I'm weighing the pros and cons of hip joint resurfacing versus a total hip replacement. My age puts me right in the middle for choosing between the two. What advice can you give me?
Hip resurfacing arthroplasty is a type of hip replacement that replaces the arthritic surface of the joint but removes far less bone than the traditional total hip replacement.
The operation begins by making an incision in the side of the thigh. This allows the surgeon to see both the femoral head and the acetabulum (or socket). The femoral head is then dislocated out of the socket. Special powered instruments are used to shape the bone of the femoral head so that the new metal surface will fit snugly on top of the bone.
The cap is placed over the smoothed head like a tooth capped by the dentist. The cap is held in place with a small peg that fits down into the bone. The patient must have enough healthy bone to support the cap.
The hip socket may remain unchanged but more often it is replaced with a thin metal cup. A special tool called a reamer is used to remove the cartilage from the acetabulum and shape the socket to fit the acetabular component. Once the shape is correct, the acetabular component is pressed into place in the socket. Friction holds the metal liner in place until bone grows into the holes in the surface and attaches the metal to the bone.
With a total hip replacement, both the femoral head and the acetabulum are removed and replaced. Understandably, there are pros and cons with each type of procedure. The joint resurfacing technique is usually reserved for younger, more active adults who will eventually need a total joint replacement.
Hip joint resurfacing helps delay the total joint replacement. The total replacement implants don't last forever. And with adults living longer and longer, avoiding second and even third hip replacements is important.
Your surgeon will help you choose the right treatment plan for you. Your age, condition of your bones, and size will all be taken into consideration. Generally, anyone 75 years old or older will have a total hip replacement. Adults 50 and younger are more likely to have a joint resurfacing procedure. It's that age group in between that is harder to predict.
Activity level is another factor. There's a big difference between the requirements of someone who is fairly inactive and another person who aims to get back to work full-time in a job that requires heavy manual labor. Again, the surgeon who is doing the procedure is the best one to give you all the pros and cons to weigh and consider in the decision.
Brian McGrory, MD, et al. Modern Metal-on_Metal Hip Resurfacing. In Journal of the American Academy of Orthopaedic Surgeons. May 2010. Vol. 18. No. 5. Pp. 306-314.
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