Houston Methodist. Leading Medicine

Hip FAQ

Question:

I'm going to have a hip joint resurfacing procedure done to help save my right hip. I'm just wondering how this can be a better operation to have than a total hip replacement when they have to wrench the hip around and dislocate the joint. Ugh! Is there any way around that?

Answer:

With every new surgical procedure come refinements and improvements in the technique by surgeons who have the experience and expertise to try something different. In a recent study, one orthopedic surgeon from the Cincinnati Orthopaedic Research Institute took on hip joint resurfacing as his project. He worked diligently over a two-year period of time to reduce the size of the incision required for this operation until it could be considered minimally invasive. He reported on the results of doing it this way compared with similar patients who had a total hip replacement. Hip resurfacing is done by entering through the hip from the back (posterior direction), cutting through the hip capsule, and usually, cutting through the hip muscles in order to pop the hip out of the socket. It's necessary to dislocate the joint in order to gain access to the round head of the femur. It's the head of the femur that's shaved smooth and rounded in preparation for a metal cap that is placed over the bone. The cap is held in place with a peg that fits down into the bone. Essentially, that's what joint resurfacing is all about. It means less loss of bone and a chance to preserve as much of the natural hip joint as possible until the inevitable total joint replacement is required. Hopefully, the conversion to a total hip replacement will be some years down the road. Younger adults who are more active and who only have arthritis in one hip are the best candidates for hip joint resurfacing. In this study, Dr. M. L. Swank performed an equal number of total hip replacements and hip resurfacing procedures and compared the results in his patients. Over time, he was able to use a smaller and smaller incision with less and less disruption of the surrounding soft tissues. The early resurfacing surgeries used a 4.5-inch long incision. That was reduced by almost a full inch over time. The total hip replacement was still possible with a much smaller incision (two inches). By the end of the study, Dr. Swank was able to avoid dislocating the joint by splitting the gluteus maximus (buttock) muscle and using the gluteus minimus to form a pocket. The head of the femur could be slipped into that pocket to perform the procedure. A similar approach was used to perform an equal number of total hip replacements. Although the hip was dislocated in order to cut off the femoral head and replace it, the resection was done under the skin. In the traditional, standard surgery, the head of the femur is popped out of the opening made by the incision and then a saw used to cut through the bone. Doing it this way made it possible (in both the resurfacing and the total replacement) to access the head of the femur without cutting through all of the soft tissues. In theory, the advantage for the patient is a smaller incision, less pain afterwards, and faster recovery of strength, motion, and function. Dr. Swank was able to demonstrate exactly that but it might be awhile yet before this approach is adopted as the standard procedure for hip joint resurfacing. Your surgeon may be willing to consider something like Dr. Swank's approach if you ask him or her about it. The bottom-line is that you want your surgeon to use the methods he or she is most comfortable with for the best result possible. Decreased pain, increased motion, and improved function are the results you are looking for -- however the surgeon accomplishes this! Michael L. Swank, MD, and Martha R. Alkire, CNP. Minimally Invasive Hip Resurfacing Compared to Minimally Invasive Total Hip Arthroplasty. In Bulletin of the NYU Hospital for Joint Diseases. June 2009. Vol. 67. No. 2. Pp.113-115.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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