Hip Replacement Alternatives
Hip Arthroscopy
Arthroscopy is a surgical procedure using a fiber optic video camera inserted into a joint. Hip arthroscopy is performed through very small incisions in order to evaluate and treat some specific hip conditions. Arthroscopy is NOT utilized during hip replacement surgery. Hip arthroscopy can be used to treat the following:
- Loose bodies - If pieces of bone or cartilage are floating around in the hip, they can cause locking, catching and pain. They can be removed through the scope.
- Torn labrum - The labrum is a ring of cartilage around the rim of the hip socket (acetabulum). A torn labrum can cause hip pain and a catching sensation. Through the arthroscope the labrum can be cleaned up or repaired.
- Bone spurs - Sometimes bone spurs form and cause impingement and pain. If they are removed before the onset of arthritis, it can help decrease pain and improve range-of-motion.
- Cartilage damage - If an isolated area of cartilage is damaged, sometimes it helps to scrape the affected area and drill holes in the bone to stimulate new cartilage to grow. This only has fair success and is NOT for generalized arthritis.
- Repair after trauma - Certain types of ligament tears and fractures can be repaired via arthroscopy.
- Evaluation and diagnosis - Patients with unexplained pain or locking may be evaluated through arthroscopy.
Hip Osteotomy
When a person has hip pain due to a shallow hip socket or abnormally-shaped femur, then an osteotomy may be an option for treatment. The word osteotomy simply means "cutting bone." An osteotomy of the pelvis or femur can correct a hip deformity and therefore decrease pain and improve function.
In adults, the most common reason to have an osteotomy is to correct a shallow hip socket (acetabular dysplasia). If a young person has dysplasia that is causing arthritis and hip pain, then he or she may be a candidate for an osteotomy. For most middle-aged and older adults who have dysplasia and hip arthritis, a hip replacement would be the usual recommendation.
There are only a small number of orthopedic surgeons in the U.S. who are skilled at doing osteotomies. Dr. Jana prefers not to do osteotomies and most of his patients do not require this procedure. However, if his patient is a candidate for osteotomy, Dr. Jana would refer him or her to the appropriate orthopedic sub-specialist.
When a person has hip pain due to a shallow hip socket or abnormally-shaped femur, then an osteotomy may be an option for treatment. The word osteotomy simply means "cutting bone." An osteotomy of the pelvis or femur can correct a hip deformity and therefore decrease pain and improve function.
In adults, the most common reason to have an osteotomy is to correct a shallow hip socket (acetabular dysplasia). If a young person has dysplasia that is causing arthritis and hip pain, then he or she may be a candidate for an osteotomy. For most middle-aged and older adults who have dysplasia and hip arthritis, a hip replacement would be the usual recommendation.
There are only a small number of orthopedic surgeons in the U.S. who are skilled at doing osteotomies. Dr. Jana prefers not to do osteotomies and most of his patients do not require this procedure. However, if his patient is a candidate for osteotomy, Dr. Jana would refer him or her to the appropriate orthopedic sub-specialist.
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Hip Resurfacing (Birmingham Hip)
Hip resurfacing or Birmingham Hip is a type of hip replacement. Currently, there are a lot of misconceptions about this procedure due to misleading advertisements. Below are some facts about this procedure: Hip resurfacing is different from traditional total hip replacement in that the head of the femur is not removed. Instead, it is shaped with tools and then a metal cap is placed on top. Hip resurfacing is not a new procedure. It was developed, used and subsequently abandoned more than 25 years ago because of extremely high rates of wear of the polyethylene socket (cup) resulting in bone damage, loosening and need for early revision surgery. To solve this problem, modern day hip resurfacing uses a metal socket rather than polyethylene. Hip resurfacing and traditional hip replacement are equally invasive. The surgical approach is unchanged - incision length is the same or longer for hip resurfacing and the same muscles are cut. Today’s hip resurfacing has not been shown to improve patient outcomes:
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While the theoretical benefits of hip resurfacing include removal of less bone from the top of the femur, the reality is that modern-day cementless femoral stems are incredibly reliable and durable. Simply put, femoral bone loss has not been an area of concern for hip surgeons. The data shows that more than 95% of cementless femoral stems are still functioning well after 20 years of use.
There are still several unresolved issues and concerns with hip resurfacing arthroplasty, including:
There are still several unresolved issues and concerns with hip resurfacing arthroplasty, including:
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Hip resurfacing requires use of a metal-on-metal ball and socket. There are now many reports of patients having severe reactions to the metallic debris that is produced with metal-on-metal hips. This can result in the need for repeat surgery and in some cases results in irreparable damage to bone and muscle.
In summary, hip resurfacing arthroplasty may be a reasonable option for patients requiring hip replacement, but it should by no means be heralded as an orthopedic breakthrough. It is simply an updated type of hip prosthesis that currently does not have any proven benefits over the current state-of-art in total hip replacement.
In summary, hip resurfacing arthroplasty may be a reasonable option for patients requiring hip replacement, but it should by no means be heralded as an orthopedic breakthrough. It is simply an updated type of hip prosthesis that currently does not have any proven benefits over the current state-of-art in total hip replacement.
