Hip Resurfacing for Young Active People!

Today more and more people are hearing about the benefits of hip resurfacing over conventional total hip replacement. This relatively new technology started with the invention of the “Birmingham Hip replacement” approximately 15 years ago.

  What is Hip Resurfacing

  Zimmer Durom™ Hip Resurfacing

  Smith & Nephew BIRMINGHAM HIP™ (trademark Smith & Nephew) Resurfacing (FDA Approved)

  AVN and Osteoarthritis sufferers

  Indications for Hip Resurfacing

  Contra-indications for Hip Resurfacing

  Advantages of Hip Resurfacing..

Also See...

  When Considering Surgery..

  Total Hip Replacement or Hip Resurfacing..

  Indications For Total Hip Replacement..

  Other Types of hip surgery..

  Hip Surgery Prices

  Our Belgian Partner Hospital

  The Surgeons

  Frequently Asked Questions

With Hip Resurfacing instead of the Femur being cut through just below the head, the head of the femur is capped with a ball cap. This cap is then inserted into the cup implant which is press fitted into the prepared hip socket

Indications are that this is an extremely durable solution for young and active patients that wish to keep full natural mobility and return to full active sports.

Hip resurfacing is suitable for Women below the age of 65 and Men below the age of 70 where the condition and strength of the bone is suitable.

Durom™ Hip Resurfacing..

One and a half decades of intense development, research and clinical evaluation in materials technology coupled with Swiss precision manufacturing has resulted in the emergence of Durom™ an exceptional Hip Resurfacing prosthesis.

Developed for the younger and more active patient, the Durom™ an exceptional Hip Resurfacing prosthesis is designed to provide high levels of joint stability whilst removing as little bone as possible. The articulating components are made of Metasul™ alloy ProtasulTM-21 WF, the first wrought-forged CoCr resurfacing prostheses, which is the same material used to restore the mobility of over 300,000 patients.

Design Detail
In designing the femoral component, many important factors needed to be considered. Bone conservation, precise positioning and an optimum cementing technique were of utmost importance. The guide pin, whilst removing less bone than comparable systems, allows for an ideal physiological transfer of load, whilst ensuring accurate positioning of the prostheses. The unique grooves, on the inner side, allow for even pressurisation of cement into the cancellous bone (a spongy type of bone with a very high surface area found at the ends of long bones), but avoids a taper effect, providing additional rotational stability.

Minimal Thickness with Maximum Strength
The acetabular cup is a flattened hemisphere, offering a greater range and freedom of movement. With a constant wall thickness of 4 mm throughout all sizes, the cup maintains an inner diameter as large as possible, whilst maintaining maximum implant strength and minimum bone resection. A coating of pure titanium, using a plasma spray under vacuum and static load is applied to the outer surface. This unique manufacturing method gives a surface roughness of 20–50 microns with a porosity of at least 25%, shown in vitro testing to significantly improve primary stability. As shown in laboratory tensile tests the adhesive strength of the titanium coating of 66.2–76.5 MPa, significantly exceeding FDA requirements of 22 MPa.

Lower Wear Rate
The high carbon CoCr alloy is produced by a forging rather than a casting process. This means that the size of block carbides is up to eight-times smaller compared to cast CoCr prostheses. The resulting lower surface roughness subsequently leads to a lower wear rate when compared with cast CoCr alloys. Co-28Cr-6 Mo-0,2C/ProtasulTM-21 WF (ISO 5832-12): a carbide-containing and therefore low-wear cobalt chrome alloy was chosen for MetasulTM.

The Key to Successful Resurfacing
As with almost any joint replacement system, precise and easy-to-use instruments are key to a success.
In developing of the Durom™ Hip Resurfacing the engineers not only focused on implant design and material technology but also concentrated on the surgical procedure, and how to resurface the hip in the best way possible. As a result, an ingenious method to accurately and precisely position components was created.

Low wear and greater joint stability
The large diameter of the Metasul™ ball head offers low wear coupled with greater joint stability and a high range of motion. This is available in combination with the extensive range of cemented and un-cemented femoral implants from Europe’s largest manufacturer of joint prostheses.

Designed to Outlast "Conventional" Hip Prosthesis
The Durom Hip Resurfacing has been specifically designed for use in young active patients who are likely to outlast a "conventional" hip prosthesis. Emphasis has been placed on a high quality bearing surface, preservation of bone stock and durable fixation of the components.

The Metasul bearing surface is a proven low wear, low-friction articulation, having been implanted in over 300,000 patients since 1988. No other metal-on-metal bearing has such a track record.

The Durom acetabular and femoral components have been designed to allow maximum preservation of bone stock. The wall thickness of the acetabular component is as low as practically possible and the cup subtends an angle of 165°, similar to the natural acetabulum. These features facilitate preservation of the acetabular bone stock.

The sophisticated femoral instrumentation permits very accurate positioning of the femoral component, allowing the smallest possible femoral implant to be used, which in turn, allows the insertion of the smallest possible acetabular component, again preserving acetabular bone stock.

The Porolock Ti VPS surface coating of the Durom acetabular component is vacuum plasma-sprayed pure titanium. This coating is associated with reliable bone in-growth, ensuring long-term secondary fixation. The carefully controlled vacuum spraying process results in a very high adhesive strength between the chrome cobalt substrate and the Porolock Ti VPS coating, reducing the risk of the generation of titanium 3rd-body-wear particles.

The femoral instruments produce an even cement mantle of approximately 1 mm, reducing the risk of fatigue failure of the bone cement. The recesses within the femoral component enhance rotational stability of the implant.

Smith & Nephew BIRMINGHAM HIP™ (trademark Smith & Nephew) Resurfacing (FDA Approved)

Design of the hip resurfacing started in 1989 and the first implantation was performed in February of 1991. Since 1991 500,000 have been fitted in Europe, the UK, and Australia. 10 May, 2006 US Food and Drug Administration (FDA) approved the BIRMINGHAM HIP™ (trademark Smith & Nephew)

Hip Resurfacing conserves more of a patient's bone than a traditional hip replacement, enabling younger, more active patients to undergo hip replacement surgery while preserving all future surgery options, including a primary hip replacement.

Hip Resurfacing also offers patients an increased better range of motion with a greatly reduced risk of dislocation. In our experience we have never heard of a hip resurfacing dislocating.

AVN and Osteoarthritis sufferers

Some organisations claim that hip resurfacing is an alternative to total hip replacement for patients suffering from abnormalities of the hip, including osteoarthritis. However sufferers with bone disease such as AVN and osteoarthritis should be cautious. Careful assessment of such candidates must take place before deciding whether hip resurfacing would be suitable.

Indications for Hip Resurfacing..

Hip resurfacing is most appropriate for physically active patients with good bone quality and adequate femoral and acetabular bone stock. Such patients will generally be under the age of 65. However patients with the following indications are also suitable for hip resurfacing.

• Primary Osteoarthritis
  
• Posttraumatic Osteoarthritis
  
• Secondary Osteoarthritis
  
• Avascular necrosis of the femoral head if remaining bone stock is adequate
  
• Inflammatory arthritis if bone quality is adequate
  
• Patients with a deformity of the femur and/or internal fixation device that would make insertion of a stemmed femoral component difficult
  
• Patients with a high risk of dislocation

Contraindications for Hip Resurfacing..

Patients with the following indications are NOT suitable for hip resurfacing.

• Active Infection
  
• Malignant Tumours
  
• Insufficient acetabular or femoral bone stock
  
• Poor bone quality (for example, osteoporosis, osteomalacia)
  
• Anticipated non-compliance of the patient, alcohol or drug abuse
  
• Decompensated renal insufficiency
  
• Known allergy to one of the constituents of the implant

• Femoral head is preserved.
  
• Femoral canal is preserved and no associated femoral bone loss with future revision.
  
• Also, the risk of microfracture of femur with uncemented stem implantation is eliminated.
  
• Larger size of implant "ball" reduces the risk of dislocation significantly.
  
• Stress is transferred in a natural way along the femoral canal and through the head and neck of the femur. With the standard THR, some patients experience thigh pain as the bone has to respond and reform to less natural stress loading.
  
• Use of metal rather than plastic reduces osteolysis and associated early loosening risk.
  
• Use of metal has low wear rate with expected long implant lifetime.