A Summary of Research on Hip Resurfacing

A Summary of Research on Hip Resurfacing

Presented at the recent American Academy of Orthopaedic Surgeons Annual Meeting

Summary of American Academy of Orthopedic Surgeons 2009 Meeting:

New papers on Total Hip Resurfacing:

Learning Curve to Perform Hip Resurfacing is Unacceptable in Today's Practice: Affirmative
Jay Lieberman M.D.
This study shows a 22% fracture rate in the first 60 cases of Hip Resurfacing. Less than 10% of patients who are candidates for Total Hip Replacement would actually fit the criterion for Resurfacing. There is a steep learning curve.

Hip Resurfacing is a Conservative Surgical Option: Negative
Laurent Sedel M.D.
Contemporary total hip replacements have better survivorship than Resurfacing. No long term results are available for Resurfacing.

Revision of Total Hip Resurfacing is as Good as Primary Hip Replacement: Negative
John C. Clohisy M.D.
Any "advantage" is questionable. Proposed equality of outcome is limited to only a portion of the failure mechanisms. A second operation is required at a financial cost, time, inconvenience and resources. Clinical data is lacking.

Conventional Total Hip Replacement vs. Resurfacing: Which is the more Conservative Approach? Conventional Total Hip Replacement
Paul F. Lachiewicz
The premises for Resurfacing are not valid. The results over 20 yrs with ingrowth THR stems are excellent. Resurfacing is technically more difficult. Early complications and revisions are more likely. Overall risks and complications outweigh any possible advantages.

Femoro-Acetabular Cup Impingement after Total Hip Resurfacing Arthroplasty
Youn Soo Park M.D. et al
Femoral head neck unit has little flexibility to adjust neck length and offset. High incidence of impingement between the retained femoral neck and metallic cup. These patients showed inferior clinical results.

Outcome of THA Following Revision Hip Resurfacing is Cause Dependent and is Worse than Primary THA
George A. Grammatopoulos MRCS et al
Revision of HRA was associated with more complications than primary THR.

Cementless Femoral Components (THR) in Young Patients: A Meta-analysis. Is Hip Resurfacing Justified?
Bryan Donald Springer M.D. et al
In only one half the follow up time, the femoral component in hip resurfacing has twice the failure rate of modern cementless femoral components in Total Hip Arthroplasty.

A Cadaveric Study Using Navigation to Compare ROM in Hip Resurfacing vs. THA
Joseph P. Nessler M.D. et al
The maximum range of flexion/extension to impingement and subluxation was greater in all THA's than in the resurfaced hip. The results do not support the claims of improved ROM with hip resurfacing.

Does Hip Resurfacing Restore the Normal Range of Motion of the Hip Joint?
Sean D. Doherty BS et al
Hip resurfacing significantly decreases the range of motion of the entire flexion/extension arc compared to intact hips (computer model).

Patient Expectations Regarding Activity Level Following Total Hip Resurfacing Arthroplasty
David R. Marker BS et al
The results of this study suggest that many patients have high expectations regarding sports activity following resurfacing. However these expectations are often not fully met due to associated pain and stiffness following surgery.

Resurfacing Hip Replacement: Outcomes at 7 Years- An analysis of 10,624 Primary Procedures
Stephen Graves M.D. et al
There is a significantly higher rate of revision at 7 yrs for resurfacing procedures with a primary diagnosis of osteoarthritis.
A number of risk factors have been identified as being associated with significantly increase disk of revision. These include: Avascular necrosis, Hip dysplasia, inflammatory arthritis, females, increased age, size of the resurfacing component, and the type of prosthesis used. The outcomes are very much dependent on patient and prosthesis selection.

Survival of an Uncemented Straight-stemmed Titanium Alloy Femoral Component in Class C Bone
John B. Meding M.D. et al
Despite a wide variety of bone quality in patients, survival of the femoral stem (for loosening) was 100%, 99.3%, 100% in the three groups at 15 yrs post op.(ease of femoral stem revision is a common justification to promote hip resurfacing)

James A. Rand Award Paper

Success of Modern Cementless Femoral Components in Young Patients: A Systematic Review and Meta-analysis of Total Hip Arthroplasty and Hip Resurfacing. Do the Results Justify Hip Resurfacing?
Bryan D. Springer M.D. et al

The pooled failure rate for THA using revision of the femoral component as an endpoint at mean f/u at 8.4 yrs was 1.3%.
At a f/u time of only 3.9 yrs, the failure rate for hip resurfacing was 2.6%. The majority of failures in the resurfacing group were due to femoral neck fractures or aseptic loosening of the femoral component.

Prevalence of Groin Pain after Hip Resurfacing
Ahmad Bin Nasser M.D. et al
Groin pain after hip resurfacing appears to be more common than after conventional hip replacement.

John Charnley Award

The Functional Outcome after Hip Resurfacing and Large Head Total Hip Arthroplasty is the Same: A Randomized, Double Blinded Study
Martin Lavigne M.D., MSc et al
Hip Resurfacing does not provide better clinical function over large head THA.

(Acknowledgement: Direct words used from the authors for the majority of above notations. I did not seek to summarize any positive claims regarding Resurfacing. This information can easily be found in the plethora of promotional information on the web. I do have a personal bias against this procedure.)