Study the options of hip resurfacing vs. replacement

Q. I’m 67 years old and my hip is in bad shape. I’ve heard there’s a way to fix your hip without replacing it. What is it?

There is a surgical alternative to total hip replacement. It’s called hip resurfacing.

The hip is a ball-and-socket joint. The ball is at the top of the femur (thigh bone), and the socket is in the pelvis. In hip replacement surgery, the ball is replaced with a metal or ceramic substitute. The socket is fitted with a metal cup to hold the new ball.

The primary difference in hip resurfacing is that the surgeon doesn’t remove the femural ball. Instead, the damaged ball is reshaped, and then a metal cap is anchored over it.

Hip resurfacing is at least as hard on the patient as a total replacement. It can take six months or more to heal completely from the surgery. Resurfacing requires a larger incision than total hip replacement.

A crucial issue in joint replacement is longevity. A substitute hip is good for about 20 years, and it is difficult to remove and replace one that’s shot. Hip resurfacing, unlike hip replacement, preserves enough bone to permit a total replacement if it is necessary later.

Surgeons estimate that 10 to 15 percent of people with bad hips can consider hip resurfacing instead of replacement. For example, resurfacing is not recommended for patients with osteoporosis, a disease that makes bones porous and vulnerable to fractures.

There is a question in resurfacing about electrically charged metal atoms that enter the body as the cup rubs against the cap in the hip joint. Some studies have raised fears that these atoms might cause disease. As a precaution, the Food and Drug Administration has said the materials used in resurfacing should not be implanted in women who plan to have children, and in patients whose kidneys have been weakened by diseases such as diabetes.

Is there an age cutoff for hip resurfacing? Every decision about surgery is one that should be made by each individual with the advice of a physician. Some who have studied hip resurfacing contend that there still isn’t enough known about the safety of the procedure. These healthcare experts advise getting a replacement hip joint if you are older than 65. Hip resurfacing was developed in the 1960s but there were unresolved problems for many years. The procedure has been popular in Europe. Thousands have had hips resurfaced in the last 10 years.

About 300,000 people in this country have their hips replaced annually. The American Academy of Orthopaedic Surgeons says joint replacement surgery is successful in more than 9 out of 10 people.


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