Hip resurfacing was developed to try and overcome some of these problems. The resurfacing is made of a durable metal alloy (chrome cobalt molybdenum), which wears only very slowly. Because of this the bearing can be made large enough to fit over the head of the femur, which is removed when a conventional hip replacement is used. If the hip resurfacing fails at a later date, revision surgery is much more straightforward compared with a conventional hip replacement.
Hip resurfacing is still regarded as an experimental operation because it has not been performed for as long as hip replacement. The results in the short to medium term are excellent, but we do not yet know what the long term (10+ years) results are.
What will happen to me?
Hip replacement and resurfacing operations take about one and a half hours and are usually done using a spinal or epidural anaesthetic. The anaesthetist normally uses sedation or a general anaesthetic as well. If you are going to have a hip replacement, the hip is dislocated and the head of the femur is removed. A new socket is placed into the pelvis. Some sockets are made of metal into which your bone grows; others are made of plastic, and are fixed into place using bone cement. Ceramic material may be used as part of the articulation due to its smoothness, reducing friction. A hip replacement stem is cemented into the femur, and the soft tissues are then repaired.
If you are going to have a hip resurfacing, the hip is dislocated and the bone surfaces are prepared using special instruments. The socket has a special coating into which your bone will grow. The femoral component is fixed into place using bone cement. If your bone is found not to be suitable for hip resurfacing during the operation, a conventional hip replacement will be used instead. The risk of this happening will be discussed with you during your consultation.
After the operation has finished you will be observed in the recovery room until the anaesthetist is happy that you can return to the ward. The physiotherapist will see you the next day and will get you out of bed. Over the next few days you will learn how to walk and manoeuvre safely. Most patients will also have hydrotherapy, which they find very beneficial.
After about a week you will be ready to go home. Physiotherapy continues for about a month and after six weeks you will be seen in clinic. At this appointment if all is well you will be allowed to drive. The next follow up appointment is at the one year anniversary of your operation when an X-ray is taken. Further follow appointments will be arranged every few years after that.
Returning to work
Most people find that they are tired for several weeks after surgery. Returning to work too soon is not a good idea as you will find it difficult to concentrate and you might experience problems with your rehabilitation. After about three months from the operation you will probably feel ready to go back to work.
Many people return to sports such as golf or sailing after about six months from their operation. For other sports you need to discuss your plans with your surgeon. Contact sports are prohibited, but lots of patients play tennis and badminton. Some even return to skiing after hip resurfacing.
Hip surgery is a major operation and there is a risk that complications might happen. These are often minor and temporary, but sometimes they can be serious and occasionally life threatening. The commonest complications are usually bruising around, or oozing from the wound. Sometimes the leg is swollen for several weeks after surgery and is usually a normal response to the surgery.
Occasionally a blood clot can develop (~ 2%, deep vein thrombosis or DVT) which will need treatment with warfarin for several months. Rarely DVTs can travel to the lungs causing collapse and occasionally death. The risk of this happening is very low, approximately 1:1000 patients, and precautions are taken after surgery to minimize the risk.
Deep infection sometimes happens (~ 1%) and often requires further surgery. Sometimes the components will have to be removed to clear the infection.
If you twist your hip excessively or have a fall it is possible that the hip will dislocate. You will need to have a general anaesthetic to put the hip back, or even further surgery. The risk is low (~2%) and is much lower beyond six months from surgery after the hip has healed.
Sometimes the sciatic nerve can be injured during the operation, resulting in permanent pain and weakness in the leg. The risk of this happening is very low (0.002%).
Your leg can be lengthened or shortened after hip surgery, and you might need a shoe raise to compensate for this. The risk is low (~2%).
Some patients have high blood pressure, heart disease or diabetes and these conditions can increase the risk of having a heart attack or stroke after surgery. The surgeon and anaesthetist will discuss the risks with you before your operation.