Patient: In the last couple of years I’ve been having pain in the right hip, during last several months the pain has become unbearable, so I am taking painkillers all the time. I can’t put on socks or tie my shoelaces. I stopped doing sports which I used to do. I can’t come to peace with the fact that at the age of 47 I am becoming an invalid, without being able to perform the normal things in life.
Doctor: Before answering your question, I will perform a clinical examination and look at the x-ray imaging of your hips.
As for the clinical features, right hip motion is restricted, exterior and interior rotations are practically blocked. Legs are equal in length. Walking with a limp.
Radiological scan of the ship shows a visable narrowing of the joint cavity with bone spurs alongside the rim.
Doctor: You have a classical hip joint arthrosis. According to the clinical features and x-ray scan, you need hip surgery, artificial hip. The question which arises is which type of endoprosthesis. There are two different types of prosthesis. Standard total prosthesis and total resurfacing prosthesis. English name hip resurfacing would be best presented by the Croatian name presvlačenje zglobnih ploha kuka (resurfacing of hip joint surfaces, or simply pokrovna proteza (resurfacing prosthesis).
Patient: what is the difference between those two prostheses?
Doctor: Standard total hip endoprosthesis consists of the body of the prosthesis, the head and the socket. In standard hip endoprosthesis, the whole thighbone head is exracted and the body of the prosthesis is inserted into the channel of the thighbone. Metal or ceramic head is then placed on the prosthesis. A metal implant for the plastic part, the so called polyethylene implant, is placed into the socket of the pelvis (acetabulum). Total hip endoprosthesis is a golden standard, especially for persons above 60 or 65 with hip osteoarthrosis. However, total hip prosthesis is not an ideal solution for active young people. Endoprosthesis record of Scandinavia showed that persons with total hip prosthesis implanted before the age of 55 have a 15 to 20 % chance for another surgery within 10 years. Every new implantation requires enough bone mass to be able to implant the prosthesis and with each new surgery there is less available bone. The risk of complications further increases. For this reason, implanting a standard hip prosthesis is avoided in caes of young active persons. Young people are much more active than the older ones so the prosthesis lifecycle is shorter in young people. The last few years saw the appearance of a new prosthesis which is recommended to the young and active. The progress of metalurgy and technology as well as that of the surgical techniques went back to the old concept; replacing only the damaged part of the hip joint. In this prosthesis what is replaced is only the worn away part of the hip joint, in fact, joint cartilage is extracted and the surfaces of the thighbone head and socket are covered with a metal prosthesis. The prosthesis consists of a metal cap which is placed on the femoral head and a metal cup in the pelvis.
Patient: What is the type of prosthesis you would recommend for me?
Doctor: Taking into consideration you are 47, the fact that you want to continue your activities, and you are a male with good, quality bone mass, I recommend total resurfacing prosthesis. Let me present to you the advantages and disadvantages of the resurfacing prosthesis.
Advantages of total resurfacing prosthesis in comparison with standard hip prosthesis:
hip anatomy is not altered, only the surface of the hip joint is covered
bone mass is preserved for any future surgeries
the hip which was subjected to surgery is better in terms of mobility, and due to larger diameter of the head of the prosthesis there is lower possibility of dislocation
the patient can cross legs, put on shoes, sit on a low chair and toilet need not be raised
using metal instead of plastic reduces the risk of osteolysis and early lossening of the prosthesis
using metal makes wearing away slower and therefore prosthesis lifecycle is longer
Disadvantages of total resurfacing prosthesis in comparison with standard hip prosthesis:
The risk of femoral neck fracture is 1% in males and 2% in females. The risk can be avoided through patient selection and good surgical technique
Potential problem because of small metal particles released into the body and excreted by urin
short monitoring time of the resurfacing prosthesis results, 10 years
counterindications in hip osteoporosis
not recommended to persons with kidney problems and women in reproductive phase
In case of complications, standard hip prosthesis is easily implanted.
Patient: Is there any difference in the surgical technique and rehabilitation between the standard and resurfacing prosthesis?
Doctor: Yes, there is. Standard hip prosthesis is nowadays implanted in a large number of hospitals. This is not so with resurfacing prosthesis. Implanting a resurfacing prosthesis is much more demanding. Experience of the surgeon and his team is essential including a well-equipped operating room. Surgery lasts longer. Rehabilitation is faster. Three months after the surgery you can go back to your everyday activities.
In short
Indication for resurfacing hip prosthesis implant is very important.
A typical candidate is a male under 60, diagnosed with arthrosis, hip dysplasia (shallow socket), avascular necrosis (death of the bone) who wants a high level of activity after the surgery. Firm bone and good bone mass is crucial for resurfacing prosthesis. Experience of the surgeon and his team is essential including a well-equipped operating room. Recovery after implanting a resurfacing prosthesis is much faster. Three months after the resurfacing prosthesis is implanted, patients can go back to everyday activities. Driving a car is allowed a month and a half after the surgery. Other activities like walking, swimming, golf etc. are allowed after 3 months. Running, skiing and similar activities are to be avoided.
It must be emphasized that the first 6 months following the surgery are very important due to bone remodelling and fixation of the implant. Any major strenuous activities are to be avoided.
Total resurfacing prosthesis of the hip is not suited for every patient. Standard hip prosthesis remains as the golden standard for all other patients.
Fig. 1 A. X-ray imaging, hip before the surgery. Secondary hip osteoarthritis, shallow acetabulum, socket. B. X-ray imaging, hip after the surgery. Standard total hip prosthesis
Fig. 2 A. Osteoarthritis of the right hip 2 B. Total hip resurfacing
