Hip resurfacing: solution to young arthritic hip

Dr Sanjeev Jain

Arthritis is the world's leading cause of disability. Arthritis in India is similar to that in any other part of the world, except that incidence of degenerative arthritis (osteo arthritis) is more as compared to rheumatoid (inflammatory) arthritis. Of greater concern is arthritis of the hip joint in young patients. This could be due to a number of disorders such as

• Avascular necrosis of femoral head (where reduced blood circulation to hip ball leads to arthritis because of death of bone).
• Childhood hip diseases (this causes arthritis in third and fourth decades of life due to abnormal bio-mechanism).
• Ankylosing spondylitis and rheumatoid arthritis (these disorders are problems of the immune system of the human body and leads to arthritis in young age).
• Post traumatic arthritis (fracture involving hip ball and socket leads to arthritis at a later stage).

These disorders are more debilitating than cancer and cardiac diseases. The high incidence of hip arthritis is really a major issue for the young patient, those barely between 20 and 30 years of age. Such a disability will limit the earning capacity. There is a solution, however, and that is hip resurfacing.

Surgery for hip joint replacement is indicated in patients who suffer from advanced stage of arthritis and all the conservative measures have failed to relieve the pain. In conventional hip replacement, hip ball is discarded and replaced with a plastic socket (cup made of polyethylene) and a metal prosthesis having a small metal ball inserted in canal of thigh bone (femur).

This hip implant is fixed to the bone with or without cement. As this hip replacement is done in India commonly on young patients, relevance of durability and high percentage of early failure is a major concern. The reduced survival rate of conventional hip replacement in young patient is due to loosening of implant because of the polyethylene debris accumulating between the plastic socket and metal ball.

In hip resurfacing, only the involved arthritic covering (degenerated cartilage) of hip ball and socket is replaced with thin metal ball and cup.

Hence complete original ball of hip is preserved and only the lining is changed. The main attraction is the feeling that this procedure attempts to assist nature.

This is so as only a small amount of bone has to be removed from the hip joint to accomplish the resurfacing.

This operation benefits in permitting the patient to maintain a normal lifestyle. The major advantages of hip resurfacing on conventional hip replacement are:

• The ball used in the system is similar to the natural ball and that in turn confers biomechanical advantages to the hip.
• Prosthesis wearout is minimal and hence no loosening.
• Improved functions and quick recovery.
• Patient can sit and squat and even participate in sports activities.
• Allow normal range of movements of hip.
• Does not change leg length.
• Duplicates or restores normal structure of hip joint and due to bigger size of ball has hardly any chance of dislocation.

So hip resurfacing is the solution to the young arthritic hip where survival rate or durability of hip joint will be very long and this can be named as ideal hip surgery for young and high demanding active patient.

The writer is consultant orthopaedic and joint replacement surgeon, Dr L H Hiranandani Hospital, Mumbi.

Email: sanjeev.jain@hiranandanihospital.org