| HIP RESURFACING | | | | (6) Poor survival in young and active patients they |
| Bone- Preserving Hip surgery | | | | require earlier revision. |
| Have you been advised a hip replacement operation? | | | | (7) Revision surgery is difficult |
| If yes, please read the following information on facts | | | | (8) The hip feels less like a normal hip |
| about the operation and a more advanced bone | | | | (9) The cup wears with time and plastic from it |
| preserving hip replacement option called Proxima hip | | | | harms bone |
| replacement and hip resurfacing. | | | | (10) Change in length of the leg after surgery leading |
| The hip joint may need to be replaced with an | | | | to leg length discrepancy. |
| artificial joint when it is irreversibly damaged and | | | | Why remove normal bone when only the surface of |
| cannot be salvaged by alternate surgery. The patient | | | | the ball is bad? |
| complains of pain and restriction of movement. The | | | | This is the logic behind hip resurfacings. This bone |
| pain may often be referred to the knee or felt in the | | | | preserving hip resurfacing involves replacing only the |
| knee and no hip symptoms. Occasionally the pain | | | | diseased bony surfaces of the head of femur and |
| may be felt more in the buttock area rather than in | | | | acetabulum. This involves sculpting the head of the |
| front of the groin. | | | | femur and covering it with a metal cap and fixing an |
| Who needs a hip replacement? | | | | uncemented socket into the acetabulum to receive |
| In India, many young patients with ankylosing | | | | the head. |
| spondylitis, avascular necrosis, post septic arthritis, | | | | Hip Resurfacing- A bone preserving hip replacement! |
| post injury suffer from hip arthritis and are advised a | | | | Preservation of bone and less stress shielding makes |
| hip replacement for disabling pain. Thus many hip | | | | it easy to revise this hip if needed. The large head |
| replacement operations are performed in younger | | | | size provides a very stable joint and recreates the |
| patients. The surgery should cater to the enhanced | | | | sensation of a normal hip joint. Patients have gone |
| demands on an artificial joint by younger and more | | | | back to playing Judo and Squash after this operation. |
| active patients. Naturally an operation designed for | | | | Advances metallurgy makes the metal on metal |
| Western elderly patients is not suitable for younger | | | | articulation likely to survive longer in the young and |
| patients. | | | | active patient. With less metal inside the bone and |
| What is a total hip replacement? | | | | less invasion of the medullary cavity of the femur, |
| In this operation the ball shaped upper end of the | | | | the risk of infection is reduced. Rehabilitation is faster |
| thigh bone (femur) and the socket (acetabulum) are | | | | and better. |
| replaced. The ball is replaced with a long metal stem | | | | Advantages of hip resurfacing: |
| that is fixed into the upper end if the thigh bone. Its | | | | (1) Allows the patient to squat and sit cross legged |
| upper spherical end articulates with a cup shaped | | | | on the floor safely |
| polyethylene socket that is cemented into the pelvis. | | | | (2) Allows a normal range of movement |
| Conventional hip replacements sacrifice a great deal | | | | (3) Sacrifices only the surface diseased bone and |
| of normal bone as the head, neck, and upper part of | | | | preserves normal bone |
| the thigh bone is removed for implantation of the | | | | (4) Imparts a more normal sensation |
| prosthesis. Moreover wear debris from the | | | | (5) The joint is likely to last longer even in younger |
| polythetheylene liner lead to osteolysis and bone loss. | | | | and active patients. |
| When this first hip is to be changed or revised after | | | | (6) Earlier and faster rehabilitation |
| its lifespan more bone loss occurs. Conventional hips | | | | (7) Less risk of dislocation |
| have a small ball to reduce friction and wear, but the | | | | (8) Easier to revise if needed. |
| ill effect of this is an increased risk of dislocation. An | | | | (9) No leg length discrepancy. |
| average dislocation rate of 3- 4 % has been | | | | Proxima hip replacement |
| reported. These implants do not last very longer than | | | | This is the latest addition to the armamentarium of |
| 20 years and revision rates of 50% at 20 years have | | | | the hip surgeon in India. It is bone preserving hip |
| been reported. Survival rates are less satisfactory for | | | | replacement. |
| the relatively younger active patients. Thus a total hip | | | | In this operation, the entire diseased head of the |
| replacement is not an ideal implant for younger | | | | femur is removed. The lining of the hip socket is |
| patients less than fifty years old who need a new | | | | resurfaced with a metal cup. A tiny uncemented hip |
| hip. | | | | with a short stem called the Proxima hip is impacted |
| Problems with conventional total hip replacement: | | | | into the upper end of the femur or thigh bone. |
| (1) Excessive bone sacrifice and loss | | | | The size of the implant matches the natural one and |
| (2) Increased risk of dislocation | | | | hence the risk of dislocation is almost eliminated. It is |
| (3) Patients cannot squat or sit cross legged on the | | | | recommended when the bony destruction is |
| floor with out the risk of dislocation. | | | | advanced and hence unsuitable for resurfacing and a |
| (4) Range of movement is less | | | | total hip replacement would be overkill. |
| (5) Patients cannot involve in sports | | | | |