An Alternative to Hip Replacement for the Younger Patient
People with bad hips have options besides a hip replacement. They can choose a more conservative procedure with greater benefits – hip resurfacing.
So, what is the difference between hip resurfacing and hip replacement? “It’s as different as putting on a hat, or cutting your head off,” says Peter Brooks, M.D., Cleveland Clinic Orthopaedic Surgeon and Chief of Surgery at Euclid Hospital.
Arthritis of the hip, in most cases, is primarily a wearing away of the cartilage on the ball and socket of the hip joint, leading to painful rubbing of bone on bone. Rather than replacing the entire hip joint, as in a total hip replacement, hip resurfacing involves shaving and capping only a few millimeters of the joint surface. Since this approach preserves more of the patient’s natural bone, it reduces postoperative risks of dislocation and inaccurate leg length.
“Ultimately, patients with hip resurfacing can return to all of their previous activities, including running, climbing, and competitive sports,” says Brooks. “Most people with hip replacements cannot achieve this."
One benefit, which is attractive to most younger and active people, is that they keep much more of their own bone. There are other benefits as well.
The implant is extremely unlikely to “pop out,” or dislocate, a problem which can plague an otherwise successful hip replacement, leading to trips to the ER. Hip resurfacing patients also may function at a higher level than total hip replacements.
Another advantage, says Brooks, is that it “feels more normal, because everything about it is more natural.” Weight bearing is carried by the bone in the same way it has always been carried. The bone gets stronger as time goes on. In contrast, hip replacement sends weight bearing loads way down the stem to the inside of the thigh bone, bypassing the upper bone that is left, causing it to weaken with time.
Perhaps the main advantage of resurfacing is found many years later. If a hip resurfacing ever fails, which is unlikely, the surgery to correct it may be as simple as doing the lower half of a primary total hip replacement. Importantly, hip resurfacing needn’t be looked at as a temporary procedure, inevitably leading to hip replacement down the road.
Results from long-term data show that it can last just as long, or longer, than traditional hip replacement in young, high-demand patients, especially men.
Since its FDA approval in 2006, more than 2,000 hip resurfacing procedures have been performed at Cleveland Clinic.
Hip resurfacing is not for everyone. Men tend to do better than women. Osteoarthritis patients do better than those with other diagnoses such as avascular necrosis. Younger men, of at least average height, and good bone quality, are the best candidates for this procedure. For the active person with hip pain due to arthritis, hip resurfacing has many advantages over hip replacement and can lead to a return of normal lifestyle and activity. You should speak to an orthopaedic surgeon about the best options in your individual circumstances.