Are There Alternatives To Hip Replacement?
Each individual contemplating hip replacement should review alternativdes with his or her physician to determine possible options.
Some alternatives to hip replacement include:
- Conservative Treatment
- Femoral osteotomy
- Hip Resurfacing
- Hip Fusion (Arthrodesis)
- Resection Arthroplasty (Gridlestone Procedure)
- Hip Osteotomy
Often pain can be controlled with medication adequately enough to provide comfort with the person's present activity level. If this is the situation, and the hip range of motion is functional, the decision to wait on surgery may be reasonable.
Alignment problems of the hip, called developmental hip dysplasia, can occur. A femoral osteotomy may be indicated if the hip weightbearing area can be broadened for a better fit. This consists of cutting the femur in order to realign the hip. However, recovery following femoral osteotomy is likely to be longer than with joint replacement.
Arthrodesis relieves pain by fusing the head of the femur head to the acetabulum . It has fewer limitations than a hip joint replacement. This procedure can be very effective if the individual's back is mobile and without symptoms because much of the movement lost from the hip joint is demanded from the back. The procedure generally requires surgical fixation with a plate and screws and occasionally use of a cast is needed while healing continues. An arthrodesis can be converted to a total hip replacement at a later date if appropriate.
Not having surgery is always an alternative. 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. For more information about these potential treatment options, see the following page: Hip Arthritis Treatments
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 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 assistive device for walking.
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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