Surface replacement of the hip is an alternative to traditional hip replacement for the treatment of conditions such as osteoarthritis, avascular necrosis, and post-traumatic arthritis. It provides a bone-conserving artificial hip joint, and is designed to preserve bone for younger, active patients.
The gold standard of the treatment of end-stage hip arthritis for the last 30 years has been a total hip replacement in which the upper part of the femur (the head and neck) is replaced with a stemmed device and prosthetic head. The socket is replaced with a hemispherical shaped cup which usually contains a bearing surface of either metal, ceramic or polyethylene (plastic). Total hip replacement is an extremely successful operation that allows patients to return to pain-free activity and improve their quality of life. Unfortunately, over time prosthetic (artificial) hip implants can wear-out as well as loosen. When this occurs, patients encounter pain, a loss of functional ability and possibly even loss of bone.
With both traditional hip replacement and surface replacement, the socket is inserted in a similar fashion. The two procedures differ in the way the femur is prepared. Whereas traditional hip replacement involves removing the head and neck of the femur, surface replacement preserves this bone. With a traditional hip replacement, after this bone is removed, prosthesis with a stem is inserted within the thigh bone. With a surface replacement, the preserved bone is sculpted to accept a metal cap with a short stem.
The preservation of bone has several potential advantages. The first is that more bone is retained in the femur, should another hip replacement become necessary. Over time, any hip replacement may loosen or show signs of wear. In a young, active population, there is a high likelihood that more than one hip replacement operation will be necessary over the lifetime of the patient. It is a well documented principle that the more bone that remains during a revision hip operation, the greater chances of success. The second advantage to a surface replacement is that the preservation of bone allows for a much larger ball size. This allows for greater stability of the hip joint prior to dislocation. The dislocation rate after surface replacement of the hip is about 10 times lower than for a traditional hip replacement.
Some of the risks of surgery of the hip include the loss of blood, formation of a clot in your leg, and the chance of infection. The overall incidence of these risks is very small. They should be discussed with your surgeon prior to proceeding with the operation.
Some of the risks of having a prosthetic hip include the chance that the ball will dislocate (come out of the socket), the parts may loosen or wear out over time, or the prosthesis may become infected. As the hip prosthesis is a foreign body, it may become infected when there are bacterial infections elsewhere in the body. It is important for patients to be aware of this possibility and make other physicians and dentists aware about the presence of a hip prosthesis. Again, these issues will be discussed with you by your surgeon.
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