Hip Resurfacing or “Birmingham Hip Replacement” is a bone preserving operation sometimes indicated for younger patients with hip arthritis as an alternative to other total hip replacement.
In hip resurfacing, the hip socket is treated in the same manner as a total joint replacement, with a smooth lining/cup placed into the socket (acetabulum) of the hip joint. The difference in resurfacing vs. total hip replacement occurs on the femoral (thigh bone) side, in that the femoral head (ball) is not removed. Instead, the femoral head is mostly preserved. Only the worn cartilage is removed and the femoral head gets “capped” with a thin prosthesis.
There are several potential attractions with hip resurfacing:
- Less bone is removed in the surgery
- The original size of the femoral head is maintained, leading to a very stable joint and low incidence of dislocation.
There are, however, also some disadvantages with the hip resurfacing procedure :
The most significant concern is that in order to have a material thin enough to use as the cap on the femur, both sides of the implant (socket and ball) are made out of metal. The joint consequently has two metal surfaces that rub against one another and in some patients metal particles can be released and cause serious tissue reaction.
Although metal-on-metal reactions largely occurred with one specific brand of metal hips (that Mr Freedman never used) and were not commonly seen with the “Birmingham” design, the number of metal-on-metal hip resurfacing procedures performed around the world has declined, as surgeons became concerned about the potential for metal reactions and other materials and implants became available.
For most young patients, Mr Freedman instead prefers ceramic–on-ceramic total hip replacement with a short stem (“e.g. mini hip) rather than metal hip resurfacing. Use of hard-bearing ceramic implants with a short stem achieves the best of both worlds in that it allows a hard-bearing articulation with negligible wear rate, while avoiding the potential issues associated with metal-on-metal. Using a special short stem allows for later revision if necessary.
However, hip resurfacing is still appropriate for certain patients. The various options and pros and cons of short stem total hip replacement and hip resurfacing will be discussed at your consultation.