Birmingham Hip Resurfacing or Surface Replacement Arthroplasty is a bone-conserving alternative to conventional Total Hip Replacement (THR). Unlike Total Hip Replacement, Birmingham hip Resurfacing does not involve the removal of the femoral head and neck nor removal of bone from the femur. Rather, the head, neck and femur bone is preserved in an effort to facilitate future surgery should it be necessary and to enable the patient to take advantage of newer technology or treatments in the future. The current generation of hip Resurfacing devices utilize a metal bearings have demonstrated a much higher level of wear resistance as well as reduced bone loss and inflammatory tissue reaction about the hip joint as compared to metal-polyethylene bearings. Derrek McMinn designed the Birmingham Hip Resurfacing in Birmingham, England and released it for use in the UK in 1997.
Cory Foulk, a patient of Dr. Bose, finished a marathon three months after his hip resurfacing surgery, and finished 11th in the Ultraman world championship eleven months later.
Jim Roxburgh continues to participate in the martial arts after having both hips resurfaced in 2004.
Ian MacLaren of the Torashin Karate Club is believed to be the first 5th dan Karate-ka in the world to have had both hips resurfaced.
Floyd Landis, 2006 Tour de France Winner.
Hip resurfacing is a technique invented specifically for younger patients with hip problems. Conventional Total hip replacement, while being a good option for an elderly person (above 70yrs) is a poor choice for young patients as it will fail rapidly. The hip resurfacing operation is an alternative to hip replacement and has 3 crucial advantages.The first is that no plastic ( polyethylene) is used like in conventional hip replacement. Since a anatomical sized 'metal on metal' bearing is used it lasts for a very long time, manifold that of conventional hip replacement and is extremely popular in Europe, Australia and some parts of Asia. The anatomy and bio-mechanics after resurfacing mimic a normal hip very closely.
The second advantage is post operatively patients are encouraged to be very active and must play some sport , do swimming etc. No activity is restricted including sitting on the floor, crossing legs etc. In short , it behaves like a normal hip enabling patients to return to their normal lifestyle. In contrast after a hip replacement one has to behave like an elderly person( for whom this has been designed) to be safe from dislocation and to prolong the life of a prosthesis. There are also other advantages in Resurfacing like preservation of bone stock ( as no bone is removed in this operation unlike hip replacement where the head and neck of the thigh bone is completely removed.) Further it has been proven that bone stock actually increases after hip resurfacing due to the restoration of normal biomechanics in the hip and proximal femur.
The normal hip joint consists of a ball rotating inside a socket. The ball is called the head of the femur and the socket in the pelvis is called the Acetabulum. The surface of the femoral head and the acetabulum (i.e. the ball and the socket) is covered by a protective layer of cartilage. This makes the joint smooth and reduces friction during movements. It covers and protects the bone like the rubber of a car tyre.
Any condition that damages the Cartilage will lead to pain, dysfunction and eventually arthritis. Cartilage can get damaged due to a number of reasons including Injury, Infection, Ankylosing Spondylitis, Avascular Necrosis ( loss of blood supply to bone), Rheumatoid Arthritis, Osteoarthritis, Developmental problem like bone Dysplasias, slipped upper femoral epiphyses etc.
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The anesthetist will be seeing you the day prior to the surgery, or earlier if required. Usually a general anesthetic is preferred for BHR due a variety of technical reasons. After the surgery, the patient will be in the recovery room for about 3 hours after which he will be shifted to the wards.
Strict adherence of instructions regarding visitors is mandatory. Only one person who will be known as the primary attendant is allowed inside the patients room.
Should the patient have any other visitor, the primary attendant will come outside the room to speak to them. The patients family must actively discourage visitors for the first 3 post-op days. Only the patient is permitted to eat inside the room.
It is preferable to take only liquids on the day of surgery and progress to a normal diet the following morning. The medical team will give instructions on ankle pump exercises. A sterile towel is kept between the dressing and the bed sheet.
The intravenous fluids are discontinued if patient is taking orally. For the first 48 hours following any surgery; pain is common due to the cutting of tissues. For this pain powerful (narcotic analgesics eg. Tramadol is given). The patient can request the nurse for these injections. These medicines also cause slight dizziness. If the patient feels comfortable, he can start walking with a walker on the first post-op day. If dizzy due to medications, the walking is postponed to the next day. The patient has to do deep breathing exercises, Static quadriceps and gluteal contraction exercises. The last dose of narcotics are given for this night.
Patient is also fitted with a pair of below knee Ted Stockings. Some patients will receive blood-thinning injections if indicated.
Patient walks with the help of a walker with the assistance of a physiotherapist for short distances. Patient goes to the x-ray dept for check x-rays. One can start lying on the un-operated side with a pillow in-between the thighs (not knees or legs).
Patient can walk for longer distances as comfortable. The patient can also start sitting in a chair with a pillow height. It is important to keep in mind that the capacity of recovery following surgery is very different among individuals. Therefore these milestones are only guidelines and variability is common. Patient continues the exercise programme in bed as per the instruction booklet.
Dressing are done again and sticker type dressing ( Curapor or Surgiwear) is done if there is no wound ooze. Patient can start to use the western type toilet and wear normal clothes that are comfortable like pyjamas, lungi, dhoti or baggy shorts. If the surgeon permits a shower is possible with a special (surgiwear swimproof) dressing applied for this purpose From this point on the mobilization programme is variable for each individual patient. In principle they progress to elbow crutches when the phsyio deems fit.
Once they can climb stairs with the help of elbow crutches, they are ready for discharge.
Compulsory wearing of TED stockings during the flight.
At home they walk with a pair of crutches usually for about 10-15 days and when completely comfortable discard the crutch on the side of the operation first. Then when the other crutch is also felt unnecessary, this is also discarded. Walking, climbing stairs or cycling can be done for long periods of time. Patient reports back to the hospital at about 12 days for removal of skin clips. Outstation patients can get this removed by a doctor locally. A letter to this regard will be given at the time of discharge. The next follow up visit is at 6 weeks when a check x-ray is repeated. Outstation patient can do this locally and post the x-ray to the doctor. A request for this is also given at the time of discharge. The subsequent compulsory visit to the doctor is at 6 months post-op.
There is no post-op restrictions after a Hip Resurfacing operation and the patient can use it as a normal hip. However the soft tissues around the hip joint, which were contracted at the time of the hip disease, will take time to relax following the excellent movement that has been restored in the hip. Hence if there is pain while attempting a certain activity like sitting on the floor, it implies the patient is not yet ready for that particular activity. One can give a gap of about a week and then try it again. Like wise the activity level improves in a stepwise manner till the soft tissues also become normal. Patient is ready for sports (inclusive of contact sport) at about 3 months post-op.
Is this a minimally invasive?
Do I need blood transfusion during the hip resurfacing surgery?
Is it a very painful operation?
When do we remove the stitches and is it very painful?
When can I start walking and climbing stairs after the operation?
Do I need lots of physiotherapy after hip resurfacing surgery?
Will I be able to sit on the floor after hip resurfacing surgery?
What is the advantage of Hip Resurfacing over conventional total hip replacement?
Are there any implants used ?
This operation can be done by a minimally invasive approach and the invasion can be kept to less than 10cms. The operation also involves minimal damage to bone.
We generally do not need blood transfusions during the operation.
Pain control techniques and minimal injury to soft tissue and bone during hip resurfacing surgery help to keep the patients comfortable in the post operative period.
Absorbable sutures are used. These need not to be removed.
Local patients are discharged four days after the operation, but overseas patients may have to stay for 8-10 days after hip resurfacing surgery.
Most patients start walking with support on the second postoperative day after removal of the drain. Team of physiotherapist takes you through a standardized protocol of mobilization and stair climbing is achieved before discharge.
The amount of physiotherapy needed depends on the condition of your joint and muscles before the operation. Most patients do not need much suppressed physiotherapy.
Yes, this hip resurfacing surgery will allow you to do that safely unless another problem prevents it.
1) Smith and Nephew (MMT) (BHR) Birmingham Hip Resurfacing.
2) Johnson and Johnson (ASR) Articular Surface Replacement.
Conventional Total Hip Replacements usually consist of a long metal component that is fixed into the femur (thigh bone) articulating with a polyethylene cup cemented into the pelvis.
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Are there any implants used?
McMinn D, Treacy R, Lin K, Pynsent PB. Metal on metal surface replacement of the hip: experience of the McMinn prosthesis. Clin Orthop, 329 (Suppl), 89-98, 1996.
Daniel J, Pynsent P.B, McMinn. D.J.W. Metal-on Metal resurfacing of the hip in patients under the age of 55 years with osteoarthritis. J Bone Joint Surg, Vol. 86-B, 2004.
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Smith & Nephew Orthopaedics is a global provider of leading-edge joint replacement systems for knees, hips and shoulders; trauma products to help repair broken bones and a range of other medical devices to help alleviate pain in joints and promote healing.
Wright Medical Technology makes CONSERVE family of Hip Products. Wright's goal in designing the CONSERVE Family of Implants, which work to provide a bone conserving, minimally invasive approach to hip resurfacing and hip replacement.
Corin Group is invloved in development, manufacture and distribution of a wide range of reconstructive orthopaedic devices. Products include hip resurfacing, total hip replacement, unicondylar knee replacement, mobile bearing total knee replacement, ankle replacement, shoulder replacement, ligament reconstruction and augmentation, spinal reconstruction, trauma products, and theatre disposables. Latest generation surgical instruments, together with minimally invasive systems and surgical navigation support this wide range of orthopaedic implants.
A new approach to stemmed total hip arthroplasty for patients in whom the condition of the femoral head or neck does not allow resurfacing, Corin has developed Optimom, a metal-on-metal stemmed large diameter total hip replacement. Optimom combines the benefits of large diameter metal-on-metal resurfacing arthroplasty with those of a stemmed femoral prosthesis that does not depend on the bone quality of the femoral neck.
Optimom represents a significant advance in hip replacement for the active patient, as well as providing improved stability for revision and DDH patients at risk of dislocation. Modular Optimom heads may be used with any Corin approved stem, providing a large diameter total hip replacement system with all the advantages of a metal-on-metal bearing surface and a large diameter articulation. Optimom Large Diameter Metal-on-Metal Total Hip Replacement System A new approach to stemmed total hip arthroplasty for patients in whom the condition of the femoral head or neck does not allow resurfacing, Corin has developed Optimom, a metal-on-metal stemmed large diameter total hip replacement. Optimom combines the benefits of large diameter metal-on-metal resurfacing arthroplasty with those of a stemmed femoral prosthesis that does not depend on the bone quality of the femoral neck.
Optimom represents a significant advance in hip replacement for the active patient, as well as providing improved stability for revision and DDH patients at risk of dislocation. Modular Optimom heads may be used with any Corin approved stem, providing a large diameter total hip replacement system with all the advantages of a metal-on-metal bearing surface and a large diameter articulation.
Optimom is available with a range of Corin and approved other hip stems for optimum flexibility and implant choice.
Johnson and Johnson's DEPUY ASR Articular Surface Replacement.
The DEPUY ASR System brings together advanced hip bearing technology with a bone and soft tissue preserving surgical approach. Its rationale is to provide surgeons with an advanced resurfacing hip system with dramatically lower wear properties which can be introduced through a conventional or minimal incision. Both approaches may be used with Intelligent Surgery giving a new level of precision. For patients it's the more natural bone conserving solution for early intervention.
Biomet has ReCap Femoral Resurfacing Head , which is a metal (cobalt chromium) cap that resurfaces the head of the femur. This conservative procedure makes the technique less invasive than traditional hip replacement surgery. The ReCap Head may require a smaller incision and less bone removal, which can allow you to recover more quickly and with less pain. The implant can also help prolong or avoid the need for future total hip replacement. However, if you should need total hip replacement in the future, the ReCap Head allows your surgeon the ability to perform the procedure with a less-invasive approach.
Zimmer UK's Durom - Hip Resurfacing.
Precision Swiss manufacturing combined with advanced design based on years of clinical experience have resulted in the Durom Hip Resurfacing which represents a substantial step forward in the field of hip resurfacing.
The principle design features are based around optimising the durability of both the bearing and the component fixation, combined with providing excellent range of motion.
Finsbury Orthopaedics has set the standards in metal-on-metal design and manufacturing technology since the early 1990s. The ADEPT Hip System is the accumulation of our experience and includes both resurfacing and total hip options.
Unique flexibility of sizing is provided with 2mm increments on the head which allows for 2 cup sizes for every head and 2 head sizes for every cup. Not only is this feature bone conserving, but it also assists with optimising the range of motion.
The critical features of the ADEPT system and technical rationale are based entirely on clinical history rather than short-term mechanical studies. The ADEPT metal-on-metal resurfacing system follows well established clinical history and has evolved from the Ring hip and Birmingham Hip Replacement.
The parallel stem inside the resurfacing head prevents cement migration into the femoral neck during impaction. The tapered section outside the head avoids intimate bone contact within the neck which reduces the risk of load transfer and stress shielding.
What is new in hip resurfacing surgery?