Both sides of the story

By Dr. James Capozzi

Two dilemmas facing hip surgeons in treating young, active patients with severe hip arthritis are: when is the appropriate time to have a hip replacement and what type of implant should be used. Traditional thinking recommends postponing hip replacement surgery for as long as possible since older patients are less abusive to their implants and tend to have greater implant longevity.  However, many younger patients are so debilitated by their arthritis that something must be done.

Recently, there has been a great interest in hip resurfacing procedures as opposed to total hip replacements for these younger patients.  The theory being that hip resurfacing allows the patient to keep more of their own bone which would then be available for future hip operations.  Additional advantages touted are metal on metal surfaces have better wear properties than traditional metal on plastic (polyethylene), larger implant head sizes dislocate less frequently and patients have a greater range of motion of their hips.

Although these advantages may bear out over time, patients contemplating hip resurfacing surgery must keep in mind that there are also well documented concerns and complications with these procedures. Because more bone is left in place during the operation, the surgical incision must be significantly longer than the smaller incisions routinely used for total hip replacements.  Metal on metal surfaces do release metallic ions which have been associated with the development of certain cancers as well as, non-cancerous growths.  There have been a significant number of femoral neck fractures reported especially in female patients. Lastly, these procedures are considered time-buying procedures.  Patients need to understand that they will most likely undergo additional surgical procedures in the future.

Activity After Joint Replacement Surgery

The primary goal of hip replacement surgery is to relieve patients’ pain but also to help them return to active lifestyles.  Although exercise and sports are strongly encouraged after surgery, certain activities may be harmful to the joint replacement.  High impact or repetitive impact activities can lead to increased implant wear and eventual loosening.  Both conditions will likely require additional surgery to correct the problem.  Joint replacement surgeons and their patients, therefore, would like the implants to last as long as possible and remain well fixed within the bone.

Although each case is different and surgeons may differ widely in what they allow their joint replacement patients to do after surgery, in general, most surgeons recommend that their patients refrain from high impact or repetitive impact sports.

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