THR vs Resurfacing?
I found this and did not see any copyright on it under FAQ's, so I thought I would post it here, absolutely amazing to me that some orthopedic surgeons actually know less about Hip Resurfacing than most of us know! Interesting enough, this surgeon does PAO's as well a Total Hip Replacements and Hip Resurfacing. When asked why not just skip straight to a Total Hip Replacement, here is his response
"Why not just have a total hip replacement instead of going through with this operation?
A total hip replacement is a major procedure with substantial restrictions of activity, numerous potential modes of failure, progressively declining success at each revision (repeat hip replacement). If a patient were to have hip dysplasia and undergo a total hip replacement in their thirties, there is a very high probability that they would need at least one to two further repeat hip replacements. Each time that this is performed, the patient would have a higher risk of losing bone, getting an infection, having a longer operation time, more blood loss, and other risks. The ultimate goal of orthopaedic surgery is to maintain the patient’s own joints until they can no longer function. A periacetabular osteotomy has been shown to increase function, decrease pain, while avoiding some of the long-term risks associated with joint replacement. As far as activities, a periacetabular osteotomy would give the patient a higher chance of resuming very vigorous activities that would be precluded for a total hip replacement."
The amazing thing is this surgeon also does hip resurfacing but does not seem to know much about it at all because in his FAQ's about hip resurfacing when asked the advantage of it over a Total Hip Replacement, his response was the following:
"What is the difference between a standard hip replacement and a resurfacing total hip replacement?
Most contemporary metal hip replacements are made of titanium alloys or cobalt-chromium alloys. The best way to understand the implants used in current replacements is to divide them into two parts. First is the metallic components that are directly fixed to the bone. These can be either through the use of cement (mostly on the femur or thigh-bone) or through a cementless or ingrowth process where the bone actually grows onto the metal. The second part of the hip replacement is made of the parts that actually move relative to one another (the bearing). These can be made of either metal on polyethylene plastic (most common) or other bearings such as ceramic-on-ceramic or metal-on-metal."
Then I found this interesting as well.
"What are its disadvantages?
The biggest disadvantage of resurfacing hip replacement is the exposure of patients to increased levels of metal ions as a result of the metal on metal joint. In spite of higher measured levels of the metal ions, no cases of cancer have been reported directly related to metal on metal hip replacements in spite of greater than 30 years of clinical use.:
Does he not know that the majority of increased metal ions are due to surgeon error?
Then when asked
"What are the advantages of the resurfacing total hip replacement ?
The greatest advantage to the resurfacing hip replacement is the preservation of the patient's bone. By maintaining as much bone as possible in the femoral neck, there is a potential for the bone to continue to be loaded mechanically. This is theorized to lead to increase mineralization in the bone and avoid a complication known as "stress shielding" where the bone that is bypassed with a metal implant is not loaded and can ultimately lose its mineralization as seen by radiographs. Additionally, in the young patient, preservation of the bone can provide increased options in the future in the event of implant failure over the years or in case of trauma."
Just found this site and thought it would be interesting to share with the group that an orthopedic surgeon actually answered these questions, first saying how great PAO's are because of how bad Total Hip Replacements are, then instead of even mentioning going to a Hip Resurfacing as a next option to a PAO, he mentions a Total Hip Replacement?
Dislocations are the most common cause for revision surgery after THR. They account for over 20% of all revisions. Dislocations occur in about 5% of all THR. About half of these cases become recurrent requiring revision surgery. They can even occur for the first time many years after the THR was done.
I have now done over 1000 hip resurfacings. Practically all the Birmingham device marketed by Smith & Nephew. So I thought I would share what I think about the technique right now. This is not a scientific paper and the views expressed are my own. I suppose I could 'prove' most of what is written below by suitable references in the literature, but some is instinct or gut feel. So it could be wrong, but chances are high the views expressed are accurate!
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 first point I want to make is I have done hundreds or thousands of total hip replacements (THR) on all sorts of people at all sorts of ages and activity levels. Some of this experience pre-dates hip resurfacing, but I still often do THR as well. There were many very happy THR patients, but quite a few with a host of problems. My patients and colleagues' patients referred to me for a second, third or more opinion! Dislocation [sometimes occurring so often further surgery was required], infection, leg length differences and completely inexplicable pain. Another frequent problem was limping or muscle weakness as a result of using the direct lateral or Hardinge approach to the hip in an effort to avoid the higher dislocation rate associated with the posterior approach - which more rarely has muscle weakness or limp associated with it.
Metal-metal Hip Resurfacing Offers Advantages Over Traditional Arthroplasty in Selected Patients
Total hip arthroplasty (THA) is among the most successful interventions in medicine. It is the best option for most patients with end-stage arthritis of the hip. However, THA has some limitations, and problems with THA are far from nonexistent. Revisions account for almost 20% of hip cases in the United States, and this number is growing.1 These revision cases pose a greater risk for patients.
The best results of Hip Replacement in young patients are published from Wrightington in the north of England. This is the centre in which the conventional hip replacement was developed by Sir John Charnley in the early 60's. To this day this centre functions as a centre of excellence in Hip surgery and the institute is named after its founder Sir John.