VIII. ALTERNATIVES TO TOTAL HIP REPLACEMENT
Total hip replacement is by far the best solution to most problems involving
severe arthritis of the hip. But rarely, in certain circumstances, other
alternatives may be more approprite. In patients who are under 40 who
have a problem with only one hip joint and are otherwise healthy, consideration
could be given 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. The advantage is 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. The disadvantages are that there is
a permanent prominent limp and with time back and knee problems often
In the 40-60 age group or in patients with certain diseases, such as congenital
hip dysplasia, an osteotomy of the hip may, occasionally,
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 have functioning
cartilage on it. It is not possible when the cartilage is completely destroyed.
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. Again, 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, you are essentially left with a “Girdlestone”.
Again, the success rate of this procedure is in the 70% range and success
again does not imply total relief of pain, but rather an improvement as
compared to the situation before the operation.
Patients that have avascular necrosis may be a candidate for a vascular
bone grafting procedure to restore blood circulation to the femoral
head and thereby, allow the bone to heal and avoid collapse of the femoral
In your particular case, one of these alternatives may be applicable.
This should be discussed with your orthopaedic surgeon.
In my opinion, there is no longer any role for partial hip replacement
(Hemiarthroplasty) in the treatment of hip arthritis. The only role for
partial replacement is in the treatment of elderly patients with broken