Hip
Resurfacing Arthroplasty: The Facts
Mr Charnley introduced the Birmingham
Hip Resurfacing Arthroplasty in Central Essex over four years ago.
Since then he has performed in excess of a hundred hip resurfacings
and he accepts referrals from other colleagues in the South East for
this operation
Mr Charnley initially became
interested in resurfacing ideas when a Fellow in Paris in 1995. On
returning to the United Kingdom he visited the designer surgeons,
Derek McMinn and Ronan Treacy in Birmingham.
Recently Mr
Charnley has also spent time in Ghent, Belgium with Dr De Smet, a
Consultant who has performed several hundred resurfacing procedures.
Resurfacing hip
arthroplasty is an alternative to total hip replacement,
particularly for younger patients, those with physically demanding
jobs and sporting hobbies.
History
The idea of resurfacing the upper part of the thigh
bone (femoral head) is really not a new concept. A variety of materials have been tried
over the past 150 years, including ivory, gold, plastics and more recently metal.
Over a decade ago, Mr Derek
McMinn in Birmingham, revisited the idea and using a metal
resurfacing of the femoral head, in conjunction with a metal socket,
has provided an alternative to a more "standard" total hip
replacement.
X-ray of a Partially Resurfaced Hip
Please click here to view
publications on this subject.
A Pelvic
X-Ray Showing a Complete Resurfacing Hip Arthroplasty.
A Resurfacing Implant
The “Theory” behind metal on metal
resurfacing is that there is relatively low friction, which
hopefully will provide a longer lasting solution than conventional
metal on plastic total hip replacements.
Since Mr McMinn and Mr Ronan Treacy redesigned modern
day resurfacing many thousands of patients have had successful
arthroplasties, accepting some minor modifications in the design of
the joint replacement.
The mid-term results, (five to seven years) are very
encouraging, performing as well if not better than conventional
total hip replacements over this time.
Resurfacing is a particularly attractive option for
young and active patients as the design permits a greater range of
movement and a lower risk of dislocation.
The surgery saves bone on the femoral side but
removes slightly more bone on the socket side.
There has been some concern that the metal ions
released in a resurfacing are not suitable for young women
considering child bearing and in patients with distorted anatomy or
osteoporotic bone, the procedure is not ideal. The reasons for this
are failure of fixation or a fracture beneath the femoral component.
Should either of these complications occur, then the
operation will need to be re-done to a more typical hip replacement.
A new development is the
combination of a metal resurfacing type socket with a large metal
articulation on a standard femoral implant.
An X-ray of Hybrid Metal on Metal Total Hip Replacement
A Pair of Cemented, Hybrid Large
Diameter Metal-on-Metal Total Hip Replacement
A
combined Metal on Metal, Large Articulation Joint Replacement Design
This allows a combination of low dislocation and low
wear rates, avoiding the risk of femoral neck fracture and it may
also be used where too much destruction has occurred to the femur to
contemplate a resurfacing arthroplasty.
Mr Charnley is very willing to discuss with his
patients what type of operation, resurfacing or otherwise if
suitable for an individual patient, particularly as there is lots of
conflicting advice in the press and from manufacturing companies.
As recommended by the National Institute for Clinical
Excellence, Mr Charnley believes that patients should be fully
informed prior to choosing which type of hip replacement they are
going to have and he encourages patients to be followed up to ensure
that their joint replacement is performing satisfactorily.
In 1996, Mr Charnley, with French Surgeons, published
papers on conservative hip replacement surgery and partial
resurfacing, (see
research and publications
section).
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