South Nassau Communities Hospital

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South Nassau in the Community

07/09/2009

Hip Resurfacing is Viable Alternative to Hip Replacement


Patients who had hip resurfacing surgery, such as the Birmingham Hip Resurfacing technique, reported a better quality of life, less pain and greater satisfaction a year after surgery than those who had a total hip replacement, according to a study presented at the American Academy of Orthopedic Surgeons (AAOS) 2009 Annual Meeting.

The study was based on data on the outcomes of 214 total hip replacement patients and 132 hip resurfacing patients that was recorded in a joint registry maintained at a single surgeon’s practice from 2003-2006. Orthopedic surgeon Dr. Elizabeth Anne Lingard of Freeman Hospital in Newcastle Upon Tyne, England, was the study’s lead researcher.

Each patient enrolled in the study completed a questionnaire preoperatively and one year after surgery. The questionnaire included the Western Ontario and MacMaster Universities Osteoarthritis Index (referred to as WOMAC, it is a 24-item questionnaire that is completed by the patient and focuses on joint pain, stiffness and loss of function related to osteoarthritis of the knee and hip) and the SF-36, a self-report questionnaire completed by the patient that measures health-related quality of life (and generates 8 subscales: physical functioning, role limitations due to physical problems, bodily pain, general health perceptions, vitality, social functioning, role-limitations due to emotional problems, and mental health; and 2 summary scores: physical component and mental component). The patients also completed a questionnaire regarding satisfaction with their procedures and outcomes one year after surgery.

The study showed that one year after surgery both groups of patients experienced significant improvements in WOMAC and SF-36. Hip-resurfacing patients, however, posted significantly higher WOMAC scores for decreased pain symptoms. When asked about patient satisfaction with the surgery, a greater number of hip-resurfacing patients said they were satisfied with their ability to perform functional activities after surgery.

“The (Birmingham) hip resurfacing technique allows me to preserve more of the patient’s natural bone structures and stability,” said Bradley Gerber, MD, Chief of Joint Replacement Surgery at South Nassau Communities Hospital. “I see hip resurfacing as the ideal solution for many of my younger, active patients who suffer from hip pain. As my patients are getting younger and younger, and are staying physically active much later in life, I’ve needed an alternative to total hip replacement that accommodates their age and lifestyle. Hip resurfacing is that alternative.”

Dr. Gerber was among the first surgeons in the U.S. to perform the Birmingham Hip Resurfacing (BHR) technique. Rather than replacing the entire hip joint, as in a total hip replacement, hip resurfacing simply shaves off the damaged cartilage and bone and a metal cap is placed onto the head of the leg bone (femur).

Total hip replacement involves the removal of the entire femoral head and neck, replacing it with a metal ball, while the BHR leaves the head and neck untouched. It is the neck length and angle that determines the natural length of a patient’s leg after surgery. Since it is not removed and replaced with an artificial device during the resurfacing procedure, there is a greater likelihood of maintaining accurate leg length.

In addition, traditional hip replacements use a plastic socket compared to the BHR implant (which is a metal socket). A plastic socket wears down over time, and may need to be replaced surgically. In fact, it is a leading cause of follow-up surgeries.

The BHR is intended for patients suffering from hip pain due to osteoarthritis, hip dysplasia (a congenital disease that, in its more severe form, can eventually cause crippling damage and painful arthritis of the joints) or avascular necrosis (a disease resulting from the temporary or permanent loss of the blood supply to the bones, often leading to collapse of the joint surface), and for whom total hip replacement may not be appropriate due to an increased level of physical activity. For these reasons, Dr. Gerber feels the BHR is ideal for patients under age 60 who live non-sedentary lifestyles.

While the BHR implant closely matches the size of a patient’s natural femoral head (hip ball), it is substantially larger than the femoral head of a traditional total hip replacement implant. This increased size translates to greater stability in the new joint, and it decreases the risk of dislocation of the implant after surgery, which is a leading cause of implant failure after total hip replacement.

In addition to the BHR, orthopedic surgeons at South Nassau’s Long Island Joint Replacement Institute specialize in custom-fitted total joint replacement as well as minimally invasive joint replacement surgery, such as the Uni-Knee® partial knee replacement and Image-Guided Knee Replacement technique. Minimally invasive joint replacement reduces trauma to surrounding tissue, blood loss during surgery, post-operative pain, and recovery time, leading to a speedier rehabilitation and return to daily activities. According to Dr. Gerber, the average length of stay of patients treated by the institute is less than 3 days, which is well below the national average.

The Joint Replacement Institute combines image-guided medical technology with minimally invasive knee replacement instrumentation. Image-guided surgical technology is used to determine the precise alignment of the replacement parts; improves the surgeon’s view of and feel for the surgical field and reduces the size of the incisions to perform a replacement.

Other procedures offered by the Institute’s physicians include reconstruction of foot and ankle injuries, pediatric orthopedics, hand and upper extremities, and meniscus cartilage transplantation and Carticel Therapy to correct recurring knee cartilage injuries.

For more information about the Long Island Joint Replacement Institute or to schedule a consultation, call 1-877-SouthNassau.



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