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Hip resurfacing: Fewer risks, more benefits.
ARTHRITIS of the hip joint is a common problem in India. It
occurs due to damage to the joint from various conditions
such as Osteoarthritis (wear and tear arthritis), avascular
necrosis (death of the bone due to lack of blood supply),
trauma or injury (previous hip fractures), infection,
rheumatoid arthritis, ankylosing spondylitis and other
diseases. It causes severe pain, stiffness, deformity,
decreased mobility and severe disability. In India, hip
joint arthritis affects even young people leading to
disruption of family and social life, inability to work and
difficulty in movement.
Traditionally, Total Hip Replacement (THR) has been the only
treatment for people suffering with hip arthritis for the
past 40 years. The surgery is conducted when the symptoms or
the arthritis cannot be controlled with medication.
THR is a good procedure in elderly or sedentary people, but
it cannot restore the mobility desired by younger and middle
aged patients. Also, it can sometimes dislocate or slip out
of joint, loosen faster in younger people (and vital bone is
lost as the prosthesis loosens) and patients often face
restrictions in terms of their lifestyle and mobility.
However, all this is possible now, courtesy the
revolutionary surgery for hip arthritis known as Hip
Resurfacing.
Better option
Over the last decade, the need for a better option to THR
was felt more than ever before due to increase in hip
arthritis incidents among young people. Subsequent medical
and technological advancements led to the development of Hip
Resurfacing surgery. Dr. Derek Mc Minn of Birmingham, the
U.K., pioneered this procedure.
In this procedure only the diseased portion of the hip
socket is cleaned and shaved instead of being removed
completely. Further, two metal pieces (made of cobalt
chrome) are fixed — one over the ball of the femur, and the
other into the pelvic socket called acetabulum. In short,
the articular surfaces of the femur and acetabulum (socket)
are replaced and the femoral head is reshaped instead of
removed.
At first, an incision is made to reveal the layer of
muscles. This is lifted, detached from the bone and held in
place to enable easy access to the femur and pelvic region.
With the knee flexed at 90 degrees, the femoral head is
dislocated. Once easily visible, the measurements of the
femoral head and neck are taken before the actual surgery
begins. The femoral head is reshaped with specialised
instruments that remove only the damaged bone. The
prosthetic head rests on the femoral ball. To ensure that
all stays in place, the prosthetic is glued to the bone.
Preserves bone
The surgery then moves onto the acetabular (hip socket)
base. Here a hemispherical cavity removing only damaged
socket bone is formed so that it allows the prosthesis to
rotate freely and yet maintains a snug and stable fit. The
metal cup or acetabular component is then lowered into the
hollow to obtain a press-fit. The surgery is completed with
the fitting together of the femoral head and the acetabular
component. Unlike THR, this surgery preserves the body's
vital bone, which is essential for faster recovery. Patients
can start walking within two days and can be discharged in
five to six days after this one and a half-hour surgery. The
marginal increase in cost is more than offset by the
multiple benefits experienced by the patient.
Patients who undergo Hip Resurfacing recover faster than
usual. They start walking the day after surgery without
support and can go home within five days. Patients are able
to walk as much as five miles a day, as early as six weeks
after the operation. Unlike in THR, they can jog, swim,
dance, run and even play high-impact sports, squat, sit
cross-legged and even use the Indian toilet with minimum
risk of dislocation. This is a procedure that is suited to
Indian conditions.
Minimally invasive
Hip Resurfacing is a bone conserving and minimally invasive
surgery. The natural feeling of the joint (Proprioception)
is preserved. Since the femoral prosthesis size is
anatomical, dislocation of the joint is rare. Unlike in THR,
polyethelene is not used as a bearing material. So problems
like loosening of prosthesis and early failure related to
polyethelene particles are eliminated. Since early loosening
is not seen in Hip resurfacing, it is expected to last much
longer than THR. If another surgery is required it is much
easier to perform because the bone mass has been preserved.
Advantages
The ball used during surgery is similar to the natural one,
which confers biomechanical advantages to the hip.
Hardly any chance of dislocation.
Improved durability, since the prosthesis does not wear out
easily.
Allows improved functions and quick recovery.
Patient can sit, squat and even can participate in sports.
Allows normal range of hip movements.
Does not change length of the leg.
Duplicates or restores normal structure of hip joint.
The writer is a Consultant Orthopaedic and Joint
Replacement Surgeon, Sri Ramakrishna Hospital, Coimbatore.
Surgeon : Dr. G.
Balasubramanian
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