samsani

Mr Srinivas Samsani

MS Orth PGI, FRCS, FRCS, FRCS Tr & Orth.
MSc Trauma, Dip Orth London.
Hip and Knee Fellow, Melbourne Australia.

Consultant Orthopaedic Surgeon
Specialisation: Knee and Hip Surgery

Hip Resurfacing

Hip resurfacing is relatively a new operation performed on younger patients with hip arthritis. Modern hip resurfacing has been performed since late 90s and has produced excellent short and medium term results. However its popularity has declined recently due to specific and serious complications associated with some of the resurfacing implants as result of allergy or reaction to the excessive metal ions released from the implant into the body. As a result of these complications, some orthopaedic companies have taken back their resurfacing implants from the market and therefore, this operation is not routinely recommended by the surgeons.

Hip surfacing is a relatively new hip operation in which the ball of the hip joint (femoral head) is reshaped to accept a spherical metal cap and the surface of the socket of hip joint (acetabulum) is replaced with a metal cup. The two metal articulating are lubricated by the special fluid secreted by the hip joint. It is a bone conserving operation as the ball of the hip joint (femoral head) is preserved and, unlike in total hip replacement, there is no stem (pin) to go down in to the centre of thigh bone (femur). If the hip resurfacing fails, revision to a standard hip replacement is relatively easy due to preservation of bone on femoral head.

The main advantages of the hip resurfaces are increased stability of the hip joint with more range of movement (less risk of dislocation), bone conservation, restoring normal anatomy, reduced risk of leg length inequality and long term durability. This operation is most suitable for younger individuals with high functional demands. It is not generally suitable for older patients, women older than 60 as their bones tend to be weaker due to osteoporosis, patients with rheumatoid arthritis and other inflammatory arthropathies, and unusual hip problems.

Special advice to the patients with hip resurfacing or total hip replacement with metal on metal articulation: All the patients who have had hip resurfacing or hip replacement with large metal on metal articulation must have regular clinical assessments by specially trained orthopaedic surgeon to detect the complications early. The assessment will involve a routine clinical examination and getting an x-ray of the hip. Orthopaedic Surgeon may also request a special blood test to measure metal ion levels and examination of hip with scan such as ultrasound or MRI.

Complications of Hip Resurfacing:

Two types of complications are seen with hip resurfacing operation.

Complications specific to hip resurfacing operation:

  • Fracture neck of femur: This is a rare complication and can occur either during or after the operation. When it happens, conversion to a standard hip replacement is usually required.
  • Reaction to metal ions: Metal ions, sometimes in excessive quantities, can be released in to the tissues from the metal on metal articulation of the prosthesis. Some patients may develop allergy or hypersensitivity reaction to these metal ions leading to soft tissue complications such as cyst like swellings (pseudo-cysts), fluid accumulations, inflammation of lining of the hip joint (synovitis) and bony complications such as bone lysis leading to loosening of prosthesis.

General complications seen with any other hip replacement operation:

  • Complications of hip replacement operation.

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