Joint Replacement Institute

There are alternatives to total hip replacement surgery. Feel free to learn about the following options:

Conservative Management

Femoral Osteotomy

Arthrodesis

Pseudarthrosis

Conservative Management

One alternative is to not have an operation. If your pain can be controlled with medication 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.

Femoral Osteotomy

For patients with developmental dysplasia of the hip (DDH), cutting the thigh bone (femoral osteotomy) or pelvis (Chiari 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.

Because of its known unpredictability, femoral osteotomy has been less popular in the United States than in Europe, but it has the advantage of not requiring artificial joint-bearing materials.

Arthrodesis

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 on 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 a 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.

Pseudarthrosis

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.