Hip Resurfacing Arthroplasty: The Facts
Mr Charnley introduced the “Birmingham” Hip Resurfacing to Central Essex over five years ago. Since then he has performed many hip resurfacings and has accepted referrals from other surgeons and hospitals in Essex for this procedure.
Mr Charnley initially became interested in resurfacing ideas when a Hip Fellow in Paris in 1995. On returning to the United Kingdom he visited designer surgeons, Derek McMinn and Ronan Treacy in Birmingham.
Mr Charnley also spent time in Ghent, Belgium with a Consultant who has also performed several thousand hip resurfacings.
Resurfacing hip arthroplasty is an alternative to total hip replacement, particularly for younger patients, and those with physically demanding sporting hobbies.
There are however certain evolving issues and outcomes as the world experience of these metal on metal hip replacements grows, (see below).
HistoryThe 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
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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.
More recently a small group of patients, (who have not been aware of metal allergies), with metal on metal total hip replacements or hip resurfacings are developing swellings, discomfort and mid-term failure of their implants due to metal sensitivity issues. The reported incidence of this is between one in a hundred and one in 600 at International meetings.
Surgeons are also aware of less successful results in patients with inflammatory arthritis, developmental dysplasia, small anatomy, avascular necrosis and osteoporosis. Such patients seemingly do not do as well with hip resurfacings as with total hip replacement.
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).
This page was last updated on 18/Dec/2008
