Hip hope
5/22/2009 10:51:00 PM | Author: fadzly
Hip resurfacing surgery offers relief for younger patients. SUZANNA PILLAY finds out how.

A COMMON type of hip arthritis characterised by the progressive wearing away of the cartilage of the afflicted joint, osteoarthritis can be very painful when it increases in severity.

It also affects movement, causing stiff hips, limited range of motion and an awkward gait, amongst other complaints.

“The general rule of thumb that doctors follow when dealing with patients with severe hip arthritis is to recommend total hip replacement (THR) surgery. However, they normally tell patients to wait until after they’re 60 years old, to undergo this surgery.

“THR is not done on the more active and younger patients or on athletes because the wear rates are very high,” said Dr K.

Sivanathan, consultant orthopaedic and arthroplasty surgeon, Tropicana Medical Centre in Petaling Jaya.

This is because in reality, many hip pain sufferers under the age of 60 will outlive a traditional hip replacement and may require additional surgeries (revision hip replacement surgeries) in their lifetime.

He said surgeons were concerned about possible complications that might surface in later revision surgeries because every time it is done, a larger surgery and larger implant had to be used.

Apart from revision surgery, other concerns about THR was the lack of femoral head (thighbone) preservation, reduced range of movements and higher risk of dislocation of implants in more active patients.

“If anybody were to do a THR, we would advise them not to squat or sit in a very low chair, because dislocation can occur. The implant head size is only 28mm in diameter so if you move it beyond a certain angle, the whole thing comes out, as opposed to a normal femoral head which has a higher range of movements.” Instead, younger patients were encouraged to live with their condition as best they could, dulling the pain with anti-inflammatory pain medication, joint supplements like Glucosamine and undergoing physical therapy to strengthen the muscles around the hip joint.

But today, the situation is different, thanks to improvements in hip resurfacing surgery implants. Young and active patients don’t have to live with hip pain anymore.

“Hip resurfacing surgery is an advanced surgical procedure for osteoarthritis and hip-related injuries that is suitable for younger or active patients under 60,” said Dr Sivanathan.

“The procedure is a minimally invasive, bone-conserving alternative to conventional total hip replacement because unlike THR, hip resurfacing preserves the head, neck and femur bone. “The femoral head and neck are not removed as in a THR. Instead, the femoral head is reshaped to accept a metal cap placed on the ball of the ball-and-socket hip joint, while the second piece is a cup that forms the socket of the joint. As the hip surfacing implant is made entirely of metal, there is a reduced risk of osteolysis and associated early loosening.” Another plus is that unlike THR, it also made replacement surgery easier. He said if the hip resurfacing implant wears out after 15 years or so, or developed problems, the revision surgery would simply convert it to a standard THR.

However, he said hip resurfacing surgery was not entirely without risk. If the procedure is not done correctly, the femoral neck can break. The person performing it has to be properly trained.

“Also, the hip surfacing implant has to be fitted at the correct angle and care must be taken not to notch the neck when preparing the femoral head to accept the cap.” Dr Sivanathan said patients who undergo hip resurfacing surgery would be given thromboprophylaxis during surgery and shortly after the operation to prevent deep vein thrombosis (DVT).

“It has been noted that in any surgery involving pelvic fractures, abdominal operations, hip procedures and knee replacements, there is a higher incidence of DVT because the patient would be recumbent in bed for a while.” The issue was highlighted last week (May 11-15), during Thrombosis Awareness Week. It was noted that patients going to hospitals for surgery were at risk from venous thromboembolism (VTE) where blood clots form in the leg veins (DVT), which may then break off and block blood vessels in the lungs, causing pulmonary embolism.

“Deaths from VTE can be minimised through thromboprophylaxis, which is the use of preventive medication, especially in those patients identified as bearing high risk of VTE. These include advanced age, obesity, immobility, pregnancy and past experience with DVT or PE,” said Dr Jamal Azmi Mohamad, consultant orthopaedic and trauma surgeon.

Although exact figures are unavailable, a study conducted in Malaysia among 88 patients who had undergone surgery for total knee replacement, total hip replacement and fracture of the proximal femur with no prophylaxis, found that 55 of them (62.5 per cent) showed evidence of DVT. The prevalence was highest after total knee replacement (76.5 per cent), followed by total hip replacement (64.3 per cent) and lastly, the fracture group (50 per cent).

Dr Jamal, who is also the former president of the Malaysian Orthopaedic Association, said there is a strong need to implement primary prophylaxis to prevent thrombosis, as it is potentially life-saving and more effective than treating complications that may result.

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