Hip Resurfacing

Hip Resurfacing is an exciting alternative to total hip replacement if you are a younger, active patient with debilitating hip pain. This innovative and technologically advanced surgical procedure resurfaces rather than replaces the end of your femur (thighbone), saving your natural bone.

Because of this you may participate in more strenuous physical activity, have lower dislocation rates and potentially have a longer-lasting implant than some traditional total-hip replacements. Further benefits are seen if there is the need for future revision surgery. The bone conserving approach of hip resurfacing allows for revision surgery with shorter recovery time and less pain as opposed to the more complex, traditional total hip replacement revision.

Although not everyone may be a candidate for Hip Resurfacing, it can be used to treat a variety of disorders including osteoarthritis, dysplasia or avascular necrosis.

Who is a Candidate?

Hip resurfacing is intended for young, active adults who are under 60 years of age and in need of a hip replacement. Adults over 60 who are living non-sedentary lifestyles may also be considered for this procedure. However, this can only be further determined by a review of your bone quality.

There are certain causes of hip arthritis that result in extreme deformity of either the head of the femur or the acetabulum (hip socket). These cases are usually not candidates for hip resurfacing.

Non-surgical Alternatives

Before deciding on hip resurfacing, your physician may try several non-surgical, conservative measures to relieve the pain and inflammation in your hip.

Lifestyle Modification

The first alternative to hip replacement involves such lifestyle modification measures as weight loss, avoiding activities involving long periods of standing or walking, and the use of a cane to decrease the stress on the painful hip.

Exercise and Physical Therapy

Exercise and physical therapy may be prescribed to improve the strength and flexibility of your hip and other lower extremity muscles. Your exercise program may include riding a stationary bike, light weight training and flexibility exercises. An aquatic therapy program is especially effective for the treatment of arthritis since it allows mild resistance while removing weight bearing stresses. For an appropriate exercise program, contact an experienced physical therapist.

Anti-inflammatory Medications

Arthritis pain is primarily caused by inflammation in the hip joint. Reducing the inflammation of the tissue in the hip can provide temporary relief from pain and may delay surgery.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) may be prescribed to decrease the inflammation associated with arthritis. A new classification of NSAIDs, called Cox-2 inhibitors, are often very effective in decreasing pain.

In a small number of cases, the doctor may prescribe corticosteroids, such as prednisone or cortisone, if NSAIDs are not effective. However, due to the higher rate of side effects associated with corticosteriods, a physician must closely monitor their use.

Glucosamine/Chondroitin

Two dietary supplements, Glucosamine and Chondroitin (commonly available in a combined tablet), may decrease the symptoms of hip arthritis. Glucosamine and Chondroitin sulfate are both naturally occurring molecules, and issues associated with both remain under active research. However, it appears that many people taking these nutrition supplements on a regular basis note a decrease in their arthritis symptoms.

The Procedure

Until just recently, your orthopedist would likely be recommending total hip replacement surgery at this point of your disease state. While it is clearly a more bone-sacrificing procedure than hip resurfacing, total hip replacement is a safe and effective surgery, and is performed more than 300,000 times per year in the United States.

As you may know, total hip replacement requires the removal of the femoral head and the insertion of a hip stem down the shaft of the femur. Hip resurfacing, on the other hand, preserves the femoral head and the femoral neck. During the procedure, your surgeon will only remove a few centimeters of bone around the femoral head, shaping it to fit tightly inside the Birmingham Hip Resurfacing implant.

Your surgeon will also prepare the acetabulum for the metal cup that will form the socket portion of the ball-and-socket joint. While the resurfacing component slides over the top of the femoral head like a tooth cap, the acetabular component is pressed into place much like a total hip replacement component would be.

The Implant

The Birmingham Hip Resurfacing implant has been in use around the world since 1997 and been implanted more than 60,000 times. It was approved for use in the United States by the Food and Drug Administration in May 2006.

Although hip resurfacing is not a new concept, the technology behind the ground-breaking Birmingham Hip was developed by British orthopedic surgeons Mr. Derek McMinn and Mr. Ronan Treacy. The two surgeons now train orthopedists from around the globe on behalf of London-based medical device manufacturer Smith & Nephew. US surgeons given access to this implant may travel to England for specialized training or may train at one of the few US centers capable of hosting these focused sessions.

Patient Benefits

The benefits to patients of the Birmingham Hip Resurfacing technique and implant are clear. The implant's head size, its bearing surfaces, and its bone-sparing technique make it a good choice for young, active patients. While the implant's rate of survivorship is comparable to standard total hip replacements after five years, these three key advantages set the resurfacing technique and implant apart from its total hip replacement counterparts.

Head Size

The most noticeable aspect of this implant is its size. While it closely matches the size of your natural femoral head, it is substantially larger than the femoral head of a total hip replacement. This increased size translates to greater stability in your new joint, and it decreases the chance of dislocation of your implant after surgery.

Dislocation is a leading cause of implant failure in total hip replacement. While total hip implants dislocate at a rate of one to three-percent over the lifetime of the implant, a study of 2,385 Birmingham Hip Resurfacing patients found that dislocation occurred in only 0.3-percent of cases five years after surgery.

Bearing Surfaces

Birmingham Hip Resurfacing takes advantage of one of the orthopaedic medical industry's most technologically advanced bearing surfaces. That means that the surfaces of the ball and the socket are made from materials that dramatically reduce joint wear when compared to traditional hip implant materials.

In this case, both the ball and socket are made from tough, smooth cobalt chrome metal. Traditionally, only the ball is made from cobalt chrome, and the socket is lined with a plastic cup. While this plastic cup has some design advantages, it does wear out over the course of many years since it rubs against the metal ball at a rate of nearly two million footsteps per year in physically active adults.

The plastic particles released into the area around the joint as a result of this plastic wear can lead to a condition called osteolysis, which causes the bone around the implant to soften, become unstable, and ultimately a corrective surgery and new implant are required.

However, when both surfaces of a hip implant are made from cobalt chrome, wear particles are reduced by 97-percent, thus potentially extending the life of the implant.

There may be risks associated with metal-on-metal hip implants, though. While no evidence has been established on the subject, some are concerned that the increased level of metal ions found in the blood of metal-on-metal hip recipients may have negative effects on the human body. For this reason, some surgeons may not implant such a device in a patient with kidney disease (since healthy kidneys filter ions from your body) or in women who are or may become pregnant.

Bone Conservation

Perhaps the greatest benefit of the Birmingham Hip Resurfacing implant is the fact that it conserves substantially more bone than a total hip replacement. This is important for two key reasons.

First, unlike a total hip replacement, the Birmingham Hip Resurfacing preserves your natural femoral neck. It is this neck length and angle that determines the natural length of your leg, and since it is not removed and replaced with an artificial device during a resurfacing procedure, concerns regarding leg length discrepancy are virtually non-existent.

Second, if your surgeon should determine you need to have your Birmingham Hip implant replaced at some point in the future, you may undergo a regular total hip replacement surgery. If you had originally undergone total hip replacement instead of hip resurfacing, you would be dealing with a more traumatic and complex procedure and you would be receiving a more invasive implant.

Frequently Asked Questions

Is the Birmingham Hip Resurfacing implant clinically proven?

The Birmingham Hip Resurfacing implant has been in use worldwide since 1997, and the US Food and Drug Administration reviewed a tremendous amount of resulting clinical data before approving it for use in this country.

Who is a candidate for the Birmingham Hip Resurfacing System?

The typical patient will be physically active, under 60 years of age, and suffering from hip arthritis, hip dysplasia or avascular necrosis of the hip. The implant can be used in patients over 60 whose bone quality is strong enough to support the implant. Your surgeon will make the determination if you are a candidate for hip resurfacing.

How long will the Birmingham Hip Resurfacing implant last?

It is impossible to say how long your implant will last because so many factors play into the lifespan of an implant. In the case of resurfacing, for instance, the metal-on-metal bearing surfaces of your new joint may extend its life longer than that of a traditional total hip replacement, but failure to comply with your physical rehabilitation regime may cause your implant to fail within months. A clinical study showed the Birmingham Hip Resurfacing implant had a survivorship of 98.4-percent at the five-year mark, which is comparable with the survivorship of a traditional total hip replacement in the under-60 age group.

How long will my scar be?

Your surgeon will use an incision of between six and eight inches in length. While some surgeons may use a slightly smaller incision, most will fall in that range.

What are my physical limitations after surgery?

Most surgeons will tell you that after the first year, you can return to whatever physical activity you enjoyed before hip pain limited your mobility. For instance, unlike total hip replacement, you will be able to return to jogging or singles tennis after your first year after surgery. During your first year, more conservative, low-impact activities like walking, swimming and bicycling are recommended for strengthening your femoral neck and the muscles around your resurfaced joint.

What's the next step?

We can advise on the best treatment option for your hip pain – contact us to get started.