Who may be candidates for a hip replacement?
Patients with advanced arthritis of the hip may be candidates for either traditional total hip replacement (arthroplasty) or hip resurfacing (hip resurfacing arthroplasty). Each of these procedures is a type of hip replacement, but there are important differences. As an orthopaedic surgeon, I thoroughly discuss the different procedures and which operation would be best for each patient's situation.
What hip symptoms or conditions exist for you to recommend them to consider a hip replacement?
I recommend someone to consider hip replacement if they’re experiencing hip pain that:
- Persists, despite pain medication
- Worsens with walking, even with a cane or walker
- Interferes with their sleep
- Affects their ability to go up or down stairs
- Makes it difficult to rise from a seated position
I believe public perception is that most people with hip conditions are senior citizens, but that is certainly not the case. I have performed hip replacements on men & women as young as their 20’s and 30’s.
What is the difference between total hip replacement and hip resurfacing?
In a traditional total hip replacement, the head of the thighbone (femoral head) and the damaged socket (acetabulum) are both removed and replaced with metal, plastic, or ceramic components.
In hip resurfacing, the femoral head is not removed, but is instead trimmed and capped with a smooth metal covering. The damaged bone and cartilage within the socket is removed and replaced with a metal shell, just as in a traditional total hip replacement.
How do you determine if a patient is a candidate for hip replacement or hip resurfacing?
As an orthopedic surgeon, my goal is to restore my patients’ quality of life. I evaluate and treat each patient as an individual by understanding their specific situation as it pertains to their physical lifestyle and goals.
When it comes to the hip, I classify patients in one of two categories:
1. Non-active lifestyle
- For patients who DO NOT lead a physically active lifestyle, I recommend traditional hip replacement surgery.
- Hip replacement surgery DOES remove the patient’s pain and restores the function.
- However, we do not recommend impact loading – jumping on it or running.
2. Active lifestyle
- I highly recommend hip resurfacing for individuals who lead active lifestyles.
- Hip resurfacing allows patients to have a VERY active lifestyle AFTER the procedure.
- With this procedure, we’re conserving bone, not altering leg lengths or mechanics of the hip, which makes it feel more like a normal hip.
- This is a great option for individuals who have physically active careers: military personnel, police officers, firemen, EMT’s, construction workers, etc;
- This is also the procedure I recommend for men & women who like to play hard. I’ve had patients in their 40’s, 50’s, 60’s & beyond get back to playing hard core tennis, compete in triathlons and run marathons.
What are the advantages of hip resurfacing?
The advantages of hip resurfacing over traditional total hip replacements is an area of controversy among orthopaedic surgeons. A great deal of research is currently being done on this topic.
- Hip resurfacings may be easier to revise. Because the components (called implants) used in hip replacements and hip resurfacings are mechanical parts, they can — and do — wear out or loosen over time. This typically occurs between 10 and 20 years after the procedure, although implants may last longer or shorter periods of time.
- If an implant fails, an additional operation may be necessary. This second procedure is called a revision and it can be more complicated than the initial operation. Because hip resurfacing removes less bone from the femur (thighbone) than a traditional hip replacement, many surgeons believe it is easier to exchange implants that fail after hip resurfacing.
- Decreased risk of hip dislocation. In hip resurfacing, the size of the ball is larger than in a traditional hip replacement, and it is closer to the size of the natural ball of your hip. Because of this, it may be harder to dislocate. This stance is controversial because several factors can affect the risk of dislocation, such as surgical approach, and the type and size of the implants used.
- More normal walking pattern. Several studies have shown that walking patterns are more natural following hip resurfacing compared to traditional hip replacement. These differences in walking are quite subtle, however, and special instruments are needed to measure them.
Who are ideal candidates for a hip resurfacing procedure?
I may recommend surgery if you have more advanced osteoarthritis and have exhausted the non-surgical treatment options. Surgery should only be considered if your hip is significantly affecting the quality of your life and interfering with your normal activities.
Unlike hip replacement, hip resurfacing is not suitable for all patients. Generally speaking, the best candidates for hip resurfacing are younger (less than 60), larger-framed patients (often, but not always male) with strong, healthy bone. Patients that are older, female, smaller-framed, with weaker or damaged bone are at higher risk of complications, such as femoral neck fracture.
The idea behind it is, you conserve bone, you don’t’ loose bone mass, and the bone does not get weak as it does sometimes with a hip replacement. It’s more durable. It’s a metal on metal prosthesis so it does not wear out like a metal-on-plastic hip.
A comprehensive evaluation will help you determine if you are a good candidate for hip resurfacing.
What is the hospital stay and typical recovery time?
In most cases, patients go home 1 to 4 days after surgery.
You may begin putting weight on your leg immediately after surgery, depending on your doctor's preferences and the strength of your bone. You may need a walker, cane, or crutches for the first few days or weeks until you become comfortable enough to walk without assistance.
A physical therapist will give you exercises to help maintain your range of motion and restore your strength. You will continue to see your orthopaedic surgeon for follow-up visits in his or her clinic at regular intervals.
You will most likely resume your regular activities of daily living by 6 weeks after surgery.
Jeffrey C. Davis, M.D. is an orthopaedic surgeon at Andrews Sports Medicine & Orthopaedic Center in Birmingham, AL. Dr. Davis has an interest in minimizing exposures for joint replacement and performing procedures limiting bone removal, particularly for younger patients. He has developed the largest hip resurfacing practice and has the most experience of any surgeon in the region, performing more than 300+ hip resurfacing procedures since 2008. The results to date show high levels of satisfaction and patients return to active lifestyles. The failure rate has been <1% in hip resurfacing over the first four years. Dr. Davis has training in anterior hip approaches along with limited incision posterior approaches to the hip, and both allow quicker recoveries.
For more information, contact Andrews Sports Medicine & Orthopaedic Center at (205) 939-3699 and request to speak with Dr. Davis's appointment scheduler.