Hip Resurfacing

Introduction

Hip resurfacing is a procedure aimed at treating hip pain caused by osteoarthritis, much like a total hip replacement. However, there are some key differences between the two procedures.

In a traditional total hip replacement, the femoral head (the top part of the thighbone) is entirely removed and replaced. Hip resurfacing removes less bone, only trimming the cartilage of the femoral head and capping it with a metal cover. This procedure offers many benefits, including easier future revisions and a decreased risk of hip dislocation.

Both options will be explored to determine which one best suits the patient’s specific needs, offering relief from pain and restoring mobility and quality of life.

Hip Resurfacing Indications and Contraindications

Indications

Patients suitable for hip resurfacing are young, healthy adults who are eager to engage in higher-impact activities deemed unsuitable for hip replacement. Tennis player Andy Murray is one of the world’s most notable hip resurfacing patients. You can follow his journey here.

Contraindications

Contraindications for hip resurfacing typically involve factors that may increase the risks or diminish the success of the procedure. These include patients with severe osteoporosis, as weak bone density may not provide adequate support for the implanted components.
 
Metal implants are contraindicated in patients allergic to certain metals.
 
Previous hip surgeries, particularly those involving significant bone removal, may limit the suitability of hip resurfacing.
 
Poor bone quality or insufficient bone stock, often seen in older individuals, can pose challenges for this procedure.
 
Patients who are overweight, have kidney issues or other severe medical conditions that affect overall health may not be ideal candidates for hip resurfacing. In each case, a thorough evaluation by the healthcare provider is essential to assess the patient’s suitability for this surgical approach and determine the most appropriate treatment plan for their specific hip condition. 

Hip Resurfacing Benefits & Risks​

Benefits

Hip resurfacing offers several potential benefits, including the preservation of more natural bone compared to traditional hip replacement, which may be advantageous for younger, more active patients. This procedure often results in improved stability and range of motion in the hip joint. Moreover, some individuals report reduced risk of hip dislocation and a more natural feel to the joint due to the large metal-on-metal articulation.

Risks

Hip replacement patients face the general surgical risks characteristic of hip replacement surgery. Hip resurfacing specific risks:

  • Pseudotumors or metallosis
  • Metal-on-metal implants can lead to metal ion release, potentially causing adverse reactions.
  • Allergic reactions to metal components.
  • Femoral neck fracture
  • Loosening of the components

Hip Resurfacing Surgical Approach

Associate Professor Munjed Al Muderis is among the few surgeons in the world trained to perform the direct anterior approach for both hip resurfacing and total hip replacement. This level of expertise ensures that patients benefit from a high level of skill and knowledge in both surgical procedures.

The aim of the procedure is to remove the painful hip joint’s surface and replace it with artificial components. The hip resurfacing procedure is done through an anterior, minimally invasive approach to the hip and involves replacing the femoral head using specialised powered instruments and applying a metal covering.

Hip Resurfacing Pre-Surgery Information​

The following is what can be expected prior to hip resurfacing surgery:

  1. Patient Evaluation: A thorough assessment of the patient’s overall health, medical history, and orthopaedic condition. When necessary, your health might need optimisation and we may refer you to another specialist.
  2. Medications: Inform your healthcare provider about any medications you’re taking, as some may need to be adjusted before surgery. You should stop taking aspirin or anti-inflammatory medications 10 days prior to the surgery. Also, you should discontinue any naturopathic or herbal medications during this period.
  3. Imaging: X-rays, CT scans, and MRIs are used to evaluate the extent of damage and plan the surgery. CT scans are especially helpful in planning the surgical steps.  
  4. Skin preparation: The night before and on the morning of the operation, you will be asked to wash the leg with a sponge provided at the pre-admission clinic. If there is any suspicion of an iodine allergy, a Betadine Skin test might be used.
  5. Bowel Prep: Glycerin suppositories will be provided at the pre-admission clinic, and you will need to administer them the evening prior to the surgery. An instruction leaflet will be given to guide them.
  6. Patient education: During a physiotherapy assessment, a qualified physical therapist will provide you with personalised instructions on gait training, the use of crutches, and pre- and postoperative exercises. You will be fitted with crutches to take home and practise before the surgery.

On the day of the Surgery

  • Surgical paperwork will be administered by the nurses, and the anaesthetist will meet with the patient to ask a few questions.
  • A hospital gown will be given, and the operation site will be shaved and cleaned.
  • Betadine skin prep will be applied to the area above the operation site and wrapped.
  • All x-rays are to be sent with the patient to the theatre.

Hip Resurfacing Surgical Procedure

Hip resurfacing involves several key steps.

  • Anaesthesia: The patient is placed under general or regional anaesthesia to ensure comfort and pain control during the surgery.
  • Incision: The surgeon makes an incision, typically on the front of the hip, to access the joint.
  • Femoral Head Preparation: The femoral head (the hip joint ball) is reshaped and contoured to receive the metal component. This step retains a significant portion of the patient’s natural bone.
  • Acetabular Cup Placement: The hip socket is also prepared, and a metal cup is inserted.
  • Metal-on-Metal Implants: The metal-on-metal articulation is created, with a metal cap placed over the reshaped femoral head and a metal cup in the acetabulum.
  • Closure: The incision is closed with sutures, and the surgical site is dressed.
  • Recovery: Patients are closely monitored in the recovery area and may require post-operative physical therapy to regain strength and mobility.

Hip Resurfacing Post Surgery

Post-surgery care following a hip resurfacing procedure is crucial for a successful recovery. Patients should adhere to several key guidelines:

  • Immobilisation: Initially, patients may be advised to use crutches or a walker to minimize weight-bearing on the operated hip. This helps protect the joint as it heals.
  • Pain Management: Pain medication is typically prescribed to manage post-operative discomfort. Patients should follow the prescribed regimen and communicate any concerns to their healthcare provider.
  • Physical Therapy: Engaging in a tailored physical therapy program is essential to restore strength, flexibility, and range of motion in the hip joint. These exercises are gradually intensified over time.
  • Weight-Bearing Progression: Weight-bearing on the operated leg is gradually increased under the guidance of a healthcare professional. Compliance with weight-bearing restrictions is crucial to avoid complications.
  • Wound Care: Patients should keep the surgical site clean and dry, follow any dressing change instructions, and be vigilant for signs of infection.
  • Activity Restrictions: Avoiding high-impact activities and certain movements that could stress the hip joint is typically advised. Patients should follow any specific activity restrictions provided by their surgeon.
  • Follow-Up Appointments: Regular follow-up appointments with the surgeon are essential to monitor progress and address any concerns or complications that may arise.
    • 1 week postop: for wound check, 
    • 2 weeks postop: for sutures removal, 
    • 6 weeks postop: for x-ray assessment of healing progressing,
    • 3 months, 6 months, 12 months and later annually for x-ray assessment of healing progress
  • Medication Management: Patients should adhere to any prescribed medications, such as blood thinners, to prevent blood clots.

Overall, attentive post-surgery care is vital for a smooth recovery and the long-term success of a hip resurfacing procedure. Patients should maintain open communication with their healthcare team and diligently follow their recommendations and guidelines.

Concerns

If patients are worried about their level of pain, experience significant bleeding, or notice fever or redness around the surgical site, they should contact the office immediately. If assistance is needed after hours, patients can contact the hospital where the surgery was performed, and they will contact Professor Al Muderis on their behalf.

Norwest Private Hospital: (02) 8882 8882

Macquarie University Hospital: (02) 9812 3000

Call on +61 2 8882 9011

X-ray facilities at all locations | Urgent appointments available if necessary.

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Professor Munjed Al Muderis
Professor Munjed Al Muderis is an orthopaedic surgeon and a clinical lecturer at Macquarie University and The Australian School Of Advanced Medicine. He specialises in hip, knee, trauma and osseointegration surgery. He is a fellow of the Royal Australasian College of Surgeons and Chairman of the Osseointegration Group of Australia.
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Disclaimer

Information provided via this website is for educational and communication purposes only. The material presented is neither intended to convey the only, nor necessarily the best, method or procedure, but rather represents techniques and procedures used by Professor Munjed Al Muderis. Professor Munjed Al Muderis disclaims any and all liability for injury and/or other damages which result from an individual using techniques presented on this website. Professor Munjed Al Muderis, to the best of his knowledge, believes the information presented is current and applicable to work being done by orthopaedic surgeons worldwide.