Hip resurfacing (hip arthroplasty)

Published by Bupa's Health Information Team, October 2010.

This factsheet is for people who are having a hip resurfacing operation, or who would like information about it.

Hip resurfacing replaces diseased or damaged surfaces in the hip joint with metal implants. Less bone is removed for hip resurfacing making it easier to repeat the operation or to have a total hip replacement in later years.

You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

How hip resurfacing is carried out

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About hip resurfacing

Your hip is a ball and socket joint. Normally, the ball at the top of your thigh bone moves smoothly in the socket of your pelvis (hip) on a lining of cartilage. The cartilage stops the bones from rubbing together. If the cartilage is worn away, the underlying bone is exposed and your joint becomes painful and stiff. As a result, walking and moving around becomes painful.

Hip resurfacing (also called metal on metal hip resurfacing arthroplasty) can help to improve your mobility and reduce pain. In this operation, metal caps (like half a tennis ball) are fitted onto the damaged surfaces of the ball and socket of your hip joint. A hip resurfacing operation can help to improve your quality of life; however, it's not suitable for everyone.

Your surgeon may recommend that you have a hip resurfacing operation if you're under 65 and have an active lifestyle. If you have weak bones or a difference in leg lengths, then you are unlikely to be suitable for resurfacing.

What are the alternatives to hip resurfacing?

Surgery is usually recommended only if non-surgical treatments, such as taking painkillers (eg paracetamol) or anti-inflammatories (eg ibuprofen), or using physical aids like a walking stick, no longer help to reduce your pain or improve your mobility.

Depending on how badly your hip joint is damaged, your surgeon may recommend a total hip replacement. Your surgeon will explain your options to you.

Preparing for your operation

Your surgeon will explain how to prepare for your operation. For example, if you smoke you will be asked to stop, as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.

The operation is usually done under general anaesthesia. This means you will be asleep during the operation. Alternatively, you may have the surgery under spinal or epidural anaesthesia. This completely blocks feeling from below your waist and you stay awake 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 will 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 before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

You will be asked to give your consent to have your name on the National Joint Register, which is used to follow up the safety, durability and effectiveness of joint replacements and implants.

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 need to have an injection of an anticlotting medicine called heparin as well as, or instead of, wearing compression stockings.

About the operation

Hip resurfacing usually takes around two hours.

Your surgeon will make a cut over your hip and thigh and separate the ball and socket (hip joint).

The worn surfaces of the thigh bone and hip socket will be carefully removed. The remaining bone will be cleaned and covered with metal surfaces.

Your surgeon will close the cut with stitches or clips and cover it with a dressing.

What to expect afterwards

You will 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. 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.

You may have to wear special pads, attached to an intermittent compression pump, on your lower legs. The pump inflates the pads and encourages healthy blood flow in your legs and helps to prevent DVT. You will be encouraged to get out of bed and move around as this helps prevent chest infections and blood clots in your legs.

A physiotherapist (a health professional who specialises in maintaining and improving movement and mobility) will usually visit you each day to guide you through exercises that are designed to help your recovery.

You will stay in hospital until you're able to walk safely with the aid of sticks or crutches. This is usually about five days. However, if you're generally fit and well, your surgeon may suggest you do an accelerated rehabilitation programme, where you start walking on the day of the operation and are discharged within one to three days.

When you're ready to go home, you will need to arrange for someone to drive you home.

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 or clips will usually be removed after 12 to 14 days.

Recovering from hip resurfacing

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

The exercises recommended by your physiotherapist are a crucial 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, you shouldn'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 will find some routine activities, such as shopping, difficult for a few weeks and will need to ask for help. You will need to use crutches for about four to six weeks.

You may be asked to continue wearing your compression stockings for a few weeks at home.

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, as the length of time before you are fit to drive will depend on several factors, including which leg has been operated on and whether your car is automatic.

What are the risks?

Hip resurfacing is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications.

Side-effects

These are the unwanted but mostly temporary effects of a successful procedure, for example feeling sick as a result of the general anaesthetic.

Your hip joint will feel sore for several weeks and you may have some pain and swelling.

Complications

This is when problems occur during or after the operation. Most people are not affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, infection, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).

Complications specific to hip resurfacing are listed below.

• Joint dislocation - this is rare but if your hip comes out of joint 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 - tiny cracks can occur in your bone while fitting the new surfaces. These usually heal, but sometimes the bone can fracture and require further surgery.
  
• Loosening - the metal surfaces may become loose from your bone and you may need further surgery to correct this.

The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.