for help if you have not yet done so. Have someone check in with you daily. You'll recover more quickly if you have help instead of trying to do everything yourself.

 

How Do Surgeons Perform Hip Resurfacing Arthroplasty?

Hip resurfacing is often performed under spinal anesthesia with sedation. You're sleeping and breathing on your own. The operation takes less than two hours.

Your surgeon will do the following during hip resurfacing:

• Makes an incision in the thigh to access the hip joint.
• Trims damaged bone and cartilage from the thighbone head (ball).
• Uses surgical cement to attach a smooth metal cap to the ball.
• Removes damaged bone and cartilage from the hip socket.
• Pushes a metal shell into the hip socket. The socket has a roughened back which attaches itself to the bone of the pelvis.
• Moves the femoral head (ball) into the hip socket.
• Closes the incision with stitches.

 

Recovery

You will be monitored in the recovery room for many hours following surgery. Once your blood pressure, pulse, and respiration are stabilized and you are awake, you will be brought to a hospital room and kept for a few days.

Soon after the operation, a physical therapist will meet with you to develop an exercise rehabilitation plan. You will be up and moving right away because your pain will be treated with a variety of pain treatment techniques, including prescription and over-the-counter pain medicines. You will adhere to the rehabilitation plan both while in the hospital and after discharge. You will be released to your home or a rehabilitation facility, where you will undergo physical therapy to rebuild strength and range of motion.

When you go home, you'll need to keep the surgery area dry and clean. Bathing instructions will be supplied to you. When you return for your follow-up appointment, the stitches will be removed.

Take just the pain medicines prescribed by your doctor. Aspirin and other over-the-counter (OTC) pain medicines might result in bleeding or other side effects.

Keep an eye out for signs of infection, including:

• Fever/chills
• Redness or swelling
• Bleeding or drainage at the surgical site
• Increased pain at the surgical site
• Numbness or tingling in the affected joint

Unless your practitioner instructs you otherwise, there is no need to alter your diet. Any activity limits, including driving, will be communicated to you. Based on your specific scenario, your healthcare professional may have further advice and instructions.

Depending on the kind of arthroplasty, you might be out of action for up to four months. In the first few days following surgery, you will need to walk with a walker, crutches, or a cane. A week following surgery, your healthcare practitioner will examine you and establish the specifics of your physical therapy regimen.

You will participate in physical therapy and aim towards resuming regular activities in the two to six weeks after surgery.  To avoid injury, you should not return to sports until you have received permission from your healthcare physician. You will notice gains in strength and range of motion in the repaired/replaced joint over the next three to four months.

By this point, the pain and swelling should be totally gone, and your practitioner will authorize your return to preferred sports and high-impact activities.

 

How Effective Is Hip Resurfacing Arthroplasty?

Hip resurfacing is just as effective as hip replacement at relieving pain and increasing mobility. Hip resurfacing has the following advantages over hip replacement:

• Improved mobility: After healing, most persons who have hip resurfacing can run, jump, and participate in all activities. People who have replacements should limit their activity to low-impact activities such as walking, swimming, and golfing. High-impact activities might cause issues by loosening the artificial joints.
• More equal leg lengths: Hip replacement surgery might result in a treated leg that is somewhat shorter or longer. Because your surgeon removes less bone during hip resurfacing, you have a lower chance of this condition.
• Reduced risk of hip dislocation: A resurfaced thighbone head (ball) fits more firmly and is of normal size into a resurfaced hip socket. The fit of artificial joints is looser, and the smaller ball may pop out of position (dislocation).
• Simpler revision (follow-up) procedures: Some patients require further "revision" surgery to replace implants that may become loose, damaged, or diseased years later. Hip resurfacing preserves more bone, making it easier to replace worn-out components with new ones. Because there is less bone to deal with, revising a complete hip replacement is more difficult. This is one of the most significant advantages for young, active individuals who require hip surgery.

 

Complications

Complications from resurfacing arthroplasty have a negative impact on results and patient satisfaction. Despite the fact that resurfacing arthroplasty remains a dependable and reproducibly effective procedure in patients suffering from severe advanced degenerative arthritic hip.

• Periprosthetic Fracture:

Resurfacing arthroplasty periprosthetic fractures (PPFs) are further distinguished by implant placement and residual stability. PPFs in the femur occur at a 1% to 2% incidence, with risk factors including reduced patient bone quality, and, while contentious, anterior femoral notching as a possible risk factor for postoperative fracture.

1. Aseptic Loosening:

Aseptic loosening in resurfacing arthroplasty occurs as a result of a macrophage-induced inflammatory response, which leads in bone loss and prosthetic hip component loosening. Patients typically present with repeated effusions and/or pain that increases with weight-bearing exercises. Patients may feel little discomfort whether at rest or with range of motion.

To adequately work up these issues, serial imaging and infection tests are required, which are eventually addressed with revision surgery if symptoms persist and the patient is declared a suitable surgical candidate. Aseptic loosening mechanisms include particle debris formation, macrophage-induced osteolysis, component micromotion, and particulate debris dispersion.

1. Wound Complications:

Resurfacing arthroplasty postoperative wound complications range from superficial surgical infections (SSIs) such as cellulitis, superficial dehiscence, and/or delayed wound healing to deep infections resulting in full-thickness necrosis, which necessitates returns to the operating room for irrigation, debridement (incision and drainage), and rotational flap coverage.

1. Periprosthetic Joint Infection:

In the acute scenario, the most common offending bacterial species are Staphylococcus aureus, Staphylococcus epidermidis, and coagulase-negative staphylococcus bacteria. Treatment can be restricted to incision and drainage, polyethylene exchange, and component retention in the acute setting (less than 3 weeks after first surgery). In addition, IV antibiotics are administered for up to 4 to 6 weeks. Although studies show a 55% success rate, outcomes vary and are typically influenced by several intraoperative, patient-related factors, including the offending bacterial organism. The surgeon is responsible for ensuring and documenting proof of infection elimination.

• Other Complications and Considerations:

Other potential complications are beyond the scope of this review but include:

• Stiffness.
• Vascular injury and bleeding.
• Peroneal nerve palsy: One of the most common complication after resurfacing arthroplasty to correct valgus deformity. During soft tissue balancing of a valgus knee, the iliotibial band preferentially affects the extension space more than flexion space and inserts on Gerdy's tubercle. The popliteus is preferentially affects flexion space more than extension space.
• Metal hypersensitivity. 
• Heterotopic ossification.

 

Conclusion

Hip resurfacing is a type of hip replacement surgery. It employs implants to alleviate hip pain and stiffness caused by osteoarthritis and other disorders. The implants replace damaged tissue and bone, allowing for more fluid mobility. Men under the age of 60 are the greatest candidates for hip resurfacing.

Hip resurfacing includes removing diseased bone and cartilage from the ball and socket. Your surgeon inserts a smooth metal cap on top of the trimmed thighbone. A metal shell is placed in the hip socket. These two metal components move in synchrony, providing for painless, fluid motion.