What is hip resurfacing?
Hip resurfacing or hip resurfacing arthroplasty is a total hip replacement alternative performed by an orthopaedic surgeon and under general anaesthesia or spinal anaesthesia. The aim of hip resurfacing is to remove damaged hip joint cartilage and cover the underlying tissue with a smooth metal implant. In this type of hip replacement surgery, the femoral head of the femur bone is not completely removed but resurfaced, hence the name.
Hip resurfacing requires an incision of between 6 to 10 centimetres along the outer side of the damaged hip which allows surgeons to trim and cap the femoral head and insert an appropriately sized cup into the pelvic bone. Larger incisions may be necessary for easier surgical access in very muscular or slightly overweight patients.
Total hip resurfacing surgery requires a hospital stay of between 2 to 4 days. Patients may usually fly home within 7 to 10 days. Long haul flights are not recommended in the first 3 months after hip replacement surgery and long distances should ideally be split into shorter journeys.
Why do I need hip resurfacing?
Hip resurfacing is the recommended procedure for younger, healthy individuals suffering from chronic hip pain or lack of mobility caused by osteoarthritis, rheumatoid arthritis and hip joint injury. Healthy bone density levels are also necessary. Hip resurfacing arthroplasty is considered to be a therapeutic treatment for a very small percentage of patients experiencing hip joint degeneration where non-surgical treatments are insufficient.
Can I prevent hip resurfacing surgery?
As osteoarthritis is the most common cause of hip joint degeneration, being genetically predisposed for this disorder means hip resurfacing surgery at a younger age is rarely if ever avoided. Osteoarthritis is caused by hereditary factors, injuries, obesity and ageing. The final two causes are usually criteria that mean a patient has been recommended to undergo total hip replacement surgery rather than hip resurfacing.
Low-impact exercise to strengthen the upper leg, lower back, bottom and hip muscles can help to alleviate symptoms and stave off hip resurfacing surgery for a short time. The use of anti-inflammatory drugs treats the symptoms but not joint degeneration. Sometimes intra-articular corticosteroid injections into the hip joint can reduce swelling and pain.
Many sufferers of osteoarthritis swear by supplements such as chondroitin sulphate or glucosamine sulphate. These supplements may indeed help the regeneration of joint cartilage but not to the extent that hip surgery, once advised, can be avoided. Supplements may very slightly increase the time between diagnosis and surgery but their positive actions are not guaranteed.
How do I prepare for a hip resurfacing? What can I expect?
Pre-travel hip resurfacing preparation
Approximately one month before your hip resurfacing procedure you may be asked to lower your food intake if you are slightly overweight. It is unusual for obese patients to be offered hip resurfacing surgery. During this period it is worth looking around your home for potential access problems and remedy access or mobility issues such as the placement of a rail beside the bath, shower or toilet and the relocation of a sleeping area to avoid stairs and allow easy access to the bathroom; these hip resurfacing tips will help during your revalidation. In addition, it is extremely helpful to strengthen the muscles of the back and upper body well before surgery takes place. You can ask your local physician or physical therapist for hip surgery exercise advice. Naturally, stopping smoking is always recommended. You will also need a recent hip X-ray, CT scan or MRI scan and in most cases a bone density scan.
Approximately 1 to 2 weeks before your hip resurfacing procedure your doctor will need to take blood for a preoperative blood test. Remedazo will inform you well beforehand which tests your home-based physician will need to carry out. Depending on your age, an electrocardiogram may be required. Some blood-thinning medications will need to be temporarily stopped, others do not. Our or your own doctor will advise you what to do.
Hip resurfacing preparation in the hospital
You will be admitted to your chosen clinic on the day of your hip resurfacing surgery. As most hip resurfacing candidates are otherwise healthy, there is little need to spend the night before surgery in a hospital setting. You will need to adhere to the anaesthesiologist’s requirements relating to pre-surgery fasting from your chosen accommodation.
From midnight of the day before the hip resurfacing procedure, you will be asked to refrain from eating. Undigested stomach contents can create serious complications during anaesthesia. If you have planned a spinal anaesthetic, these rules still apply as there is always a small chance that you will need to be sedated or fully anaesthetised. Smokers should stop smoking at least 24-hours before an operation. Between midnight and six hours before anaesthesia you may only drink water or clear liquids. You are not permitted to eat, drink or smoke in the 6 hours preceding anaesthesia. Failure to comply may mean the anaesthesiologist and surgeon will be forced to postpone your procedure. This is purely for your own safety. It is possible to brush your teeth during this period but no water may be swallowed. In certain circumstances, medical staff will administer oral medication with a little water. This is administered under the advice of the anaesthesiologist and is therefore permitted.
Approximately 30 minutes to 1 hour before the planned procedure time you will be collected from your room and brought to the operating department either in your bed, on a gurney, in a wheelchair or on foot.
Preoperative hip resurfacing preparation requires:
An intravenous line
A blood pressure cuff placed on the upper arm
The completely painless placement of electrodes to the chest to measure heart activity
A finger or ear sensor to measure oxygen levels in the blood
A spinal or general anaesthetic
At the surgeon’s signal, you will be anaesthetised.
What happens during a hip resurfacing operation?
A hip resurfacing arthroscopy is a relatively new procedure that takes between 90 to 180 minutes and is carried out in a supine position. The surgical site is broadly disinfected and sterile drapes placed so that only the hip area is visible. If, for personal reasons, you prefer a single-gender surgical team this can be arranged, although all staff from our carefully-selected clinics are extremely professional and respectful individuals.
During hip resurfacing, a single vertical incision of between 6 and 10 centimetres is made along the outer side of the hip. This allows your orthopaedic surgeon to remove the damaged cartilage and thin layers of cartilage-producing bone from the pelvis joint and access the top of the thigh bone. The orthopaedic surgeon makes careful measurements so the correct implant sizes can be selected from immediately available stock. These metal implants are shaped to mimic the natural, healthy cartilage of your hip joint. The screwed-in femur cap replaces the damaged edges of the femoral head and fits into the cup-shaped pelvic joint known as the acetabulum. The acetabulum prosthesis is of a semi-circular shape.
At the end of the procedure a hollow and sterile soft, plastic tube with a collecting bottle called a drain is be placed through the incision. The bottle provides a light vacuum that quickly removes blood and fluids produced within the site of the operation.
What happens after hip resurfacing? What can I expect?
You will be woken by the anaesthesiologist immediately after surgery if you have undergone a general anaesthetic and transported from the operating theatre to the recovery room. Spinal anaesthesia requires that patients remain in the recovery room until both legs regain sensation and mobility. It is possible that you experience an itching sensation as the products within the spinal anaesthetic wear away. This sensation ends as lower limb mobility returns. During your stay in the recovery room, you will be carefully monitored. Hip resurfacing patients remain in the recovery ward until they are fully responsive and any pain is well under control.
When the anaesthesiologist is satisfied with your recovery from the effects of the anaesthetic you will be brought to a surgical ward. Remedazo patients continue to be carefully monitored for a minimum of 24-hours after surgery. Pain medication is given at regular intervals according to your personal doctor’s prescription. Gradually decreasing doses of pain medication may need to be taken for up to three months after your hip resurfacing surgery. Blood-thinning injections will be administered to the stomach area for approximately twelve days. These injections lower the risk of blood clot formation. The intravenous catheter will continue to administer fluids for approximately 48-hours and your drain will be removed by a trained nurse or doctor within 48-hours after your arrival in the surgical ward.
The majority of hip resurfacing patients are out of bed within 24-hours of exiting the recovery room. Rehabilitation begins immediately under the guidance and care of a trained physical therapist. Your physical therapist will teach you how to get in and out of bed, and how to manoeuvre during the 4-week revalidation period. In the hospital, nursing staff, crutches and walkers will assist you when getting out of bed and moving around. A pain medication regime will be prescribed to relieve any discomfort.
The average hospital stay for hip resurfacing is 3 days. By this time you will be able to move around with assistance. Remedazo will arrange transportation to your accommodation and your personal Remedazo team will provide all support until you have safely and comfortably returned home. We ensure anticoagulant injections are administered during your stay, including the day of your flight home.
Long-term postoperative care includes the removal of stitches after 10 to 14 days. This can be done by your general practitioner at home. You will require crutches or similar support for at least one week after surgery. A revalidation plan should be followed to encourage the best outcome. You will need to recover for least 4 weeks before returning to work, depending on your profession.
Short- and long-term benefits of hip resurfacing
Hip resurfacing surgery will help you regain painless mobility in the hip joint, enabling you to enjoy non-contact sports and an outdoor lifestyle, to climb stairs without discomfort and enjoy a full range of previously painful activities. Hip resurfacing is a relatively new procedure that allows surgeons to bridge the gap between conservative therapy and total hip replacement in younger (under 60 years of age) and healthy individuals. A resurfaced hip will last for between 15 and 20 years. There is less risk of hip dislocation after hip resurfacing surgery than in other hip replacement surgery. Revision surgery at a later stage is much easier for the surgeon to perform and with fewer complications. Range of movement (ROM) is also reported to be higher than in patients fitted with total hip prostheses.
Short- and long-term disadvantages of hip resurfacing
During any surgery the chance of postoperative infection is a potential risk; all patients fitted with implants are administered antibiotics as a preventive measure before surgery commences. Your chosen clinic’s doctors and nurses are trained to recognise the symptoms of infection very early on. Other short-term risks include bleeding, adverse reactions to anaesthesia, blood clots and breathing problems. It is important you continue to receive your anticoagulant therapy for the full term as recommended by your surgeon and wear compression stockings until you are moving around on a regular basis. As hip resurfacing is a quite new procedure it is also very important the operation is carried out by an experienced surgeon. Remedazo can arrange an e-consult with top orthopaedic surgeons highly experienced in hip resurfacing techniques.
Long-term complications of hip resurfacing are the loosening of one or both implants, metal ion corrosion and femoral neck fracture.
Metal ion particles have been found to be released into the body as the metal surfaces of the hip resurfacing implants glide across one another. There is a risk that these released particles may shorten the lifespan of the prosthesis.
Resurfacing procedures do not remove the entire femoral head, so fractures in the neck of this piece of bone are possible; however, as eligibility for hip resurfacing is limited to younger individuals with healthy bone density this risk is very dependent upon the individual patient.
Hip resurfacing arthroscopy requires you to make temporary and, in some cases, permanent lifestyle changes. Only low-impact sports are recommended after this type of surgery. However, the painless range of activities and increased mobility experienced after hip resurfacing more than make up for these restrictions.
Hip resurfacing alternatives
It is possible that you have been given a choice of one or more alternative treatments or have not yet made an appointment for your free e-consult and are simply browsing the possibilities.
The most common hip resurfacing alternative is a total hip replacement. The use of corticosteroid injections, mobility aids and painkillers do not treat the degeneration of cartilage and are therefore short-term solutions. Stem cell regeneration of damaged cartilage may be an option.
Of course, there is no alternative for professional medical advice. Please call us to arrange your e-consult and the opportunity to speak personally with specialist orthopaedic surgeons. You can discuss hip resurfacing eligibility and any alternatives that interest you with them, ask for second and even third opinions, and take the first step towards your personalised Remedazo holistic care package.
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