You will usually only be recommended surgery if non-surgical treatments no longer help to reduce your pain or help you walk more easily. This could mean taking over-the-counter painkillers (eg paracetamol) or anti-inflammatory medicines (eg ibuprofen) first. Or using physical aids such as a walking stick.
Depending on your age and how badly your hip joint is damaged, your surgeon may recommend a total hip replacement. He or she will explain your options to you. See our frequently asked questions for more information about the advantages and disadvantages of hip resurfacing compared with hip replacement.
Your surgeon will explain how to prepare for your operation. For example, if you smoke, your surgeon will talk to you about the benefits of stopping. This is because smoking increases your risk of getting a chest and wound infection, which can slow your recovery.
The operation is often done under spinal or epidural anaesthetic. This completely blocks feeling from below your waist and you’ll be awake during the operation. Alternatively, you may have surgery under general anaesthetic. This means you’ll be asleep during the operation. Your surgeon will advise you which type of anaesthesia is most suitable for you.
If you're having a general anaesthetic, you’ll be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it's important to follow your anaesthetist's advice.
Your surgeon will discuss with you what will happen and any pain you might have. This is your opportunity to understand what will happen. Preparing questions to ask about the risks, benefits and any alternatives to the procedure will help you to be informed. You may be asked to give your consent for the operation to go ahead by signing a consent form.
You may be asked to give your consent to have your name on the National Joint Register. The register is used to follow-up how safe your joint replacement is and its ability to last. As well as how well the joint replacement works.
You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs (deep vein thrombosis, DVT). You may also need to have an injection of an anticlotting medicine called heparin as well as, or instead of, wearing compression stockings.
A hip resurfacing operation usually takes around two hours. This is about the same length of time as hip replacement surgery.
Your surgeon will make a cut over your hip and thigh and separate the ball and socket (hip joint). He or she will carefully remove the worn bone and cartilage from the surfaces of your thigh bone and hip socket. The remaining bone will be cleaned and covered with metal surfaces. The ball of your thigh bone is then placed back into your hip socket.
Your surgeon will close the cut with stitches or clips and cover it with a dressing.
You’ll need to rest until the effects of the anaesthetic have passed. You may not be able to feel or move your legs for several hours after a spinal or epidural anaesthetic. And you may need pain relief to help with any discomfort as the anaesthetic wears off.
A special pillow may be placed between your legs to hold your hip joint still and stop it from dislocating (moving out of position).
You may have to wear special pads on your lower legs. These are attached to a machine called an intermittent compression pump. The pump inflates the pads and encourages healthy blood flow in your legs, which helps to prevent deep vein thrombosis (DVT). You will be encouraged to get out of bed and move around as this helps to prevent chest infections as well as DVT.
A physiotherapist (a health professional who specialises in maintaining and improving movement and mobility) will usually visit you regularly and guide you through physiotherapy exercises. It’s important that you do these as often as your physiotherapist tells you. They are designed to help your recovery by restoring movement and strength in your hip.
You’ll stay in hospital until you're able to walk safely with the aid of walking sticks or crutches. This is likely to be between one and four days after your operation.
When you're ready to go home, you’ll need to arrange for someone to drive you. Your nurse will give you some advice about caring for your hip and a date for a follow-up appointment before you go home.
Your stitches will usually be removed after 12 to 14 days.
If you need pain relief, you can take over-the-counter painkillers such as paracetamol. Speak to your pharmacist if you have any questions about your medicine. And make sure you read the patient information that comes with your medicine.
The exercises recommended by your physiotherapist are an important part of your recovery so it's essential that you continue to do them. There are certain movements that you shouldn't do in the first eight weeks. For example, don’t cross your legs or twist your hip inwards and outwards. Your physiotherapist will give you further advice and tips to protect your hip.
You should be able to move around your home and manage stairs. You may find some routine activities, such as shopping, difficult for a few weeks and you may need to ask for help. You will need to use crutches for a few weeks.
You may be asked to wear your compression stockings for a few weeks at home until you have gained mobility.
You can usually return to light work after about six weeks. But if your work involves a lot of standing or lifting, you may need to stay off for longer.
Follow your surgeon's advice about driving. The length of time before you are fit to drive will depend on several factors. These include which leg you’ve been operated on and whether your car is automatic.
See our frequently asked questions for more information about your recovery.
As with every procedure, there are some risks associated with hip resurfacing. We have not included the chance of these happening as they are different for every person and specific to you. Ask your surgeon to explain how these risks apply to you.
These are the unwanted but mostly temporary effects of a successful procedure.
Your hip joint will feel sore after and you may have some swelling.
This is when problems occur during or after the operation. The possible complications of any operation include an unexpected reaction to the anaesthetic, infection, excessive bleeding or deep vein thrombosis (DVT).
Complications specific to hip resurfacing are listed below.
- Joint dislocation. If your hip joint comes out of place, you may need another operation to correct this.
- Difference in length. Your leg may be slightly shorter or longer, and you may need to wear a raised shoe on the shorter side to correct your balance.
- Hip fracture. Cracks can occur in your bone during or after fitting the new surfaces, especially in the neck of the thigh bone (femur). You may need another operation to treat these.
- Loosening. The metal surfaces may come loose from your bone and you may need further surgery to correct this.
- Infection. Your surgeon will prescribe antibiotics to minimise this risk.
How long will the metal parts last?
At the moment, little is known about how long the metal parts used in hip resurfacing will last. However, more research is currently being carried out.
The National Institute for Health and Care Excellence (NICE) has issued guidance about the chance of needing another operation after hip resurfacing. Less than five in 100 people should need another operation after 10 years. Some research suggests that some people may need to have further surgery sooner than this. This will depend on your age, sex, surgeon and the exact type of implant used. Have a chat with your surgeon about how these ‘risks’ apply specifically to you. Hip resurfacing is a more recent development than hip replacement surgery. This means there’s been less time to follow-up how effective it is in the long term.
The most common reasons for a hip resurfacing device to fail are:
- fracture in your thigh bone
- loosening of the part attached to your thighbone
Other reasons include infection, repeated dislocation of the joint and, rarely, an allergic reaction to particles in the metal surfaces.
You may be able to have another hip resurfacing or a hip revision operation if the metal parts attached to your hip fail.
What are the advantages of hip resurfacing compared with hip replacement?
AnswerIf you have a hip resurfacing operation, your joint is less likely to dislocate (move out of position). Not a lot is known about the medium- to- long-term safety and reliability of hip resurfacing compared with hip replacement. Because of this, they are being used less often in the UK.
Hip resurfacing may have a number of advantages compared with total hip replacement. These include:
- a reduced risk of dislocation
- an improved range of movement
- being able to be more active
For these reasons, it may be an appealing option if you take part in vigorous activities, such as snowboarding or skiing.
Another advantage of hip resurfacing is that less bone is removed compared with a hip replacement. This means that if you need to have further surgery on your hip joint in later years, it may be easier to carry out.
It’s important to weigh up the disadvantages of hip resurfacing compared with hip replacement. The National Institute for Health and Care Excellence (NICE) states that not much is known about the medium- to long-term safety and reliability of hip resurfacing.
Hip resurfacing surgery is more complicated and difficult to carry out than hip replacement. Your surgeon should have had specialist training in this procedure.
Research has indicated that the chance of needing another hip replacement (revision) is higher if you have hip resurfacing compared to total hip replacement. There’s also a risk that tiny metal particles may be released as the metal parts move against each other. Some of these may get into your blood and damage the surrounding tissues. This in turn could lead to side-effects including pain and swelling.
It’s important to remember that the people who have hip resurfacing surgery are often different from those who have hip replacements. It’s usually younger people, who are active and have stronger bones who have hip resurfacing. Older people with weaker bones are not suitable for resurfacing. Therefore, hip resurfacing may not be a suitable procedure for you. Speak to your surgeon for more information and advice.
What can I do to make my recovery easier?
It’s important that you try to be as fit and healthy as possible before your operation. You can also prepare your home for when you return from hospital.
If you're having hip resurfacing, it's a good idea to try and be as fit and healthy as possible before your operation. This will help to speed up your recovery.
Your surgeon will explain how to prepare for your operation. For example, if you smoke your surgeon will talk to you about the benefits of giving up. Smoking increases the risk of complications after a hip replacement infection, loosening of the implant and the need for another operation.
You can exercise to strengthen your upper body. This will help you to get around when using walking aids, such as crutches, after your surgery. If it's possible, try to strengthen your leg muscles. Strengthening the muscles in your legs will speed your recovery. And make it easier to do the exercises your physiotherapist gives you after your operation. Your surgeon or physiotherapist will be able to recommend exercises for you.
You may also want to prepare your home for when you return from hospital. This may involve rearranging furniture to make it easier for you to move around safely. It’s a good idea to place items that you often use at arm level, so you don't have to reach for them. An occupational therapist can advise you on aids for your home. It also helps to stock up on non-perishable food so that you don't need to go shopping immediately after your surgery.
You may need help after surgery. It's a good idea to arrange to have a friend or family member stay with you for a couple of weeks after the operation.
- Hip resurfacing. American Academy of Orthopedic Surgeons. www.orthoinfo.aaos.org, published March 2014
- Hip resurfacing. Medscape. www.emedicine.medscape.com, published 1 April 2014
- Hole JW, Koos KA. Human Anatomy. Mosby. 2nd Ed. Dubuque. 1994: 204
- Osteoarthritis. PatientPlus. www.patient.co.uk/patientplus.asp, published 12 March 2013
- Hip Replacement. PatientPlus. www.patient.co.uk/patientplus.asp, published 18 March 2011
- Total hip replacement and resurfacing arthroplasty for end-stage arthritis of the hip (review of technology appraisal guidance 2 and 44). National Institute for Health and Care Excellence (NICE), February 2014. www.nice.org.uk
- Map of Medicine. Elective hip surgery. International View. London; 2013 (Issue 2)
- Sørensen, LT. Wound healing and infection in surgery. The clinical impact of smoking and smoking cessation: A systematic review and meta-analysis. Arch Surg. 2012;147(4):373–383. doi:10.1001/archsurg.2012.5
- Total hip replacement. American Academy of Orthopaedic Surgeons. www.orthoinfo.aaos.org, published December 2011
- Anesthesia for hip and knee surgery. American Academy of Orthopedic Surgeons. www.orthoinfo.aaos.org, published March 2014
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- Singh JA. Smoking and outcomes after knee and hip arthroplasty: A systematic review. J Rheumatol. 2011;38;1824–1834. doi: 10.3899/jrheum.101221
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