Protrusio acetabuli Grade III
Traditional treatment has been total hip replacement. Since many cases occur in young patients, a conventional total hip replacement is not ideal since it removes more host bone. Invariably a revision hip replacement will be required in a young patient undergoing a total hip replacement. A bone sparing option like Hip resurfacing or short-stem hip replacement is preferable. Hip resurfacing is possible in mild grades where bone grafting is not required. In the more severe grades, bone grafting is mandatory. An anti protrusio cage can also be used to reconstruct a severe medial wall deficiency. In advanced grades of protrusion, placement of the cup in the anatomical position is crucial for long term success. The cup has to rely on peripheral fixation with press fit and additional screws. Therefore hip resurfacing as an option goes out of the realm.
In the present case, an innovative approach was adopted for hip reconstruction. Hip resurfacing was ruled out because of the necessity for bone grafting and severity of the condition (Grade III in this case)
A bone sparing Proxima hip replacement was planned. The uncemented Pinnacle cup was lateralized by bone grafting. Peripheral fit and screw fixation achieved a snug interference fit. A metal liner was used.
Hard on hard bearings were chosen in view of their established favorable long term outcomes. Hard on cross linked poly was not chosen because of the lack of long term results. On the femoral side, a Proxima stem with a Ceramic 36 mm head was used.
As can be seen, the Proxima hip is a stem less femoral implant. It gains purchase in the proximal cancellous bone of the femur. It sacrifices very little bone from the head of the femur. Most of the neck portion is left intact.
The Final result is shown in this x ray

Proxima Hip prosthesis

A lot of people will have to face as a part of the aging process one of those things is hip replacements for hip pain.

According to The National Institue of Arthritis and Musculoskeletal and Skin Diseases there are over 193000 hip replacements performed in the U.S. each year. In the UK, the numbers are about 5, 00000 per year.

Hip replacements have been the mainstay of treatment for hip arthritis. An alternative considered nowadays is a procedure called hip resurfacing. The main advantage that hip resurfacing has over a total hip replacement is the amount of bone removed. More bone is preserved in the top end of the thigh bone (femur) called the neck and head. During a resurfacing it is quite a bit less then the amount of bone that is removed during a total hip replacement. Is that a good thing or bad thing? It is a good thing because as a general rule a patient will recover quicker and go through less pain with a hip resurfacing then they would if they had a total hip replacement. Another advantage is that since the head size matches the natural size, there is little risk of dislocating your hip. This will give you a lot more freedom of activities.

When a young patient goes to an orthopedic surgeon because they are experiencing pain in their hip joints the doctor will more often than not try to put off surgery as long as possible. This is no longer necessary. Once the patient reports that the pain that they experience is beginning to limit their day to day activities surgery will be performed. However these young arthritic patients should understand that a hip replacement may have to be redone. This fact makes hip resurfacing a very viable option in younger patients.

The surgery itself can be performed in different ways. We use the approach from the side. Our incisions are quite small and measure about 7 inches. We prefer to keep the hip joint capsule in tact. Keeping the hip joint capsule intact is less damaging to the blood supply in the hip area and limits the risk of the patient dislocating their hip after surgery.

The surgery is performed by making a cut on the side of the hip. The femoral bone is then dislocated from the hip. The head of the femoral bone is then shaped so that a new metal cap fits over the head snugly. This is then placed over the end of the bone and held in place by a pin & cement fixation. The hip socket itself may be left alone or a thin metal cup can be placed in the socket. To make room from that metal cup a reamer is used to remove the cartilage from the acetabulum and to shape the socket for the metal cup. The metal cup is pressed into the socket. Friction holds it in place until new bone grows and fills in the holes of the surface of the metal cup and attaches it to the bone.

The patient is generally released from the hospital 2-4 days after their surgery. Physical therapy starts almost immediately with a therapist helping the patient get out of bed on the very first day. Therapy progresses quickly with the patient walking around with crutches the second day after the surgery. The patient can expect to have physical therapy between 1-3 times a day while they are still in the hospital. Generally, the patient will be released when he or she is able to get out of bed, walk 75 feet with the aid of crutches or a walker, and is able to climb stairs.

If you are looking at having to have hip surgery, ask us at the Madras Joint Replacement center in India, whether or not you may be a candidate for hip resurfacing. If you are able to have your hip resurfaced over having to have it totally replaced, you will enjoy several advantages to a hip replacement.

Hip Resurfacing prosthesis

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