Hip Resurfacing: What You Need to Know
Hip resurfacing (HR) has been marketed over the years as a "less invasive", "tissue sparing" option over total hip arthroplasty (THA). To be completely accurate, the surgical approach has to be done the same way that a THA is done, therefore, it is not any "less invasive" than a THA. A HR can also be done through a direct anterior approach, just as a THA. Secondly, when proponents of HR explain that there is less bone removed it is from the femoral side. However, since the HR is limited to a Metal-on-Metal bearing surface, more bone has to be removed from the acetabular side to accommodate the much larger femoral head. To me, this is "robbing Peter, to pay Paul", so to speak. From my perspective, revising a hip replacement is much more challenging when there is defective acetabular bone compared to femoral bone loss.
Below are a list of implications peculiar to HR that I am concerned about:
- Requires a Metal-on-Metal bearing surface: metal ions in blood (unknown implications), adverse local soft tissue reactions.
- Failure from femoral neck fractures: commonly seen in women >50y/o, BUT also older men with smaller bone diameter.
- Surgeon volume-dependent: more technically challenging than THA.
- Revision requires either another Metal-on-Metal bearing or complete exchange of the acetabular component.
There is no doubt that many people have done well with hip resurfacing. But, so do patients with a standard THA! Data has shown that HR placed by highly experienced surgeons perform overwhelmingly better than those done by everyone else. There continue to be a handful of these centers around the country who are well-experienced at HR & whose patients have great outcomes. In fact, I trained at such an institution: The Rubin Institute for Advanced Orthopaedics, under Dr. Michael Mont who has one of the highest volume HR practices in the country. I learned a great deal about the technical nuances of HR from him & feel very comfortable in performing the procedure. However, I have made the conscious decision to only offer this procedure to young, healthy males with good bone quality who adamantly do not want a THA.
For my young, active patients, I prefer to recommend a "femoral neck-sparing THA" over HR. The idea is that only the head is removed from the femur & a smaller, shorter femoral stem is used that engages the femoral neck.
Reasons why I like this concept over a HR?:
- Options for the bearing surface (Ceramic-on Polyethylene, Ceramic-on-Ceramic, Metal-on-Polyethylene), therefore, avoiding all the problems associated with Metal-on-Metal.
- Truly bone conserving: minimizes bone removed on BOTH sides of the hip, not just the femur.
- Easy exchange of bearing surfaces if excessive wear occurs in the future (do not have to remove the metal components fixed to the bone, therefore, no bone loss)
If you are wanting to learn more about hip resurfacing, femoral neck-sparing THA or to see if you are a candidate for either, I would be very interested in discussing this more with you at our office.