Arthritis in the hip is a real pain. In addition to the nagging discomfort, it slows people down and limits their activities. Until now, the best option for most people with severe arthritis was a total hip replacement for permanent pain relief. Now a procedure called hip resurfacing is gaining favor as an alternative to total hip replacement. Recent advances in the design of the implant used in resurfacing have prompted orthopedic surgeons such as Dr. Geoffrey Westrich, co-director of joint replacement research at the Hospital for Special Surgery in Manhattan, to recommend hip resurfacing as a better option for some patients.
"For the right candidate, often a younger patient, hip resurfacing may be preferable to total hip replacement because it preserves bone, reduces the risk of dislocation, and generally allows people to return to a higher level of activity after surgery," according to Westich. "It is especially worth considering for younger patients, who may need another surgery 15 years down the road after the implant wears out. Such revision surgery is easier following hip resurfacing because more bone is preserved."
The hip is called a ball-and-socket joint: the ball-shaped head of the upper thigh bone fits inside a cup-shaped socket in the pelvis. In total hip replacement, the entire spherical section of the thigh bone is removed. In the newer procedure, the orthopedic surgeon resurfaces the joint, much like a dentist would cap a tooth. The worn cartilage and damaged first layer of bone are removed and a new metal surface is installed.
Hip resurfacing generally allows patients to engage in higher levels of activity after the surgery and recuperation. "With total hip replacement, we're concerned higher impact activities could cause the implant to loosen, causing dislocation. This is less of a concern with hip resurfacing. After rehabilitation, patients can return to most activities," Westrich says.
Westrich's hip resurfacing patients include a 39 year-old patient whose activities were significantly limited due to his arthritis. "The pain was getting unbearable. I couldn't sleep, I had a bad limp, walking up and down stairs was almost impossible. I couldn't even bend down to tie my shoes. It was also starting to affect my back," he said.
The patient's strong and healthy bones and desire to return to an active lifestyle made him a good candidate for hip resurfacing. "I'm definitely happy I had it done," he says. The excruciating hip pain he suffered is gone, he can now kneel down and tie his shoes, and he walks without a limp. Like total hip replacement patients, those opting for resurfacing still go through intensive physical therapy following the procedure.
Not all patients qualify for hip resurfacing, and the proper diagnosis is key. The best candidates tend to be younger patients, generally under 65, with debilitating arthritis. However, active older patients with good bone quality may also be eligible, according to Westrich. Patients with problems in the bone around the hip joint, bone loss as a result of their arthritis, or osteoporosis would not be candidates for hip resurfacing. For more info: www.hss.edu.