Hip Resurfacing

Hip resurfacing is a surgical procedure that involves reshaping the hip joint rather than replacing it entirely, as in a total hip replacement. It typically involves a metal-on-metal bearing surface and is geared towards young active patients facilitating a returning to a higher level of activity.

Hip resurfacing surgery is as effective as a THR at improving pain and mobility. It also offers some potential advantages:

  1. Wear resistance: Due to the metal-on-metal articulation the bearing is considered a hard-on-hard bearing surface and very durable. In the first few years it undergoes a period of ‘run in wear’ or self-polishing. Beyond this period, it has a very good wear resistance and may not wear out in the same time period as a total hip replacement.
  2. Greater range of motion. It can offer a greater range of motion than a THR and typically preserves bone stock, potentially making any future revisions easier.
  3. Reduced dislocation: The femoral component of a hip resurfacing is larger than that of a total hip replacement and therefore the resurfacing can undergo a greater range of motion before the hip can leaver and dislocate.

The Process of a Hip Resurfacing and What to Expect

Pre operatively

Prior to your surgery Mr Griffiths will meet with you at a consent appointment to discuss with you the risks of the surgery and the rehabilitation back to your normal activities. You will also have a separate pre assessment appointment whereby you are reviewed by the pre assessment teams to ensure you are fit for surgery. They will go through your medications with you and tell you what to stop and when to stop them.

It is very important to stay as fit and healthy as possible to speed up your recovery post operatively. Regular exercise preoperatively is important to strengthen your muscles and improve your overall cardiovascular health. Painkillers can be helpful to allow you to mobilise if pain is an issue.

It is important to prevent any cuts or grazes before your surgery as they could pose an increased risk of infection and could lead to a delay in your surgery.

On the day of surgery

Typically you will be asked not have any food for a minimum of 6 hours before your surgery.

Typically, you can continue to drink water up until your surgery.

You will be reviewed by Mr Griffiths and the anaesthetist before your surgery.

The surgery is usually undertaken either under spinal or general anaesthetic and this can be discussed with the anaesthetist prior to the surgery.

The surgery typically takes about an hour but you’ll spend some time in recovery before going back to the ward. During the procedure, Mr Griffiths will ‘block’ the hip with a local anaesthetic block and this, along with the regional anaesthetic (if used) will act to make you feel more comfortable in the immediate few hours following your surgery. The local anaesthetic will, however, wear off several hours following the surgery. It is therefore important to keep on top of your pain killers following the surgery so that you have a good baseline level of pain relief for when the local anaesthetic wares off.

Mr Griffiths has a specialist interest in enhanced recovery with the aim of early mobilisation, typically within hours following your surgery, in order to optimise your pain and overall function while reducing your overall risks of complications. As such, unless otherwise stated, you will be mobilised, fully weight bearing with crutches for confidence, either the same day or the next morning following your surgery.

Following Discharge

Upon discharge you will be mobilising with crutches and, unless stated, you can come off the crutches when confident. The physiotherapist teams will also guide you on this. You can drive when you can perform an emergency stop and most people return to driving within 4-6 weeks following their surgery. Although the pain relating to the diseased joint disappears very quickly it can often take a period of time to get over the hip replacement surgery. The first 6 weeks involves intensive physiotherapy to strengthen the muscles around the joint, though it can take 3-6 months to get over the surgery fully. If your aim is to get back to social sports, typically patients return to sports around the 3 months mark with a phased approach, though this can be discussed at the time of your follow up appointment.

You will be followed up closely by Mr Griffiths and a member of the rehab team to ensure your expectations are met and your outcomes are fully optimised.

You will be followed up closely by Mr Griffiths and a member of the rehab team to ensure your expectations are met and your outcomes are fully optimised.

The Process of a Hip Resurfacing and What to Expect

Pre operatively

Prior to your Hip Resurfacing Surgery, Mr Griffiths will meet with you at a consent appointment to discuss with you the risks of the surgery and the rehabilitation back to your normal activities. You will also have a separate pre assessment appointment whereby you are reviewed by the pre assessment teams to ensure you are fit for surgery. They will go through your medications with you and tell you what to stop and when to stop them.

It is very important to stay as fit and healthy as possible to speed up your recovery post operatively. Regular exercise preoperatively is important to strengthen your muscles and improve your overall cardiovascular health. Painkillers can be helpful to allow you to mobilise if pain is an issue.

It is important to prevent any cuts or grazes before your surgery as they could pose an increased risk of infection and could lead to a delay in your surgery.

On the day of surgery

Typically you will be asked not have any food for a minimum of 6 hours before your surgery.

Typically, you can continue to drink water up until your surgery.

You will be reviewed by Mr Griffiths and the anaesthetist before your surgery.

The surgery is usually undertaken either under spinal or general anaesthetic and this can be discussed with the anaesthetist prior to the surgery.

The Hip Resurfacing Surgery typically takes about an hour but you’ll spend some time in recovery before going back to the ward. During the procedure, Mr Griffiths will ‘block’ the hip with a local anaesthetic block and this, along with the regional anaesthetic (if used) will act to make you feel more comfortable in the immediate few hours following your surgery. The local anaesthetic will, however, wear off several hours following the surgery. It is therefore important to keep on top of your pain killers following the surgery so that you have a good baseline level of pain relief for when the local anaesthetic wares off.

Mr Griffiths has a specialist interest in enhanced recovery with the aim of early mobilisation, typically within hours following your surgery, in order to optimise your pain and overall function while reducing your overall risks of complications. As such, unless otherwise stated, you will be mobilised, fully weight bearing with crutches for confidence, either the same day or the next morning following your surgery.

Following Discharge

Upon discharge you will be mobilising with crutches and, unless stated, you can come off the crutches when confident. The physiotherapist teams will also guide you on this. You can drive when you can perform an emergency stop and most people return to driving within 4-6 weeks following their surgery. Although the pain relating to the diseased joint disappears very quickly it can often take a period of time to get over the hip replacement surgery. The first 6 weeks involves intensive physiotherapy to strengthen the muscles around the joint, though it can take 3-6 months to get over the surgery fully. If your aim is to get back to social sports, typically patients return to sports around the 3 months mark with a phased approach, though this can be discussed at the time of your follow up appointment.

You will be followed up closely by Mr Griffiths and a member of the rehab team to ensure your expectations are met and your outcomes are fully optimised.

You will be followed up closely by Mr Griffiths and a member of the rehab team to ensure your expectations are met and your outcomes are fully optimised.

Risks

Hip resurfacing surgery is very successful at improving pain and function.

There are some particular risks to the procedure, and it is important that these are considered before the suitability of such a procedure is undertaken.  

Metal on Metal Implants and Adverse Reaction to Metal Debris (ARMD)

Hip resurfacing is a metal-on-metal bearing (metal head articulating on a metal cup) with the metal alloy being cobalt and chromium. As the bearing wears small particles of cobalt and chrome can come off the hip and some patients can react to the cobalt and chromium particles, which can lead to an ‘adverse reaction to metal debris.’  This can, in some cases, cause damage to the bone and soft tissues surrounding the joint. It can also lead to a raise in the levels of cobalt and chromium within the blood.

The incidence of such a reaction is rare but there are certain factors that can increase the risk of a reaction and should be considered before undertaking a hip resurfacing procedure.

You will be followed up closely to ensure you outcomes are optimised and the risks around developing a reaction are minimised.

Other risks include:

  1. Bleeding – you may require a blood transfusion, although this is very rare.
  2. Infection – the risk of infection is extremely low. (<0.5%) You will have antibiotics at the time of surgery to help prevent against this. Early mobilisation is important to help reduce infection risk.
  3. Wound problems.
  4. Nerve injury. The risk of nerve injury is very low. It can cause weakness and numbness in the leg which would usually resolve but in rare circumstances can be long lasting.  
  5. Pain and stiffness – early mobilisation is important to improve pain and stiffness.
  6. Dislocation –This is very rare due to the large femoral head.  The physiotherapy teams will guide your rehab and show you how to protect the hip.  
  7. Leg length changes.
  8. Fracture.
  9. Loosening of the implant.
  10. Avascular necrosis – Loss of blood supply to the femoral head. This can lead to loosening of the implant.
  11. Failure of the implant.
  12. Revision surgery.
  13. Heterotopic ossification – new bone formation in the tissues around the hip. This is rare but can lead to stiffness.
  14. Deep vein thrombosis / Pulmonary embolism – you will receive blood thinners (anticoagulation) after your hip replacement. This will be discussed at the time of your consent appointment.
  15. Anaesthetic complications – The anaesthetist will review you on the day of your surgery and discuss the anaesthetic options and risks of the anaesthetic with you at that stage.

Other Hip Treatments