Sarah Lewis, PharmD
What is hip resurfacing?
Hip resurfacing is surgery to treat chronic hip pain due to arthritis and other hip conditions. It involves implanting a new socket into your hip joint, similar to hip replacement. However, hip resurfacing keeps more of the femur (thighbone) than hip replacement. Hip resurfacing can restore pain-free range of motion and hip function.
Your hip joint is a ball and socket joint. The ball of the femur fits into a socket in your pelvic bone. In both hip replacement and hip resurfacing, surgeons clean out the socket and line it with an artificial surface.
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The difference between the procedures lies in what happens to the femur. Hip resurfacing involves reshaping the ball or head of the femur, fitting it with a metal cap, and relocating the ball back into the socket.
Hip replacement involves removing the ball or head of the femur and some of the bone below the ball, called the femoral neck. Surgeons then insert a long stem with an artificial ball into the thighbone. The artificial ball inserts into the socket to form the hip joint.
Hip resurfacing has some advantages over hip replacement. It keeps more of the femur intact and provides greater hip stability after surgery. You can also have a hip replacement in the future if needed.
Hip resurfacing is major surgery with serious risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all of your treatment choices before having hip resurfacing.
Why is hip resurfacing performed?
Your doctor may recommend hip resurfacing to treat chronic hip pain that interferes with your daily activities or decreases your quality of life. Not everyone is a candidate for hip resurfacing. The best candidates for hip resurfacing are younger than 60, live an active lifestyle, and have strong bones and a large frame. Males tend to meet these requirements more often than females.
People with kidney problems or allergies to metal should not have this surgery. The artificial surfaces in hip resurfacing are metal and can release metal ions into the blood. This is usually not a problem for people with healthy kidneys.
Your doctor will only consider hip resurfacing if other treatment options have not improved your condition. Ask your doctor about all of your treatment options and consider getting a second opinion.
Your doctor may recommend hip resurfacing to treat chronic hip pain due to degenerative diseases including:
Dysplasia, which is when the hip joint doesn’t develop normally causing the joint to wear out
Inflammatory forms of arthritis, including rheumatoid arthritis
Osteoarthritis, which is the breakdown of cartilage and bone
Osteonecrosis, or death of bone. Osteonecrosis is a rare condition.
Traumatic arthritis, which is similar to osteoarthritis and develops after a fracture or severe sprain or strain
Who performs hip resurfacing?
Orthopedic surgeons perform hip resurfacing. Orthopedic surgeons are specially trained to treat problems of the bones and joints. They perform surgery and prescribe other treatments.
How is hip resurfacing performed?
Your hip resurfacing will be performed in a hospital or surgery center. It is major surgery that involves a large incision in the thigh and hip. The incision is usually larger than for hip replacement because the surgery is more difficult.
Your surgeon will dislocate your hip joint, trim your femur bone, and fit it with a metal cap. Then, your surgeon removes the damaged cartilage from the hip socket and replaces it with a metal liner. Finally, your surgeon will relocate your hip joint to complete the surgery.
Types of anesthesia
Your surgeon will perform your hip resurfacing using either general anesthesia or regional anesthesia.
General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the surgery and do not feel any pain. You may also receive a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.
Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.
What to expect the day of your hip resurfacing
The day of your surgery, you can expect to:
Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. The surgical team will give you blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have.
A surgical team member will start an IV.
The anesthesiologist or nurse anesthetist will start your anesthesia.
A tube may be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgical procedure as they happen.
The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and during your recovery until you are alert, breathing effectively, and your vital signs are stable.
What are the risks and potential complications of hip resurfacing?
As with all surgeries, hip resurfacing involves risks and complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
General risks of surgery
The general risks of surgery include:
- Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding, which can lead to shock
Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs, heart or brain and cause a pulmonary embolism, heart attack, or stroke.
Infection and septicemia, which is the spread of a local infection to the blood
Potential complications of hip resurfacing
Problems with hip resurfacing are not common but include:
Dislocation of the hip joint
Formation of new bone along the hip joint causing pain and stiffness
Metal ion dispersal into the bloodstream. This is usually not a problem for people with healthy kidneys because the kidneys can filter and excrete the metal ions. In some cases, people can develop metal sensitivity resulting in pain and swelling.
Nerve or blood vessel damage
Wear and tear of the joint requiring a hip replacement
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery. This includes physical therapy and other rehabilitation treatments.
Informing your doctor if you are nursing or there is any possibility of pregnancy
Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my hip resurfacing?
You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome. You can prepare for hip resurfacing by:
Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Arranging for a ride home after hospital discharge. It is also a good idea to have someone stay with you for the first 24 hours.
Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Losing excess weight before the surgery through a healthy diet and exercise plan
Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and can help the healing process.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. Your doctor will give you instructions for taking your specific medications and supplements.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your surgeon with concerns and questions before surgery and between appointments.
It is also a good idea to bring a list of questions to your appointments. Questions can include:
Why do I need hip resurfacing? Are there any other options for treating my condition?
If you find a problem or another condition during surgery, will you treat it right away or will I need more surgery later?
How long will the procedure take? When can I go home?
What restrictions will I have after the surgery? When can I return to work and other activities?
When will I start physical therapy? Where do I go for it?
What kind of assistance will I need at home?
What medications will I need before and after the surgery? How should I take my medications?
How will you treat my pain?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my hip resurfacing?
Knowing what to expect can help make your road to recovery after hip resurfacing as smooth as possible.
How long will it take to recover?
You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.
You will likely stay in the hospital for several days. In some cases, you may need to stay in a rehabilitation center after you are discharged from the hospital. This will help you improve your mobility and joint function so you can safely return home.
You will have physical therapy to help you recover and regain hip strength and movement. You will also need to use crutches for up to four weeks after surgery. Crutches prevent your hip from bearing too much weight too soon and reduce the risk of femur fracture. Your surgeon or therapist will tell you when it is safe to return to your normal activities.Recovery after surgery is a gradual process. Recovery time varies depending on the type of anesthesia, your general health, your age, and other factors. Full recovery takes up to three months.
Will I feel pain?Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up and physical therapy appointments after hip resurfacing. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Change in alertness, such as passing out, unresponsiveness, or confusion
Chest pain, chest tightness, chest pressure, or palpitations
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Inability to urinate or have a bowel movement
Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot
Numbness or tingling in the affected leg or foot
Pain that is not controlled by your pain medication
Unexpected drainage, pus, redness or swelling of your incision
How might hip resurfacing affect my everyday life?Hip resurfacing may reduce your symptoms and improve hip function so you can lead an active, normal life. Hip resurfacing can help you to be more independent and return to activities, such as walking, biking, and navigating stairs. Hip resurfacing generally allows for return to a greater level of activity as compared to hip replacement. However, you should still check with your doctor before starting any new activities or sports.
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