Hip Resurfacing

What is a Hip Resurfacing?
With Hip Resurfacing instead of the Femur being cut through just below the head, the head of the femur is capped with a ball cap. This cap is then inserted into the cup implant which is press fitted into the prepared hip socket Indications are that this is an extremely durable solution for young and active patients that wish to keep full natural mobility and return to full active sports. Hip resurfacing is suitable for Women below the age of 65 and Men below the age of 70 where the condition and strength of the bone is suitable.

Indications for Hip Resurfacing
Hip resurfacing is most appropriate for physically active patients with good bone quality and adequate femoral and acetabular bone stock. Such patients will generally be under the age of 65. However patients with the following indications are also suitable for hip resurfacing.

• Primary Osteoarthritis
• Posttraumatic Osteoarthritis
• Secondary Osteoarthritis
• Avascular necrosis of the femoral head if remaining bone stock is adequate
• Inflammatory arthritis if bone quality is adequate
• Patients with a deformity of the femur and/or internal fixation device that would make insertion of a stemmed femoral component difficult
• Patients with a high risk of dislocation

Contraindications for Hip Resurfacing

• Patients with the following indications are NOT suitable for hip resurfacing.
• Active Infection
• Malignant Tumours
• Insufficient acetabular or femoral bone stock
• Poor bone quality (for example, osteoporosis, osteomalacia)
• Anticipated non-compliance of the patient, alcohol or drug abuse
• Decompensated renal insufficiency
• allergy to one of the constituents of the implant

Advantages of Hip Resurfacing

• Femoral head is preserved.
• Femoral canal is preserved and no associated femoral bone loss with future revision.
• Also, the risk of microfracture of femur with un cemented stem implantation is eliminated.
• Larger size of implant "ball" reduces the risk of dislocation significantly.
• Stress is transferred in a natural way along the femoral canal and through the head and neck of the femur. With the standard THR, some patients experience thigh pain as the bone has to respond and reform to less natural stress loading.
• Use of metal rather than plastic reduces osteolysis and associated early loosening risk.
• Use of metal has low wear rate with expected long implant lifetime.

When Considering Surgery..
When considering overseas surgery both The Sunday Times and David Hancock, the author of The Complete Medical Tourist suggest certain points to take into consideration:

• Be realistic. A stay in a tropical location may sound alluring, but could you get the same treatment or better nearer home?
• Work out the travel costs. India has fantastic medical centre's but it is a nine-hour flight away.
• Think of the cost of taking a companion along to accompany you too.
• Think of the physical implications of the journey -a day in economy class is a long time when you are recovering from an operation. Business class is comfier but much more expensive.
• Stay in constant touch with the medical facility you have chosen. Ask which physician will be performing the operation, how many he has done before.
• Ask what kind of post-operative support the facility has.
• Ask what arrangements are made for transfers between the airport and the medical centre on arrival and departure.
• What arrangements are made for your carer?
• Ask for testimonials of patients who have undergone procedures at the medical facility. Contact the people personally.

Total Hip Replacement is indicated in..
Males over 70 and females over 65 (with week or thin bone stock)

• Those with a degenerative bone disease such as AVN or arthritis
• The prosthesis may be constructed of various materials but is usually made of forged steel rather than cast steel (these were prone to break). The exterior of the unit is rough and porous so that the unit when press fitted with combine with the bone, which actually grows into the unit. This creates an immensely strong bond, which is hard to separate (rather like barnacles on a ship).

The ball will probably be titanium, cobalt crome plated or ceramic (there is some concern from patients as to whether the ceramic ball will break but providing the unit is properly engineered this is extremely unlikely). The advantage of ceramic is that it is both extremely robust and has a very low friction coefficient, which means a low wear rate. Sometimes the cap may be ceramic but these in rare cases have been known to break under excessive stress conditions. One popular combination is a ceramic ball and composite cap, these are found to have less wear. Modern units can wear at the rate of 1 micron a year; some years ago wear rates were more likely 200 microns a year so great improvements have been made. One thing to be weary of is ensure that your surgeon is fitting a leading manufacturers unit not a generic copy such as those that you may receive in cheaper surgery. If it is possible find out what the surgeon will be fitting and do they fit a very good standard of unit. If you are a private patient that is paying their way you should be able to ask these questions and receive a satisfactory answer. Government health services will fit units from a standard procurement list. This list may be quite limited by the number of models and sizes, as health services seek discounts by bulk purchasing methods. In addition the prosthesis on the procurement list may be dated as it takes time for new products to be accepted. Zimmer is our organisations brand of choice simply because we consider them the best on the market, they have an excellent proven track record and are the largest makes in the market. Incidentally their units are also the most expensive but when choosing prosthesis we always choose the best.

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