Alternatives For Total Hip Replacement
One alternative is not to have an operation. If your pain can be controlled with medication (pain killers: such as paracetamol, or non steroidal anti-inflammatory drugs; or disease management medication: like glucosamine-sulfate), physiotherapy, and adapting your physical activities, so that you are sufficiently comfortable and you are content with your present activity level and motion in your hip, then you may decide to wait (AKA watchful waiting).
For patients with developmental dysplasia of the hip (DDH), cutting the thigh bone (femoral osteotomy) or pelvis (Ganz, Berne or Bernice osteotomy) in order to realign the hip may be indicated if the hip weight-bearing area can be broadened or made more congruent. This is often useful in young patients. Recovery following osteotomy may be longer than with joint replacement, implicating no weight bearing for 6 weeks up to 3 months!
Arthrodesis is rarely performed, but is an especially effective procedure for younger patients, particularly those who are of short stature and who are otherwise healthy. "Arthrodesis" relieves pain by fusing the femoral head to the acetabulum. It has none of the limitations that a joint replacement or other procedure has in terms of restrictions in activity level. If the patient's back is mobile and without symptoms, it is a very worthwhile procedure. The procedure generally requires internal fixation with plate and screws and occasionally cast immobilization while healing takes place. An arthrodesis can be converted to a total hip replacement at a later date, usually 15 years on average after the operation.
In our clinic, this technique is no longer used since we apply the BHR resurfacing technique or ceramic-on-ceramic couples in those cases. Furthermore, an arthrodesis resulting in diminished functionality (e.g. problems with long-term seating in a plane) is nowadays in our present society unacceptable.
A pseudarthrosis (Girdlestone operation) involves removing the femoral head without any replacement. The procedure is performed for hip infections and when the patient's bone stock is inadequate for another reconstructive procedure. This leaves the patient with a leg which is shorter and usually less stable (although the changes are less apparent following a resurfacing failure as compared to total hip failure). After this type of operation the patient almost always needs to use at least one crutch especially for long distance walking.