Hip Resurfacing Surgery
Hip resurfacing has been developed as an alternative to standard total hip replacement, aimed at younger people who may need to have a series of operations through their life. High rates of failure were seen in the initial phase of use of hip resurfacing and the technique fell out of favour. However, changes in the materials and the designs have allowed this method to become popular again, although we are still waiting for the longer term results which say that hip resurfacing is as good as hip replacement.
Hip resurfacing is performed with the patient on the opposite side to the operated one and the tissues are cut to expose the gluteal muscles which are cut through, getting down to the hip capsule which is also cut through to allow the hip and socket to be separated.
Once the hip is disarticulated, which is the word for the two parts of a joint being forced apart from each other. Once this occurs the leg is manipulated so that the femoral head rotates away from the operation site, allowing the socket to come into view. Any bony outgrowths or osteophytes are nibbled away with special instruments to stop them potentially impinging on nearby structures.
The cartilage rim or labrum is also removed from around the hip socket, leaving the socket ready for reaming. Reamed is performed with a power tool bearing a hemispherical end which cuts its shape into the socket and the size of the reamer is gradually increased until the required level of adjustment has occurred.
The socket is then cleaned and the acetabular (hip socket) component added with a special introducer and banged into place with a hammer. Once it is solid the introducer is removed and attention then turns again to the femoral head. This is a metal on metal hip resurfacing so both components are made of metal in this case.
Once the femoral head is prominent again in the wound it is prepared for the bone cuts which need to be made. The femoral head is cut at the sides and the top so it looks like a cotton reel. Now the femoral component is filled with low viscosity (i.e. quite fluid) cement and pressurised into place, being tapped further into place with a hammer. Once the area has been cleaned again the joint is put together and the leg is manoeuvred around to make sure the joint is stable and that it doesn't catch on anything.
Three times during the operation, local anaesthetic and adrenaline are injected into the tissues around the wound, allowing the patient up to 12 hours pain free time after their operation, hastening hip resurfacing recovery and allowing the patient to participate in hip resurfacing exercises with the physiotherapist.
While private hospitals and private surgeons perform most hip resurfacing, NHS hospitals still perform a number of these operations. Further reading about hip resurfacing surgery is at About.com:Orthopedics and hip resurfacing at Wikipedia.