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Hip resurfacing surgery: A superior alternative to hip replacement
Dr Ameet Pispati
 Arthritis
of the hip joint is a common problem in India. It occurs due to damage to the
hip joint from various conditions such as avascular necrosis (death of bone
due to lack of blood supply), trauma or injury (previous hip fractures), infection,
rheumatoid arthritis, ankylosing spondylitis and other diseases. It causes severe
pain, stiffness, deformity, decreased mobility and severe disability. In India,
hip joint arthritis affects even the younger population who are barely 20 or
30 years of age. This can lead to disruption of family and social life, inability
to work for a living and difficulty in moving about.
Traditionally, for over four decades, Total Hip Replacement (THR) surgery has
been the only treatment for people suffering with hip arthritis. The surgery
is conducted when the symptoms or the arthritis cannot be controlled with medications.
THR is an excellent procedure in elderly or sedentary people, but it cannot
restore the mobility desired by younger and middle aged patients. Also, it can
sometimes dislocate or slip out of joint, loosen faster in younger people (and
vital bone is lost as the prosthesis loosens) and patients are often restricted
in terms of their lifestyle and mobility. For example, patients who have had
THR are not allowed to squat, bend, and cross their legs among others. However,
all this is possible now, courtesy the revolutionary surgery for hip arthritis
known as Hip Resurfacing.
Over the last decade, the need for a better option to THR was felt more than
ever before due to increase in hip arthritis incidents among the younger lot
of the population. Subsequent medical and technological advancements led to
the development of Hip Resurfacing surgery. This procedure was pioneered by
one of the world’s leading hip surgeons Dr Derek McMinn in Birmingham,
UK that has given a fresh breath of life to hundreds of people in several parts
of the world. The maxim of the surgery is “Don’t get a hip replacement,
just reline or resurface your arthritic hip!” This is what hundreds of
satisfied hip resurfacing patients are now urging other arthritis patients to
do.
Hip arthritis patients these days have a much advanced version of the resurfacing
surgery called Articular Hip Resurfacing (ASR). Patients who have undergone
ASR are able to walk as much as five miles a day, as early as six weeks after
the operation. Unlike in THR, they can jog, swim, dance, run and even play high-impact
sports, squat, sit cross legged and even use the Indian toilet after this surgery
with minimum risk of dislocation.
Hip resurfacing procedure
Articular surface replacement (ASR) is a revolutionary 4th generation hip resurfacing
technique. It has been derived from the word ‘articular surface’ which
means surfaces that rub together. Unlike the conventional method, hip-resurfacing
procedure is one where only the diseased portion of the hip socket is cleaned
and shaved instead of getting removed. Further, two highly specialised metal
pieces (called ‘components’ or ‘prosthesis’) are used, one
fixed over the ball of the femur bone, and the other fixed into the pelvic socket
called acetabulum. In short, the articular surfaces of the femur and acetabulum
(socket) are replaced and the femoral head is reshaped instead of removed.
At first, an incision is made to reveal the layer of muscles.
The same layer is lifted, detached from the bone and held in place to enable
easy access to the femur and pelvic region that needs to be worked on. With
the knee flexed at 90 degree, the femoral head is dislocated. Once easily visible,
the measurements of the femoral head and neck are taken before the actual surgery
begins. The femoral head is reshaped with specialised instruments that remove
only the damaged bone. The prosthetic head rests on the femoral ball. To ensure
that all stays well in place the prosthetic is glued to the bone.
The surgery then moves onto the acetabular (hip socket) base.
Here a hemispherical cavity removing only damaged socket bone is formed such
that it allows the prosthesis to rotate freely and yet maintain a snug and stable
fit. The metal cup or acetabular component is then lowered into the hollow to
obtain a press-fit. The surgery gets complete with the fitting together of the
femoral head and the acetabular component. Unlike THR, this surgery preserves
body’s vital bone which is very essential for faster recovery. Patients
can start walking within two days and can be discharged in five to six days
after this one and half-hour surgery. The marginal increase in cost is more
than offset by the multiple benefits experienced by the patient.
As a growing number of people in their productive years are getting affected
by arthritis, ASR provides the needed solution and relief. With revision surgery
as a possibility, ASR provides the patients with a better quality of life by
allowing them to fulfill their family, professional and social responsibilities.
The writer is one of India’s leading hip surgeons and
a consultant orthopaedic surgeon at Jaslok & Bhatia Hospitals, Mumbai
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