Hip replacement vs hip resurfacing

When it comes to solving hip issues, there are a variety of ways that they can be managed. In this article, a consultant orthopaedic surgeon discusses the merits and differences between total hip replacements and hip resurfacing.

What to know about the hips

The hips are the junction where the femur connects with the pelvis in a ball-and-socket joint configuration. The top of the femur, called the femoral head, slots into a niche of the pelvis called the acetabulum. The bones are held together by a network of tendons and muscles, and the areas where the bones touch and rub together are covered by cartilage, which also helps to facilitate smooth movement.

Hips can become dysfunctional due to issues like pain (such as femoral-acetabular impingement), fractures, dislocation, arthritis (such as osteoarthritis and rheumatoid arthritis), and instability, greatly limiting patients and impacting their quality of life negatively,

Both a total hip replacement and a hip resurfacing involve implanted prostheses which will revive the functionality of the hip and enable mobility – in fact, hip resurfacing is one technique of a hip replacement. Either procedure is often used to address hip pain, dysfunction, and arthritis.

Total hip replacement

A total hip replacement involves the removal of the femoral head and the implantation of prosthetic replacements made of ceramic, metal, and silicone at the top of the femur and in the acetabulum, recreating the function and form of the natural joint with prosthetics. During the procedure, the whole of the femoral head is removed and a large portion of the femur is hollowed to fit the implant. It is typically utilised for older patients, as the lifespan of a hip replacement is 20 or so years. This means that younger patients who receive a hip replacement are likely to need a revision in the future after a couple of decades. However, it is a procedure with high success and satisfaction rates, and patients benefit from near-immediate pain relief, although the recovery period is long.

Hip resurfacing

Hip resurfacing is a similar procedure, but instead of the femoral head being removed, it is instead shaved down and reshaped to be capped with a metal component. The acetabulum is still fitted with an inserted prosthetic, the same as in a total hip replacement but totally in metal. It is a technically more difficult procedure to perform, but in some cases, hip resurfacing can be more advantageous, particularly for younger patients, than a total hip replacement for reasons such as:

• More of the femur is preserved, meaning that there is more bone to work with for any possible future revisions
• There is a reduced risk of dislocation, as the cap over the shaped femoral head is larger
• There is a better distribution of weight on the bone
• They are better suited for physical activities
• They tend to last longer than full hip replacement

However, hip resurfacing can cause tiny metal molecular debris (metal ions) to become embedded into the nearby tissue which can lead to adverse effects like swelling and pain, possibly impacting the heart, nervous system, and thyroid, and thus may necessitate revision. There is also a risk of fractures in the bone bridge right below the femoral head, called the femoral neck, that can occur in bones that are brittle or bad quality.

If you are considering a hip replacement, you can consult with a specialist on Top Doctors today.