Debilitating hip pain can hold you back from a lot of things, which can be frustrating especially for those who are physically active. The impairment can impede you from doing sports and other simple tasks. However, when the problem affects younger individuals a Birmingham Hip Arthroplasty has been known as a dependable solution.
To understand why this is a good treatment for some, but not for others, we answered 10 important questions about this procedure.
Basic Hip Anatomy
Our thigh bones (femur) are connected to the hip bones (pelvis) by two ball-and-socket joints. The top portion of your femur is called a “ball”, also referred to as the femoral head, and it fits perfectly into the “sockets” (acetabulum) of the pelvis.
When you move, the femoral head glides inside the socket which is also lined with cartilage for smooth and painless movement. However, any damage to this joint can make any hip motion painful as the bones rub against each other abnormally.
1. What is hip resurfacing?
Having started in the seventies, hip resurfacing is not a new concept. It’s a bone-preserving approach to hip arthroplasty designed for younger patients. Previous versions were marred by early failure rate caused by a femoral neck fracture and loosening at the sockets.
However, today’s resurfacing has gone a long way, marked by three major changes to “get it right”. This includes implant materials and design, modernised instrumentation, and refined surgical technique.
Over the years, hip resurfacing has proven to be a dependable option to relieve hip pain. A total hip replacement would have been the conventional solution, but hip resurfacing offers a different approach in replacing worn-out joints in the right patients without invading the thigh bone.
In a resurfacing procedure, an orthopaedic surgeon trims and caps the femoral head and fashions it to fit the smooth metal covering. The hip bone socket is also resurfaced and placed with a metal shell to create a metal-on-metal joint.
2. What is Birmingham Hip Arthroplasty?
The Birmingham Hip is the face of hip resurfacing today. It was designed by Ronan Treacy and Derek McMinn in its namesake city in England and was first implanted in 1997.
There have been several other devices in the past, but they have all exited the market either by recalls, withdrawals, and high incidence of complications. But, there is one that stood out, and that is the Birmingham Hip System.
This prosthesis is a two-part system which involves a metal cap placed over the resurfaced femoral ball, just like a crown on a tooth. On the other side, the pelvic socket (acetabulum) is press-fitted with a metal cup resulting in a metal-on-metal joint with both pieces made out of an alloy of cobalt-chromium – a durable metal used in artificial implants today. This metal composition reduces wear by virtue of its hardness.
The outer surface in a Birmingham prosthesis is designed to be roughened and porous to allow for bone growth when implanted. It also comes with a short stem that measures approximately 1-2 inches which allows it to be inserted with the proper orientation and alignment.
3. What are the benefits of a Birmingham Hip Arthroplasty?
Hip resurfacing has been an attractive option particularly in patients who are likely to need revision hip replacements in their lifetime. Since it focuses on replacing the portion of the joint that is damaged with a natural shape, it skips the need to overhaul the entire hip joint.
Activity and bone preservation are two of the main advantages of a Birmingham Hip Arthroplasty. Along with its perceived advantages in bone conservation, improvements in materials, design, and manufacturing techniques bolstered the quality of results.
Its design allowed minimal bone loss and the large diameter of the articulation ensures stability and longevity. This also reduces the risk for dislocation and inaccurate leg length following surgery, which then encourages the optimal range of motion. Soon after recovery, patients can be as active as they want.
Another advantage is the fact that Birmingham Hip doesn’t involve femoral canal reaming due to its shorter stem, it theoretically reduces the risk of having pieces of fat getting lodged into blood vessels in the lung (fat embolism) during the operation.
This approach also benefits the surgeon because it gives relative ease of revision if it fails. Furthermore, less bone work involved means less pain. Consequently, it results in a quicker rehabilitation and recovery.
4. What are the risks of hip resurfacing?
As a surgical procedure that creates some degree of bone trauma, a hip resurfacing treatment comes with the following risks:
- Excess bleeding
- Blood clots
- Injury to nearby nerves
- Complications from anaesthesia
Your own risks of complications may vary according to your age and existing conditions. However, the benefits far outweigh the risks. Therefore, a thorough discussion and evaluation must be done with an orthopaedic surgeon to know what risks apply to you.
5. Who are the right patients for Birmingham Hip Arthroplasty?
Not everyone can be a suitable patient for this procedure. Selection should be thorough to ensure that patients getting this type of prosthesis has the physiological capacity and pathology to warrant the need for a Birmingham Hip.
Here are certain factors orthopaedic surgeons look for in potential candidates:
1. A person with non-inflammatory hip arthritis (e.g. osteoarthritis or traumatic arthritis) and inflammatory arthritis (e.g. rheumatoid arthritis) but are too young and active to have a hip replacement.
2. Men less than 65 and women less than 60 years old.
Your suitability is determined by your surgeon, which involves an evaluation of your bone quality and the size of your femoral head. Therefore, it’s important that you openly discuss your options with your surgeon.
6. Are there certain considerations women must make about bone resurfacing?
In its infancy, hip resurfacing was offered to young male and female patients. However, published results revealed that females had a higher revision rate and poorer outcome. Therefore, this approach should be used with caution in women. For that, it has a narrower window of selection for females due to factors like child-bearing earlier in life and bone density later in life.
The decrease in bone quality which occurs during menopause would lead doctors to suggest bone density tests to make sure that bone quality is good before hip resurfacing is considered.
7. What can I expect in the immediate post-op period?
Generally, you may have to stay in admission for a day or two. However, this may vary depending on the extent of your hip injury or other medical conditions.
People are usually up and walking the day of surgery, and some pain around the incisions can be expected, but it can be relieved with pain medications. You should also be able to resume a full diet. An X-ray will also be requested to check if your surgery has been successful.
8. What is the recovery period like?
Your recovery will usually begin the day after surgery. A rehabilitation team will work with you to provide the proper care and encouragement you need during the vulnerable post-surgical period. Therapy can last four to six weeks at most.
Basic precautions involve instructions on when you can put weight on your leg. Assistive devices such as cane and crutches are often needed for a few days or weeks, and a physical therapist will teach you how to do this properly. Therapy is also invaluable because from it you can be trained on how to perform basic tasks such as moving up and down the bed, transition from sitting to standing, sitting to lying, etc. While these may be simple tasks, learning to do them safely is necessary to protect the hip from accidents and injuries.
With the right conditioning, the hip can regain strength and maintain a good range of motion. Patients often resume regular activities within six weeks of the surgery.
9. How do I care for my surgical wound properly?
While at home, you can expect to see some fluid draining from your incision. While this is normal, you should always be keen to observe for any changes. For instance, if the drain from the incisions turns yellow or white, and is accompanied by an increase in redness, swelling, or severe pain. If you experience any of these symptoms, inform your healthcare provider right away. To avoid complications, see to it that you follow post-op appointments with your orthopaedic surgeon. After a week or so after surgery, the staples or stitches may be removed.
10. Why should you consider a Birmingham Hip Arthroplasty?
The Birmingham Hip resurfacing technique has provided long-term successful outcomes around the globe in more than two decades of being used in practice.
The low-friction, low-wear, high-biocompatibility properties of metal-on-metal devices make this prosthesis an optimal bearing for hip resurfacings. This is beneficial for younger patients who wish to have a chance to return to impact activities or those that require a wide range of motion, with lower risks for dislocations. It allows individuals to resume physical activities not possible with traditional hip replacement.
There is no form of hip replacement that can last forever. So, if you’re younger, we know that you are going to need a revision down the line. In this case, it’s easier to revise a resurfacing than a traditional total hip replacement, giving you an “extra bite off the cherry” in terms of hip operations.