Alternatives to Hip Replacement

Are there other choices for patients with severe arthritis?

hip pain
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Severe hip arthritis can cause pain and difficulty walking. Many patients who have these problems because of hip arthritis will elect to undergo total hip replacement surgery. However, total hip replacement is not without its own problems, and therefore many patients wonder if there are alternatives to hip replacement.

Alternatives to Hip Replacement

Nonsurgical Treatment

Not having surgery is always an option.

Patients who have severe arthritis of the hip, but function adequately, can choose to live with their condition. There are effective treatments for hip arthritis that may help patients avoid the need for a total hip replacement. Among these are physical therapy, walking aids, anti-inflammatory medications, cortisone injections, and joint supplements.  In general, hip replacement surgery is not an urgent procedure, and most often there is no harm in delaying surgery until you feel the time is right.  There are some exceptions to that, but for most people, a hip replacement is an elective surgery.

Hip Resurfacing

Hip resurfacing surgery is an alternative to standard hip replacements for patients with severe arthritis. In a hip resurfacing surgery, the implant is smaller, and less normal bone is removed. Hip resurfacing is gaining interest, especially in younger patients. During the hip resurfacing procedure, only a small amount of bone is removed from the ball-and-socket hip joint, and a metal cap is placed on top of the ball.

A metal socket is placed in the pelvis, similar to the hip replacement procedure. This hip resurfacing preserves much more normal bone than a standard hip replacement.  Hip resurfacing surgery has become much less common in recent years because of concerns about using so-called metal-on-metal joint replacements.

  These metal-on-metal replacements include all current hip resurfacing implants.

Partial Hip Replacement (Hemiarthroplasty)

A partial hip replacement is a commonly performed surgical procedure, but not commonly performed for hip arthritis.  During this surgical procedure, only the ball of the ball-and-socket hip joint is replacement.  This is an effective treatment for certain types of hip fractures, when only the ball of the hip is damaged.  The problem for people with severe hip arthritis, is that the socket of this hip is also damaged, and therefore also needs to be addressed.  For this reason, partial hip replacements are generally not a good option for hip arthritis surgery.

Hip Fusion (Arthrodesis)

Hip fusion is a seldom performed procedure now that hip replacement has become so successful. Hip fusion surgery eliminates all motion at the hip joint by having the bones of the femur and pelvis heal together. They are held in this position by a large metal plate and screws. Hip fusions are usually done in young patients who are heavy laborers.

The hip fusion does not wear out like hip replacements would in these patients. The hip fusion allows the patient to perform physically demanding tasks that could lead to early wear on a total hip replacement. The problem with hip fusion is that patients will have no motion of the hip, they will walk with a limp, and may eventually need further surgery to convert to a hip replacement.

Resection Arthroplasty (Gridlestone Procedure)

A resection arthroplasty is a procedure where the bone around the hip joint is removed and the joint space is allowed to fill with scar tissue. This procedure is usually done in patients with severe infection that cannot be controlled, or in patients whose physical condition is such that they have little chance of normal walking. Patients who undergo a Girdlestone resection arthroplasty will likely need some device (crutches or walker) for walking.

Hip Osteotomy

Hip osteotomy is a procedure that is done to realign the bones of the hip joint. The osteotomy can be performed on the thigh bone (femur), the pelvis, or both. Osteotomies are usually performed on patients with an underlying problem that has led to early arthritis of the hip joint. For example, developmental conditions such as hip dysplasia can lead to early hip arthritis. Hip dysplasia occurs in infants and leads to malaligned bones around the hip. The osteotomy helps to realign the bones and relieve the symptoms of early arthritis. These procedures must be done in carefully selected patients.

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