Hip Resurfacing

Hip resurfacing provides a more conservative and less traumatic alternative to total hip replacement surgery providing the younger more active patient unmatched quality of life.

Hip resurfacing (HRS) implants have been cleverly engineered to resurface the bone in the hip joint. The head of the femur is resurfaced with a metal dome and the socket is resurfaced with a metal cap. There is no need for the bone to be cut and removed as in a standard hip replacement.

It is particularly relevant to young, active people, people who want to return to high-level activities. There is a much lower rate of wear, and potentially much greater durability.

What is Hip Resurfacing

Hip Resurfacing is an artificial joint replacement used for the treatment of severe arthritis as an alternative to conventional Total Hip Replacement.

In hip resurfacing, the femoral head is not removed, but is instead trimmed and capped with a smooth metal covering.

The damaged bone and cartilage within the socket is removed and replaced with a metal shell, just as in a traditional total hip replacement.

Who is suitable for Hip resurfacing?

Patients who exhibit osteoarthritis on x-ray may not need a total hip replacement to relieve pain and restore function of the hip. The alternative option is hip resurfacing surgery (HRS).

Hip resurfacing has been designed to address patients with mild to moderate osteoarthritis before extensive bone destruction has occurred.

There is a high probability that the pain due to the arthritis itself, the worn bone surfaces, will resolve with a partial hip replacement procedure.

It is important to understand that pain due to other causes such as referred from the back, poor circulation or damaged nerves, other types of information, etc, may continue. At times, it is necessary to understand that only an incremental improvement can be achieved.

In some instances, low-grade, mild pain may persist for a prolonged period of time after joint resurfacing and therefore, this type of joint surgery should be considered only if:

Other methods of treatment have been tried, and have failed to help
You have debilitating and severe pain with loss of function and loss of quality of life
You are emotionally and psychologically prepared for surgery
You have understood thoroughly and comprehensively what the operation involves, and that the potential risks to you are outweighed by the potential benefits

What are the advantages of Hip resurfacing surgery?

With the development of hip surgery many advantages exist compared to the traditional full hip replacement procedures:

Ease of Revision
Hip resurfacing removes less bone from the femur than a total hip replacement which means it is usually easier to exchange implants if they fail.

Smaller Device
The device is chrome cobalt and molybdenum combination. It is smaller than a traditional total hip device so less of the bone needs to be operated on providing the patient with a rapid, postoperative mobilisation program.

Minimal Bone Removal
Hip resurfacing literally means retreading the bone with a metal prosthesis. Therefore, there is a significant decrease in the amount of bone removed. Only a small amount of bone needs to be removed.

Decrease in Complication Rates
Hip resurfacing greatly reduces the disruption of the joint therefore providing a shorter recovery period and a decrease in complications. A dramatic reduction of dislocation rates and a reduction to the problem of leg lengthening or shortening.

Shorter Recovery Time
Most hip patients are walking 4 hours after surgery. Total time spent in hospital is approximately 1-2 days. Within 2 -3 weeks most patients are back driving, resuming most of their normal activities. Hip resurfacing dramatically improves quality of life.

How is the condition diagnosed?

The most common and very effective method of diagnosing a hip problem is an X-ray. The X-ray should be performed while you are standing. Most hip problems are worse when you weight bear in the joint, therefore a weight bearing x-ray is an effective diagnostic tool.

The X-ray must show loss of cartilage or deformity of the head of the femur and in the acetabulum for you to be considered for this surgical technique. Next you need a specific and clear description of your pain.

Historically, arthritic pain is dull and annoying and primarily in the joint. It hurts when you are standing and usually goes when you are sitting. Arthritic pain in the hip sometimes migrates into the groin. It also can run down your thigh and into your knee.

What is involved in the procedure?

Hip resurfacing surgery or retread surgery requires the removal of the worn bone surface only. This means, the bone removed is minimised to 4-5mm from the head of the femur and approx 4-5mm from the acetabulum. The bone surface is then replaced with a metal cover.

Hip resurfacing surgery may be performed as an overnight procedure. This means the nursing/physiotherapy staff on the ward will have you out of bed and walking within 4 hours after the surgery.

The surgery is approximately 2-3 hours of operating time. There is approximately 1 hour in the recovery room after surgery.

The incision is approximately 20 – 30cm in length and it runs over the outer edge of your hip joint. The scar line may not be completely flat immediately after surgery. This will settle down a few weeks after surgery. The operation itself is performed with the patient on their side.

The surgical cut is closed with sutures and at the skin with staples. The staples need to be removed 10-14 days after surgery while the sutures will dissolve. The dressing is designed for compression. This particular dressing stays in place for 48hrs.

What happens after surgery?

Immediately after surgery, you will wake up in the recovery room. You may feel a bit groggy. Professor Kohan and his staff will monitor you, checking your blood pressure, temperature and pulse. Dr Kerr will also assess your pain level. Post-operative x-rays will be performed in recovery.

After 45 minutes – 1 hour you will then be transferred back to your room on the ward.

When you arrive to your room, you will have:

A compression garment around the operation site to apply pressure there. This is removed 24 hrs after surgery.
A pain catheter which will be removed before discharge. We inject local anaesthetic through this to maintain the pain relief.
TED Stockings (knee high white stockings) on your legs which must be worn for 2 weeks post procedure.
A drip in your arm. This will provide hydration and blood if you need it.

In the first week following surgery you may experience:

Swelling – From your thigh down into your foot is common. This at times may be quite marked. The swelling will increase for the first few days after surgery and will gradually diminish. Some swelling can be present for 12 months or so. The swelling may be diminished by walking as the muscle function will push the fluid away. When you stop walking, the limb should be elevated above the level of the hip.

Bruising – Marked bruising can be found in some patients. This can be found from your thigh down into your foot. At times the bruising can be quite dramatic but it will resolve. It is the result of some residual bleeding making its way to the surface. The body will eventually remove the bruising. It is also the result of the blood thinning tablets you will be taking.The blood thinning tablets will tend to make the bleeding after surgery a little more marked because the blood clotting is impaired. This is however preferable to developing a blood clot.

Blistering – On occasions blisters will develop near the operation and possibly above it. The blistering is due to surface fluid. It looks dramatic but it is of no consequence and always resolves. One cause may be the bandage rubbing on the skin. Sometimes, when the blood dries in the bandage it can be like cardboard and rub on the skin producing these blisters. We change the bandage after about a week but would prefer not to interfere with that earlier because of the risk of infection. After about a week the wound is sealed enough to be a reasonable barrier against infection. Another cause for the blistering is tissue swelling. This is associated with the bruising and is a result of fluid leaking into the skin. These blisters always go away. They may burst and leak fluid and again the appearance may be dramatic. Sometimes if they are large we may burst them. This is so that the dressings sit more comfortably.

Muscle soreness – Your muscles can feel stiff and sore to touch. During the operation some stretching and pulling of the muscles occurs. This may result in some pain like a corked thigh. Occasionally you may feel cramps and spasms. The discomfort however will resolve and activity such as walking, stretching, physiotherapy, etc, will help to speed the improvement.

Heat – The operated site may feel hot and the heat may last for 12 months. As part of the healing process the operation site requires more blood supply from the body and it is this extra blood supply which is the cause of the local heat.

For the first 2 weeks after surgery, your activity level is usually limited. However, you will be able to walk independently, use the bathroom and perform normal activities of daily living

After 3 weeks or so you will be able to engage in moderate activities, i.e. driving a car and climbing stairs

Within 6 weeks Hip flexion must still be limited to 90 degrees however you will have resumed most of your normal activities.

Complete surgical healing takes 6 – 8 weeks. During this time some swelling and discomfort is normal, and should be manageable with the prescribed medication.The most important thing is to have a positive attitude.

Restrictions still need to be observed for the first six months after surgery. This is to allow the bone to strengthen around the new hip components and to minimise the risk of hip fracture through excessive loading and activity in this early, vulnerable period.

You should not run or jump in this period, and should not carry more than 10Kg.

Apart from these restrictions you should be able to return to the activities you were able to manage the week before the operation.

PRECAUTIONS

The major precaution following Hip Resurfacing surgery is limiting hip bending for the first 2 – 6 weeks to 90 degrees.

There are four rules of thumb to remember to keep your hip in position:

When sitting, keep your knees below your hips (Sitting on a small pillow helps)
Avoid crossing your legs while lying down or sitting
Avoid bending over at the waist
Sit with your knees 10 – 20cm apart
Incision care

The incision is usually closed with skin staples. These need to be removed 10 days after surgery. Sometimes, dissolvable stitches are used, which do not require removal. A decision is made on the basis of local circumstances at the time of the operation.

You may not get the incision wet until the staples are removed; a sponge bathe for 10 days after surgery instead of a shower is recommended.

You may shower 2 days after the sutures are removed, but may not bathe or swim until 2 weeks from surgery.

You may apply Vitamin E or some moisturizing lotion to the incision after the staples, or dressings are removed.

Some swelling and warmth is expected after surgery however if you develop increased redness, oozing from the cut, or fever, please call the office immediately.

Walking

You will be out of bed and walking within 4 hours after surgery. Upon discharge from hospital you will be walking with crutches. You may discontinue using crutches after being assessed by Professor Kohan 1 – 2 weeks after surgery. After this time you may use a cane, or if you feel confident you may discontinue using any walking aids.

You may go up and down stairs as needed, but only straight legged for the first 2 weeks.

After this time there should be enough flexibility and repair in the muscles around your hip.

Expectations

Each individual has his/her own set of expectations. Each patient is treated as an individual with general health, age and attitude considered.

One of the important things to remember is that you are not ‘sick’ but have a problem with your hip that needs to be fixed. Getting back on your feet after surgery is the most important goal: “Motion is Lotion”.

Resurfacing the bones in your hip can relieve your pain and stiffness and return you to most of your activities you enjoy

Estimate of Fees

Generally our ‘Estimate of Fees’ is accurate however, on occasion unforeseen circumstances can arise during the operation which may require additional medical services or a different, more costly prosthetic device to be used. If this happens there may be additional costs to you that are not covered by the estimate.

This will be fully explained to you after the operation should it occur.

Professor Kohan’s Surgical Fees
Medical Item No: 49318

Surgical Assistant Fees
The surgical assistant fees will either be billed to you directly or Professor Kohan will bill you on his behalf. A Medicare rebate applies:

Medical Item No: 51303

Anesthetic Fees
You will meet with Dr Kerr, the anesthetist before your operation so that you can obtain an estimate of his fees. These will be billed to you directly. A Medicare rebate applies:

Medical Item No’s : 17620, 17690, 21214, 23111, 22045, 18225

There will be 2 ‘no charge’ consultations after your Hip Recurfacing procedure.

Aftercare appointments with Professor Kohan following your procedure include:

7 Days Post Surgery – This appointment is in order to check the skin cut & for Professor Kohan to asses your overall recovery.
14 Days Post Surgery – At this appointment the skin clips will be removed. An ultrasound will also be done by our radiographer in the rooms in order for Professor Kohan to check for blood clots.
6 Weeks Post Surgery – At this appointment Professor Kohan will asses the X-ray and monitor your overall recovery.
Consultations after this time attract a fee which is reimbursed in part from Medicare.

These fees should be discussed with the hospital directly. Please be sure to check with your health fund regarding a gap or out of pocket expenses.

These fees are payable directly to the sonographer.