Bone-Sparing, Total Hip Resurfacing Arthroplasty Surgery (Metal-on-Metal Device)
Last updated Friday, January 18, 2008
Considering surgeryWho should consider total hip resurfacing arthroplasty for total hip resurfacing arthroplasty and in what cases? Young, active patients should
consider hip resurfacing when:
- arthritis
has been resistant to conservative measures;
- the
patient is sufficiently healthy to undergo the procedure;
- the
patient understands the risks and alternatives;
- the
surgeon is trained and experienced in hip-resurfacing surgery;
-
no medical or surgical contraindication to hip
resurfacing exists.
What happens if nothing is done for total hip resurfacing arthroplasty (best case/worst case scenarios)? Pain
can be managed with medicine, assistive devices, and some alternative
therapies. For some young, active patients, nonsurgical management of
debilitating, advanced hip arthritis is not satisfactory.When performed by an experienced surgeon, how effective is total hip resurfacing arthroplasty for total hip resurfacing arthroplasty likely to be and how long will the benefit last?
In the hands of an experienced
surgeon trained in hip resurfacing, total hip resurfacing arthroplasty is effective
in restoring comfort and function to the hip of a well-motivated patient. A
2007 study of 59 hips reported significant improvement in pain, function, range
of motion, and activity among patients who were, on average, six years
postoperative. The study, published in The
Journal of Bone and Joint Surgery by H.C. Amstutz and colleagues at the
Joint Replacement Institute, reported five cases (8 percent) of femoral
failure, requiring subsequent total hip arthroplasty.
This and other studies have helped
physicians better discern which patients have a better chance of a successful
outcome.
Although hip resurfacing can allow a patient to
resume some physical activities, high-impact activities such as running,
basketball, and singles tennis are more likely to lead to earlier loosening of
the implant and need for revision surgery.How urgent is total hip resurfacing arthroplasty for total hip resurfacing arthroplasty? Total hip resurfacing arthroplasty
is not considered urgent. It is an elective procedure that can be scheduled
when circumstances are optimal. The patient has time to become informed and to
select an experienced surgeon. Before
surgery is undertaken, the patient should:
- be
in optimal health;
- understand
and accept the risks and alternatives of surgery;
- understand
and be committed to the postoperative rehabilitation program.
What are the most frequent and most serious risks of total hip resurfacing arthroplasty for total hip resurfacing arthroplasty? How common are they?
The most common risk of hip
resurfacing is fracture of the femoral neck. In one study, the rate of fracture
was 1.46 percent. The procedure’s technical challenges, and patient selection,
might increase risk of fracture. Infection is a rare, but potentially
catastrophic risk. Component loosening is an infrequent complication, according
to published literature.
Potential risks exist from the
production of metal ions (cobalt and chromium) caused by the rubbing of the
metal implant’s components. Proper component positioning appears to be
essential to reducing significant production of metal ions. There is a
theoretical concern that these ions may pose a cancerous risk – though
long-term data does not currently support this assertion. But a patient who has
kidney problems might have difficulty filtering these ions from the blood; he
or she should avoid implantation of metal-based hip components.
For the same reason, hip
resurfacing also is not recommended for women of childbearing age who plan to
have children because of the uncertainty about the effects of metal ions on the
developing fetus.
Hypersensitivity to metal ions is a
risk that is being increasingly recognized and may lead to loosening of the
components. While little correlation appears to exist between skin
hypersensitivity and metal hypersensitivity in the hip joint, hip resurfacing
is not recommended for people with documented allergies to metal or jewelry.
A
thorough preoperative evaluation in preparation for surgery is important for
minimizing potential risks of hip resurfacing surgery. For example, some
patients will need a formal cardiology evaluation in addition to a general
orthopaedic evaluation if there is a significant history of heart disease. An
experienced joint replacement team will use special techniques to minimize the
risk of many of the above mentioned complications, but cannot always totally
eliminate them.If risks occur during or after total hip resurfacing arthroplasty for total hip resurfacing arthroplasty how are they managed? Many
of the risks of total hip resurfacing arthroplasty can be effectively managed
if they are promptly identified and treated. A coordinated effort at managing
risks should be undertaken by the orthopaedic surgeon in conjunction with the
patient’s primary care doctor. Infection might require a washout in the
operating room or an exchange of components. Loosening of the components might
require revision surgery. Fracture usually requires revision to a conventional
total hip arthroplasty. This can be accomplished relatively easily by removing
the femoral resurfacing cap and implanting a standard, long-stemmed femoral
head and neck device, as with total hip replacement. The patient should contact
the surgeon with any questions or concerns about risks. Surgery for Total Hip Resurfacing Arthroplasty at the University of Washington If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-4288 (outside the Seattle area: 800-440-3280) to make an appointment.
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