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Surface Hip Replacement

Surface Hip Replacement

Surface Hip Replacement

Total hip replacement surgery is a highly successful procedure for patients crippled with arthritis of the hip joint. This operation is now done in patients at younger and younger age group because arthritis, from various causes, can damage hip joint at any age. Younger patients live longer and continue to pursue full and active life style even after hip replacement surgery. Their desire is for early and complete return of function with no limitations on their activities. Their active life style places a lot of stress on the artificial implant and affect the survivorship outcome of conventional total hip replacement surgery in younger patients inferior to those in elderly age group.

Surface replacement is one of the newer technology in total hip replacement surgery designed to endure challenges placed on artificial implant by young and high demand patients.

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What is Surface Hip Replacement?

Surface Hip Replacement is different from conventional total hip replacement:

  • On the femur side, head is not sacrificed, rather it is reshapened and replaced with a snugly fitted metal lining cup (e.g. capping a tooth)
  • Artificial ball on the femoral side is same as the original femoral head unlike conventional total hip replacement.
  • Acetabular cup / Socket does not have any plastic component, rather it has metal lining, therefore unlike conventional total hip replacement it has metal on metal lining on both side.

What are the advantages of Surface Hip Replacement?

As compare to conventional hip replacement surface replacement is more stable, allows more movements, have negligible risk of dislocations and majority of them have high level of patient satisfaction. A patient can squat / sit cross-legged on floor and thereby able to pursue lifestyle activities to suite our Indian culture, something forbidden with conventional total hip replacement. Patient can also start moderate impact sports activity as well. As capping of femoral head is done and medullary canal is not violated, repeat (revision) surgery is just like doing conventional hip replacement surgery on femoral side, therefore it is also known as bone preserving hip operation. They are in use for the last 10 – 15 yrs and in these times more percentage of surface hip replacement patients are surviving in comparison to conventional total hip replacement, except for increase complication in the first few months.

What are the disadvantages of Surface Hip Replacement?

Surface hip replacement is technically a high demand surgery and is not meant for every arthritic hip. We choose our patient carefully to achieve desirable success after surface hip replacement.

Concern of high metal ions in the body: As surface hip replacement has metal lining on both sides (compare to metal on plastic in conventional hip replacement) there is increase in metal ion particles concentration after surgery in patients' blood sample, especially in the first two years. Can metal ions cause cancer in long term has been a concern, however not even a single reported case even with older generation of metal on metal prosthesis done over 30 years ago.

Similarly metal ions can cross-placental barrier; therefore women of childbearing age should be careful in choosing this option.

Patients with renal failure or those who are prone to develop end stage renal disease should refrain from choosing surface hip replacement or metal on metal prosthesis.

Who is not a suitable patient for Surface Hip Replacement?

  • Insufficient bone stock
  • Poor bone quality: Osteoporosis / Osteomalacia
  • De-compensated renal insufficiency
  • Severe femoral head deformity / head neck ratio < 2
  • Alcohol and/or drug abuse
  • Known allergy to one of the constituents of the implant
  • Postmenopausal women
  • Child bearing age women

What are the benefits of Surface Hip Replacement?

Surface total hip gives you a very stable hip with virtually a normal range of motion and allows higher activity after surgery compare to conventional total hip replacement. As chances of dislocation are less, you are allowed to do most of the activities of daily living very early. However, sitting cross leg on floor and squatting is allowed after 4 – 6 months of surgery, so as to allow the artificial cup to get integrated with the bone in patient's acetabulum or socket.

You are requested to refrain from high impact sports / jumping etc., even you see advertisement or patient story on Internet, as this increases the risk of fracture of neck of femur.

All joint replacement surgeries have some complications, however they are very few. The advantage of Surface Total Hip is that it allows the option of a total hip if it fails then a standard total hip stem can be used during revision surgery. For younger or more active patients who are more likely to cause an implant to come loose, this can be a great advantage.

8 wks after surgery
5 wks after surgery
2 wks after surgery
12 wks after surgery
Before surgery
After surgery
Preop X-ray
Postop X-ray


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