Surgery Alternatives

Total hip replacement is by far the best solution to most problems involving severe arthritis of the hip. But occasionally in certain circumstances other alternatives may be more appropriate. In patients who are under 40 who have a problem with only one hip joint and are otherwise healthy, consideration should be give to arthrodesis of the hip. This is when the hip is fused (i.e. the femur bone grows to the pelvis bone) such that no motion occurs at the hip. This completely relieves pain and provides a stable leg for walking. It's advantages are that there are no implants that can come loose or fail in the future. It provides a very durable long lasting result that does not have the activity restrictions that total hip replacement has. For a manual laborer it may be ideal because there are no lifting restrictions.

In the 40 to 60 age group or in patients with certain decreases such as congenital hip dysplasia, an osteotomy of the hip may be the best operative procedure. This is where the upper end of the femur bone near the hip is cut and the hip joint rotated into a new position. This procedure requires that some portion of the hip still has functioning cartilage on it. Therefore, it is not indicated when the cartilage is completely destroyed. Another prerequisite for this operation is sufficient motion in the hip to allow enough rotation of the hip at surgery. Therefore, stiff hips with minimal side movement or rotation are not good candidates for this procedure. This procedure has approximately a 70% success rate and success is defined here as improvement of symptoms rather than complete freedom of pain. It is, however, a conservative operation that preserves the hip joint and can allow future conversion to a total hip replacement.

Another alternative is resection arthroplasty of the hip. This was developed by a man by the name of Girdlestone and is frequently referred to as the "Girdlestone Procedure". In this case a severely arthritic hip is improved by removing the entire ball portion of the upper end of the femur. This essentially removes the hip joint and allows the femur to shorten. Scar tissue develops between the upper end of the femur and the pelvis bone and allows motion with minimal pain. The leg, however, is quite short and weak and usually patients require at least a cane and often two crutches to walk. The older the patient, the more difficult it is to walk with a resection arthroplasty. This procedure is usually reserved as a salvage for failed hip replacements that for some reason cannot be revised. In this instance when the hip replacement is removed, what is left is essentially a "Girdlestone". The success rate of this procedure is in the 50-70% range and success again does not imply total relief of pain, but rather an improvement as compared to the situation before the operation.
In your particular case one of these alternatives may be applicable. This should be discussed with your orthopaedic surgeon.