Emory Orthopaedists Offer Alternative to Total Hip Replacement

-A total hip replacement has been the customary surgery for individuals who have arthritis of the hip. However, an alternative to traditional hip replacement called hip resurfacing was recently introduced in the United States and now is used by Emory Healthcare doctors.

The procedure preserves more of the natural bone structure of the hip and provides a larger head ball, contributing to a more stable hip joint with the potential for increased range of motion.

Greg Erens, MD, assistant professor in Emory University School of Medicine's Department of Orthopaedics, says he is providing hip resurfacing as alternative to hip replacement for younger, more active patients with significant hip degeneration.

Hip pain due to arthritis or other debilitating hip ailments can severely affect a person's ability to lead a full and active life. Surgery to replace a hip joint that has been damaged can provide great relief from the pain.

"The reason for replacing a joint with an artificial implant is to stop bones from rubbing together, which causes a great deal of pain," says Erens. "However, the goal is not only to prevent pain, but also to improve function. Hip resurfacing can help a patient return to a more normal lifestyle and a higher level of activity."

The hip joint is like a ball and socket. In a traditional total hip replacement, the head ball (femoral head) is completely removed and replaced with a stem inserted into the upper thigh bone (femur). A new head ball is then attached to the stem. A metal socket with an inner liner is utilized.

In a total hip resurfacing, the patient's own femoral head is not removed. Rather, the femoral head is shaped and capped with a metal component, allowing a large head ball to be used and preserving bone which may be needed later on in life. A polished metal socket is used, without the need for an inner liner. This metal-on-metal construct allows very low wear rates. The hip resurfacing components are sized for each patient and made of cobalt chromium metal.

"It's certainly an exciting advance," says Erens. "The large hip ball of a resurfacing gives patients good range of motion, restores more natural hip biomechanics and preserves existing bone.

"Recovery is similar to total hip replacement with early mobilization and return to activity," he adds. "Most patients are walking within 24 hours of surgery with physical therapy. Activity is progressed and most patients find that resuming a more normal, pain-free lifestyle occurs rapidly. Patients have been extremely pleased with the outcome."

Erens cautions, however, that this implant is not for everyone. People with brittle bones, severe deformity of the hip, dead bone or who are significantly overweight are not good candidates for hip resurfacing and may be at increased risk for complications such as femoral neck fracture or early failure of the implant.