Hip Resurfacing Frequently Asked Questions

Finding a Hip Solution

• What is the best hip resurfacing device?
  The devices that are currently marketed in the United States, namely the Smith and Nephew Birmingham Hip Resurfacing (BHR), the Microport (formerly Wright) Conserve Plus, the Biomet Recap and Corin Cormet have excellent results from experienced surgeons. Beyond that, the quality of your surgeon and care of placement will make more of a difference than the brand name. Some published results for the different devices can be found on our Surfacehippy files page.
  
  
• I have one of the re-called devices, should I have it removed?
  The primary issue with the devices like the Depuy ASR is that the design was such that it required very precise placement. Although there are an abnormally large number of those devices that had early failures, if yours is within tolerance you may still enjoy many years of service from the hip. It is advisable though to see your surgeon and have it evaluated. You should also have your blood metal levels checked periodically for early detection of potential problems.
  
  
• Who is the ideal candidate for hip resurfacing surgery?
  The ideal candidate is a young, active male with a diagnosis of osteoarthritis and dense bones. More details can be found on our Benefits and Risks Page. A surgeon experienced with hip resurfacing surgery can evaluate your specific situation.
  
  
• Can women have hip resurfacing surgery?
  Yes, hip resurfacing can be done on women. However, clinical studies and joint registry data have identified some additional risk of early failure for smaller, female paitients and patients with dysplasia or avascular necrosis (AVN). More women than men have dysplasia. So resufacing becomes a risk-reward trade off. Some surgeons have decided that the reward for female patients is not worth the additional risk compared to other surgical options. Those surgeons will not do hip resurfacing on women. Others may only accept females with osteoarthritis and/or bones of a certain minimum density. In our Surfacehippy surgeon fact sheets we have tried to identify any firm selection criteria that each surgeon might use.
  
  
• There seem to be a few surgeons who are mentioned prominently in online forums, etc. Do I need to use one of those surgeons?
  No, it is not necessary to use a "rock star" surgeon. Over the years the surgeons who are considered a rock-star surgeon have varied. It is very important to find an experienced surgeon, however, and you can start by looking at the list of surgeons on our experienced hip resurfacing surgeons page.
  
  
• How much surgical experience is necessary?
  Hip resurfacing is more challenging than the typical hip replacement. It is important that the surgeon install the components of the hip resurfacing device at the propoer angles. Research has shown that there is improvement in angle of placement up to about 100 resurfacings, so about 150 should be sufficient. The further you are from the ideal candidate profile, the more experience is necessary to insure that your surgeon has had experience with patients like you.
  
  
• Should I go overseas for surgery?
  Generally that is not necessary, and poses additional risk of deep vein thrombosis (DVT) if long plane flights are required. In the early days, before hip resurfacing was approved in the United States it was more common for people to travel overseas to find an experienced hip resurfacing surgeon. More recently, some people lacking health insurance or unable to get insurance approval for hip resurfacing in the United States or Canada have traveled overseas (to England, Belgium or India, for example) to save money when paying cash or to see a surgeon willing to take on their higher risk case.
  
  
• How can I find someone who has been treated by a specific surgeon?
  You can introduce yourself and post a question about the surgeon to the group. You can also search the archive of more than 170 thousand past messages to the group. To search, login to your Yahoo account and go to the Yahoo Surfacehippy group site. Locate the search box near the top of the page labelled "Search Conversations". Enter your doctor's name in the search box. Click on "Search Groups". When the search results appear, click using the right mouse button to open the messages in a separate window, leaving the search results in the original window. This will help you navigate through the search results without re-entering the search string.
  
  
• Why is my experienced surgeon not included in your surgeon fact sheets?
  Many of the fact sheets have been contributed by patients of the respective surgeons. We need to know about your surgeon. If he/she is experienced, use the following embedded links to download a blank fact sheet in either RTF or Word Format. Please complete as much of the form as possible and return it to kbrews AT cox DOT net. The moderator will check the form, convert to pdf, and post to the group website.
  
  
• Is it important to have a device that has not been heat treated? While the developer if the BHR claims that heat treatment softens the metal, the hardness of cobalt-chrome is primarily due to the presence of carbide and hardness is only one factor affecting metal-on-metal wear. All the devices cited above are made of high-carbide ASTM F75 Cobalt-Chrome. Side by side wear tests by one surgeon actually show the Conserve Plus wears at a lower rate than the BHR.
  
  
• Wouldn't a ceramic-on-ceramic hip resurfacing device have less wear?
  Possibly, but ceramic components need to be quite large to avoid breakage making the actabular component of a hip resurfacing device unacceptably large. Attempts to create hip resurfacing devices with ceramic coatings on a metal base have not been successful when implanted in humans.
  
  
• Can my hip pain be cured with hip arthroscopy rather than resurfacing? A few hip issues may be addressed with hip arthroscopy, permanently or temporarily. It is not as commonly helpful as in knees and shoulders, however. Femoraoacetabular impingement (FAI), snapping hip and some forms of dysplasia are among the conditions that may be successfully treated with arthroscopy. Lack of cartilage due to osteoarthritis (bone-on-bone wear) is not treatable with arthroscopy. Have your hip evaluated by a surgeon to see if this could be effective for your specific situation.
  
  
• Are there new materials or treatments that are available now or in the near future to stave-off or completely avoid surgery?
  From time-to-time articles are published touting cartilage replacement systems or stem cell treatments to restore cartilage. While these seem promising for the future, to date these are not proven in clinical use. Furthermore, if you have a chronic mechanical defect in your joint it may wear-out any replaced cartilage, so such treatments may not address the root cause of your hip pain. if you still have some cartilage remaining you might consider helping lubricate the joint by taking a liquid hyaluronic acid supplement.
  
  
• How do I know when it is time to have surgery?
  This is a very personal decision that depends on your life situation, your job and your threshold of pain. Basically if your hip problem is significantly detracting from your quality of life, ability to make a living, or ability to care for your children or dependents, you should get your hip problem addressed surgically. Pain relief using narcotics is not good in the long term as it can lead to dependence. Also, even if you are able to tough-out the pain, continuing to use a hip that is wearing bone-on-bone may lead to the formation of cysts in the femoral head that can weaken your femoral head and make you ineligible for hip resurfacing.
  
  

Recovery from Surgery

• How long does it take to recover from surgery?
  The time for recovery varies a lot and is dependent on the length and complexity of surgery, the hip diagnosis (hip dysplasia generally requiring longer recovery than osteoarthritis), and the physical condition of the patient going into surgery. Generally you can plan for about a week of major downtime, a few weeks of reduced productivity during initial recovery, while final recovery to a perfectly normal gait may take up to a year
  
  
• How long after surgery can I travel?
  Traveling presents additional risks, including the risk of blood clots known as deep vein thrombosis or DVT. Consult with your surgeon on this, but generally at 7-10 days post-op is safe. The surgeon should provide a DVT prevention protocol, which may involve blood thinners like Warfarin or Lovenox, and/or regular exercises to maintain blood flow while confined to a car or airplane.
  
  
• What physcial therapy is required after surgery?
  Immediately after surgery you will be instructed in some simple exercises to do in bed and taught how to walk with crutches. Walking with crutches is generally recommended for the first 6 weeks or so, then a more extensive physical therapy can be prescribed to help the patient regain range of motion and restore a natural gait.
  
  
• What restrictions will I have after surgery?
  Restrictions immediately after surgery will depend on the surgical approached used. The most common approach and the one offering the best visibility for the surgeon is the posterior approach. In order to preven dislocation most patients will be asked to obey the 90-degree rule (do not sit with your hip at angle of 90 degrees or more - knees should not be above hip) for the first 4-6 weeks after surgery with the posterior approach - until the soft tissue around the joint is healed. After that time a resurfacing patient may have little to no restrictions on movement and activities. Some surgeons may ask you to avoid bungie jumping or skydiving. Consult your surgeon for his protocol and activity restrictions.
  
  

Long-term Questions

• Where can I get a blood metal test
  Periodic testing for blood levels of cobalt and chromium is suggested as a way to monitor the status of the joint as well as to avoid very high metal levels of metal which may cause other systemic health issues. You can get an order for a blood metals test from your surgeon or primary care physician (Cobalt: CPT Code 83018 and Chromium: CPT Code 82495). Major labs such as LabCorp and Quest in the United States can do the test. Try to use the same lab for each subsequent test as each may have slightly different methods of measuring and mixing different methods might give a false indication of change of blood levels from one measurement to the next.
  
  
• What are the units of blood metal test results?
  Blood metal levels are most often reported in units of micrograms per liter (μg/L) or, equivalently, parts per billion (ppb). In some countries the results are reported as nanomoles per milliliter. Because of differences in molecular weight, the conversion formula is different for cobalt and chromium. To convert cobalt measurements multiply micromoles per liter by 0.059 and for chromium multiply by 0.052. So, for example, in the the case of 50 nmoles/L of each, you end up with 2.95 μg/L cobalt and 2.60 μg/L chromium.
  
  
• What are typical results for blood metal tests?
  0 - 5 μg/L Excellent
  5 - 7 μg/L Good
  7- 10 μg/L Marginal
  > 10 μg/L Reason to perform additional testing for improper fit or excess wear
  Note: There may be a period of run-in wear in the first year or two (depending on activity level) with somewhat elevated metal levels that may subside over time as the head and cup become custom polished with time.
  
  
• My blood metal tests are high, will I need a revision?
  High levels of metal could indicate a need for revision, but revision is rarely done based on blood metal readings alone. Consult with your surgeon for further examination. Further examination may include an MRI using the MARS (metal artifact reduction sequence) technique, physical examination, and/or aspiration of fluids from the hip joint capsule.
  
  
• Is there any way to reduce the blood metal levels for a well-functioning hip?
  You may want to consider the methods outlined in the Proposed Metal Defense Protocol. Methods have not yet been clinically tested, but based on scientific research of the individual components.