Hip Resurfacing

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What is hip resurfacing?

Hip resurfacing is a type of surgery to replace a damaged hip joint.

In the normal hip joint, the rounded head of the thighbone (the femoral head) moves smoothly inside the round socket of the hipbone. Normally, the socket is lined with cartilage, which helps the bones move smoothly. When there is damage to this joint, moving the femoral head may cause pain as the bones scrape together abnormally.

During hip resurfacing, your surgeon makes an incision to access your hipbone and thighbone. Next, he or she trims and caps your femoral head with a smooth metal covering. Your surgeon also removes the part of the damaged bone with the hipbone socket, replacing it with a metal shell.

Hip resurfacing is a type of hip replacement surgery. In traditional hip replacement surgery, the surgeon removes your femoral head completely instead of just capping it with a metal covering. He or she also replaces the socket of the hipbone, just like in hip resurfacing surgery.

Why might I need hip resurfacing?

You might need hip resurfacing if you have significant damage to your hip joint. Different types of medical conditions can damage this joint, like:

Osteoarthritis (most common)
Rheumatoid arthritis
Osteonecrosis
Injury or fracture of the hip joint
Bone tumor in the hip joint

The damage to your hip joint, if significant, eventually causes pain and can interfere with your activities of daily life. Hip resurfacing may help decrease your pain, improve your joint mobility, and result in a better quality of life. Usually, healthcare providers only recommend hip resurfacing if you still have significant problems even after the use of other, more conservative treatments, like pain medicines and assistive walking devices.

Talk with your healthcare provider about the benefits and risks of having hip resurfacing instead of traditional total hip replacement. Hip resurfacing may decrease the risk of certain complications, like hip dislocation. But it may increase the risk for other complications. These include femoral neck fracture and reaction to metal ion debris. If you have hip resurfacing, it may make it easier for your healthcare provider to perform later revision surgery on your joint than in the case of total hip replacement. Hip resurfacing may be a better choice for some people. This is especially true for younger adults (less than 60 years) with larger frames and healthy bones.

What are the risks of hip resurfacing?

Most people do very well with their hip resurfacing surgery. However, as with any surgery, the procedure does carry some risks. Possible complications of hip resurfacing include:

Infection
Excess bleeding
Blood clots
Injury to nearby nerves
Femoral neck fracture
Dislocation of the hip joint
Metal ion risk
Complications from anesthesia

Your own risk of complications may vary according to your age and your other medical conditions. For example, people who smoke may have an increased risk of poor bone healing. Ask your healthcare provider about the risks that most apply to you.

How do I get ready for hip resurfacing?

Ask your healthcare provider how you should plan to prepare for your surgery. Ask whether you should stop taking any medicines ahead of time, like blood thinners. If you are a smoker, you should try to quit before your surgery. Don't eat or drink after midnight the night before your procedure. Your healthcare provider may order additional imaging tests, like magnetic resonance imaging (MRI), of your hip.

How is hip resurfacing done?

Your healthcare provider can help explain the details of your particular surgery. The details of your hip resurfacing surgery will depend on the nature of the injury and the surgical approach. An orthopedic surgeon will do the surgery aided by a team of specialized healthcare professionals. The whole operation may take 2 or 3 hours. In general, you can expect the following:

Most likely, you will get general anesthesia, so you’ll sleep through the operation and won’t feel any pain and discomfort during the procedure. (Or you may get spinal anesthesia and a medicine to keep you relaxed but awake.)
A healthcare professional will carefully monitor your vital signs, like your heart rate and blood pressure, during the operation. You may have a breathing tube inserted down your throat during the operation to help you breathe.
You may get antibiotics, during and after the procedure, to help prevent infection.
Your surgeon will make an incision in your thigh, usually on your back side, cutting through skin and muscle.
Your surgeon will take your femoral head out of the hip joint socket. He or she will trim the head with special instruments, placing a metal cap over the head.
Someone will then remove the damaged cartilage and bone lining the socket.
A metal cup is pushed into the socket.
Your surgeon will place the femoral head back in the socket.
The surgeon will surgically close the layers of skin and muscle around your incision.

What happens after hip resurfacing?

Talk with your healthcare provider about what you can expect after your surgery. You may have some pain around your incision after your procedure, but pain medicines may help to relieve the pain. You should be able to resume a normal diet fairly quickly. You may have imaging done, like an X-ray, make sure your surgery was successful. Depending on the extent of your injury and your other medical conditions, you might be able to go home within the next couple of days. In most cases, people go home in 1 to 4 days.

Your healthcare provider will let you know when you can put weight on your leg. You might need to use a cane or crutches for a few days or weeks. You may need to work with a physical therapist, who can help you maintain range of motion and strength. You will probably be able to resume many of your regular activities within 6 weeks of the surgery.

You might have some fluid draining from your incision. This is normal. Let your healthcare provider know right away if the fluid from the incision turns yellow or white or if there is an increase in redness, swelling, or draining from your incision. Also, let your healthcare provider know if you have a high fever, chills, or severe pain that is not improving. Make sure to keep all of your follow-up appointments with your orthopedic surgeon. You will probably have your stitches or staples removed a week or so after your surgery.

The mechanical components of your hip may wear out or loosen over time. Because of this, you may need a revision surgery 10 to 20 years after your original hip resurfacing surgery.