Hip Joint Preservation Surgery, Hip Resurfacing, Revision Hip Replacement

Hip pain can be excruciatingly painful, leading to disruption in everyday activities such as walking, running, driving, sitting, playing sports, and even sleeping. This debilitating pain can cause patients to avoid sitting or working for a prolonged period of time, leading to more complications such as more stiffness, more pain, and even weight gain. Hip pain requires medical intervention to relieve pain, regain the optimum level of activity, and improve quality of life.

Several forms of treatment are available for relieving hip pain, such as total hip replacement surgery, but preserving the hip joint may be the main goal, especially for those who wish to regain maximum activity after surgery. 

Revision Hip Replacement Surgery

Revision Hip Replacement (RIR) surgery is a surgical procedure for correcting any damage done to the artificial hips after a Total Hip Replacement (THR) surgery as a result of normal wear and tear of the implants or due to loosening of the implants. There can be other reasons for performing a Revision Hip Replacement surgery, such as dislocation, infection, alignment issues, and broken bones around the implants. The goal of Revision Hip Replacement surgery is to improve the function of the hips.

Revision Hip Replacement surgery is usually performed in elderly patients who have already undergone total hip replacement surgery. During a revision hip surgery, a part or all of the artificial hip joint may be removed and replaced with a new one. In case the surgery is required due to an infection, the treatment may be performed in two stages. During the first stage, the artificial joint may be removed, and the infection may be treated first. After the infection has cleared, a new artificial hip may be placed in its place.

Risks & Benefits of Revision Hip Replacement Surgery

While Revision Hip Replacement surgery can help relieve pain and improve mobility, strength and coordination of the torso and leg, there can be certain complications, which may include the following:

• Lung or heart complications due to anaesthesia
• Blood clot
• Scarring
• Recurrent infection
• Need for additional revision surgeries

Alternative Options

Hip resurfacing, also known as surface replacement, is an alternative to Total Hip Replacement (THR); thus, indirectly, it helps to avoid painful complications of THR as well as that of Revision Hip Replacement surgery. Hip resurfacing is predominantly a hip preservation surgery that preserves part of the natural bone structure. Hip preservation is based on the idea of improving the mechanics of hip joints surgically to address common hip problems at an early stage with a goal to delay or prevent painful arthritis that would require total hip replacement surgery.

Hip Resurfacing Surgery

Hip Resurfacing, a form of hip replacement surgery, involves trimming the damaged bone and cartilage of the hips and replacing the trimmed area of the bone with a smooth metal cap on top. Hip resurfacing is different from hip replacement in the sense that only a part of the hip is trimmed, and most of the bones in the hip joint are retained instead of being removed completely and replaced with the new metal hip socket implant.

Hip Joint Preservation

Hip joint preservation pertains to the preservation of the hip joint of a person in certain cases of defects and diseases of the hip joint. Preservation of the hip joint is a multimodal approach with comprehensive objectives aiming to restore normal functional movement of the hips and eliminate pain. Hip preservation also aims at preventing and/or delaying arthritis while retaining the health and optimum activity level of adolescents and young adults.

Some of the hip joint conditions that may benefit from hip preservation include:

• Hip dysplasia

The hip joint is in the form of a ball and socket in which the top head of the thigh bone (femur) sits into the pelvic socket and is known as the acetabulum. When the socket does not cover the head of the femur bone adequately, the condition is known as hip dysplasia.

• Femoroacetabular Impingement (FAI)

Hip impingement or Femoroacetabular Impingement is the condition of the hip joint in which the ball and the socket both have irregularities in their shapes, leading to the wearing off of the hip joint.

• Tear in the Labrum

A hip labral tear is most commonly caused by an underlying condition. Treating hip labral tear involves understanding the underlying cause of labral tear and treating it to restore the function of the hip joint completely and minimise the chance of recurrent injury. If a condition of hip dysplasia or hip impingement is left untreated for a long time, it may lead to painful arthritis. This may require treatment through hip replacement surgery.

• Perthes’ Disease

Perthes’ disease is a paediatric condition affecting children under the age of 12 years wherein the blood supply is disrupted, causing the hip bones to deteriorate. This can lead to pain, limping, and limited movement of the hip joint.

• Slipped Capital Femoral Epiphysis (SCFE)

Slipped Capital Femoral Epiphysis is a paediatric hip condition that can occur in the preteens or teenage years in which the head of the femoral bone slips off the neck of the bone and falls in the backward direction. This condition develops gradually over time and can cause stiffness, pain, and instability in the affected hip.

• Avascular necrosis (AVN)

Avascular necrosis is a condition in which the femoral head loses supply of blood, leading to the death of the affected part of the bone. Although the dead part of the bone may be replaced by newer bone tissues gradually, the newer bone that grows in its place is usually weaker than the original bone and cannot tolerate the weight put on it and eventually collapses. This irregularity in the bone over time results in the wearing away of the cartilage in the hip joint, ultimately causing arthritis.

Surgical Procedures for Hip Preservation

There are a few minimally invasive surgical procedures available for treatment depending on the objective of surgery and the condition to be treated. Some of these procedures include the following:

• Hip Arthroscopy

Hip Arthroscopy is a minimally invasive surgery used to treat labral tears that may have been caused by conditions such as hip dysplasia or hip impingement. Hip arthroscopy also helps to correct underlying structural problems in the hips as a result of the labral tear.

• Periacetabular Osteotomy (PAO)

The condition of hip dysplasia is treated by this procedure by chafing the bone around the hip socket, allowing surgeons to reposition the socket to provide the required coverage in the area of the hips. When used in the case of early-stage hip dysplasia, periacetabular osteotomy can help to reduce pain in the hips and preserve functionality of the hips.

• Core Decompression with Free Vascularized Fibular Grafting (FVFG)

This procedure is specially employed for the treatment of AVN in the head of the femur, wherein the dead part of the hip bone is removed, and a part of the bone, along with the blood vessels around the bone, is inserted from the fibula. This allows the new bone to replace the femoral head, which can help regain the normal functioning of the hips.

• Core Decompression with Subchondral Graft

A tiny part of the avascular necrosis in the hips may not be treated with FVFG; instead, core decompression can be performed with bone grafting. This can be placed right under the subchondral cartilage surface.

Comprehensive Treatment from World-Class Doctors

At Apollo Hospitals, Karnataka, the best orthopaedic hospital in Bangalore, we are committed to providing advanced forms of treatment using state-of-the-art facilities and minimally invasive equipment to ensure the best-in-class treatment of our patients. With support from highly qualified orthopaedic surgeons and interdisciplinary orthopaedic specialists possessing vast experience and skills in treating orthopaedic surgeries over the years, we have been exemplary in delivering various innovative orthopaedic treatments with incredible rate of success over the past years.