Surface Replacement

Glucosamine & Chondroitin Tablets FAI (impingement) surgery


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What is it and why?

  • This procedure is performed under anaesthesia - either general or regional.

  • The top of the femur is reshaped and covered with a thin hemispherical metal shell.

  • Unlike a total hip replacement, where all the diseased bone is removed, in a surface replacement very little bone is removed.

  • The socket is shaped and a metal liner is put in place. Therefore, surface replacements have ‘metal-on-metal’ articulation.


  • Treatment involves Home/self-help
    Home/self-help
  • Treatment involves Hospital
    Hospital
  • Treatment involves Daycase procedure
    Daycase procedure
  • Treatment involves Inpatient procedure
    Inpatient procedure
  • Treatment involves Local anaesthetic
    Local anaesthetic
  • Treatment involves General anaesthetic
    General anaesthetic
  • Treatment does not involve Regional block / Spina
    Regional block / Spina
  • Pain
    Pain

    Painful for 2+ weeks

  • Mobility
    Mobility

    Affected 2+ months

  • Daily activities
    Daily activities

    Affected for 2+ weeks

  • Driving
    Driving

    No - 6+ weeks

  • Leisure activities
    Leisure activities

    Affected 2+ months

  • Light exercise
    Light exercise

    Affected 2+ weeks

  • Heavy exercise
    Heavy exercise

    Affected 3+ months

  • Light work
    Light work

    Affected 4+ weeks

  • Heavy work
    Heavy work

    Affected 3+ months

  • Intimate
    Intimate

    Affected 2+ months


Overview

What does it involve?

  • This procedure preserves the bone. It also provides an almost-natural shape and surface area for the hip joint and decreases the risk of dislocation.

  • It may be more suitable for younger patients who wish to continue with most of their intensive activities including some sports.

  • With a rapid recovery programme in place, the length hospital stays following surface replacement has been significantly reduce to only a few days. For a select few patients, this can be done as a day case operation. 

Effort/burden

  • This is usually a one-off procedure to address pain and mobility issues.

  • You must consider and accept the specific risks of this operation, as well as more general risks associated with a major operation.

  • It may take a couple of months to recover from a surface replacement.

  • There are some limitations and precautions you will have to observe to decrease the risk of complications. Examples of these include not sitting cross-legged, no deep squats and avoiding leaning forward too much by bending at the hip.

Benefits

  • There is good evidence to support surface hip replacement. It is one of the best procedures available to improve quality of life.

  • This procedure has excellent patient satisfaction; over 90% of patients are happy with their outcome.

  • Clinical success, as recorded with patient outcome measures such as Oxford Hip Score’s, are generally very good to excellent after hip replacement surgery.

Limitations and side effects

  • You should consider all the limitations and side effects of a major operation.

  • Your scar may be sensitive for a few months after the operation. As a result, you may not be able to lie on the side where your operation took place.

  • Immediately after the operation, pain is likely to get worse before it gets better. Medications will be provided to help you with this.

  • Hip pain may not completely decrease, but is likely to improve significantly.

  • There may be side effects from the medication, especially painkillers, antibiotics or anaesthetic agents. These include skin rash, constipation, liver or kidney damage etc. Please ask your doctor if you wish to know more.

  • You will need to take care of the area that was operated on. This may mean being more careful with dressing and wound care - the outreach nurse or practice nurse from your GP will help you manage this.

  • You will need to attend your GP practice or hospital for a wound check and follow-up appointments.

  • Your work, activities of daily living, walking, sleeping, intimate relationship, family life, leisure activities and driving will all be affected for a few weeks to months after this procedure.

Risks

  • Certain types of metal-on-metal hip replacements do not work very well and may generate unacceptable amount of metal ions from wear. This may result in cyst formation around the bone and soft tissues around the hip, affect liver or kidney function from heavy metal ions (e.g. cobalt or chromium). This is called Metalosis.

  • If Metalosis should occur, then you will have to undergo extensive revision surgery where the surface replacement will be converted to a standard hip replacement.

  • General risks: Heart related problems (heart attack, irregular heartbeats), lung related complications (pneumonia, lung collapse), post-operative confusional state, post-operative decline of brain function (cognitive decline), kidney failure, urinary tract problems (infection or retention with the need for using catheter), nerve damage, damage to blood vessels, deep vein thrombosis (DVT), pulmonary embolus (PE), complex pain, pressure sores, diathermy burns, wrong side surgery, severe allergy to medications, damage to structures unrelated to surgery (like lips/teeth/throat, eyelids etc) regret of undergoing surgery and death.

  • Specific Risks: Pain, bleeding, swelling, stiffness, superficial infection, inflammation, sensitive scar, change in appearance of the operated area, puckered scar, thick scar, numbness, failure of tendons or muscles to heal, deep infection needing further surgery, poor alignment of the implant, leg length difference, dislocation, back pain etc.

Cost

  • This is a very high-cost option for both patients and the NHS.

  • Patients: You will need to take time off work, have help during the initial recovery stages and visit the hospital and physiotherapy department. This may involve paying for taxis, parking or favours from friends and family.

  • NHS: Generally expensive, costing approximately £8,000 to £10,000 per procedure. However, the cost can be much more should a complication occur and require treatment.

What if no treatment is done?

  • Ongoing pain.

  • Your arthritis may deteriorate and affect your activities of daily living, family life, work environment and leisure activities.

  • If the condition progresses, more complex and demanding procedures may be required.

  • If your arthritis progresses significantly, no further treatment may be available. You may regret not opting for treatment earlier


Glucosamine & Chondroitin Tablets FAI (impingement) surgery