Dear Doctors: My older brother worked construction his whole life, and now he has bad arthritis in his left hip. He was in enough pain that he finally saw his doctor about it. Instead of a hip replacement, they want to do hip resurfacing. What is that? Will it be as effective as a hip replacement?
Dear Reader: Hip resurfacing is a type of hip replacement surgery. As with your brother, the most common reason that someone needs this type of surgery is advanced osteoarthritis. Also known as “wear-and-tear arthritis,” it is common in older adults and among certain professions. Osteoarthritis of the hip can cause pain that is severe enough to limit mobility and interfere with the activities of daily life.
To understand the difference between traditional hip replacement and hip resurfacing, we need to take a closer look at the hip joint. It’s a ball-and-socket joint, which allows for the impressive range of motion we have in our legs. The rounded top of the femur, which is the larger leg bone, forms the ball. This is known as the femoral head. It fits into a cuplike socket in the pelvis, known as the acetabulum. Both the ball and socket are covered with smooth cartilage, which allows them to glide painlessly against each other. In osteoarthritis, that cartilage gradually wears away, which makes movement painful. And when nonsurgical approaches to managing osteoarthritis pain are not successful, hip replacement surgery is often recommended.
In a traditional hip replacement, both the femoral head and the acetabulum are removed. They are then replaced with components made of plastic, ceramic and sometimes metal. But in hip resurfacing, damaged bone and cartilage from the femoral head and the acetabulum are trimmed away. The surgeon then lines the socket with a metal shell, and covers the femoral head with a smooth metal cap.
Advantages of this procedure over a total hip replacement include more rapid recovery, improved mobility and decreased risk of hip dislocation. It’s also easier to exchange implants if they wear out or fail.
However, there are some drawbacks. One is the risk of a femoral neck fracture, which occurs in a small number of hip resurfacing patients. This results in the need for a complete hip replacement. The other is something known as metal ion risk. Because hip resurfacing uses two metal components, the resulting friction can, over time, lead to the release of tiny metal molecules. This can cause pain and swelling in the surrounding tissues, which can necessitate further surgery.
The metal ions can also move throughout the body via the bloodstream, and have been associated with adverse effects to the heart, nervous system and thyroid, as well as cancer. Metal ion risk is a potential complication in traditional hip replacements that use a metal ball and a metal socket.
It’s important for your brother to talk about all of this with his surgeon. Getting a second opinion, which can help him weigh the risks and benefits of the two types of hip replacement, can be helpful as well.
At UCLA Health, our team is among the best in the nation. We use the newest, most advanced techniques that promote excellent patient outcomes.
(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)
