Hip Resurfacing Problems
Hip resurfacing has been developed as an alternative strategy to the more typical cemented hip replacement, especially in people who are younger (under 65 years) and who are more active than most elderly people.
Standard hip replacement has long term results over the last 20 to 30 years and hip resurfacing does not yet have follow up results for much over ten years, meaning we cannot be sure that hip resurfacing surgery will have better results than the standard.
Despite a good record and a generally safe operative course for most people there are hip resurfacing complications which are worth considering before agreeing to surgery. Being aware of the potential downsides is useful so that if they occur patients can be prepared and deal with the situation promptly.
Apart from the typical problems of loosening, wear of metal ions (due to the metal on metal hip resurfacing components) and fracture of the bone under the prostheses there are a number of other potential problems.
Infection is a very serious complication and occurs in around half a percent of cases and in the immediate period after the operation is readily treatable in most cases. Later and more persistent infections may necessitate the removal of the components and long term antibiotic treatment until the infection is removed. Then new components may be introduced or in intractable cases the joint area may be left to scar up, leaving a weak and short leg.
Infections can occur many years later after the operation and this seems to be related to the fact that the implants are very susceptible to bacteria circulating in the blood supply. So it's very important that any one with a joint replacement attends the doctor if they have a significant infection such as a tooth infection or an infection ingrowing toenail.
Dislocation is an important issue in standard hip replacement, with around four percent suffering a dislocation in the first six to twelve weeks after operation. This may be related to the operative technique and that the ball of a cemented hip replacement is very much smaller than the natural size of the head of the femur.
As the hip resurfacing femoral head is much bigger then the chances of dislocation is much smaller at 0.2%, allowing the patients to work on hip resurfacing exercises with their physiotherapists to restore range of motion and strength to the hip joint. This increased joint stability means a speedier hip resurfacing recovery process.
Deep vein thrombosis, a clot in the veins of the calf muscles, is a serious and relatively common complication of many kinds of operation including hip resurfacing surgery. Preventative measures are mobilising patients early and wearing compression stockings.
Many of the potential problems are the same for hip replacement and hip resurfacing. NHS hospitals mostly perform cemented hip replacements for elderly people with osteoarthritis but some more specialised centres do offer hip resurfacing for younger and more active patients.