What is hip resurfacing (hip replacement arthroplasty)?

From the Guidelines

Hip resurfacing is recommended for younger, more active patients with good bone quality who have hip arthritis or similar conditions, as it preserves more of the patient's natural bone structure and offers potential benefits including greater stability and reduced risk of dislocation. When considering hip resurfacing, it's essential to weigh the potential benefits against the risks, including femoral neck fracture and potential metal ion release from the metal-on-metal bearing surfaces 1. The decision to proceed with hip resurfacing should be made through a shared decision-making process between the patient and their physician, taking into account the patient's unique goals, preferences, risk tolerance, and medical condition 1. Some key points to consider when evaluating hip resurfacing include:

• The patient's age and activity level, as hip resurfacing is typically recommended for younger, more active patients 1
• The patient's bone quality, as good bone quality is necessary for the success of the procedure 1
• The potential risks and benefits of the procedure, including the risk of femoral neck fracture and metal ion release 1
• The need for specialized surgical expertise and the importance of avoiding high-impact activities for at least 6 months after surgery 1. It's also important to note that hip resurfacing may not be appropriate for all patients, particularly those with poor bone quality, significant bone deformities, or certain medical conditions 1. Ultimately, the decision to proceed with hip resurfacing should be based on a thorough evaluation of the patient's individual needs and circumstances, and should be made in consultation with a qualified healthcare professional 1.

From the Research

Hip Resurfacing Overview

• Hip resurfacing arthroplasty (HRA) was introduced to address limitations in standard total hip replacement (THR), particularly for young patients requiring return to sport and high functional activity 2.
• HRA aims to mimic natural anatomy with a metal on metal (MoM) bearing, but concerns have emerged regarding early failure, high revision rates, and potential systemic consequences of metal ion cardiotoxicity 2.

Patient Selection and Outcomes

• Studies have shown that patients under 55 years of age, who account for around 12% of hip replacement surgery cases, may benefit from HRA 2.
• A study comparing outcomes of HRA in patients 60 years of age or older with those younger than 60 found similar clinical outcomes, including improved Harris hip scores and Short Form-12 scores 3.
• Another study reviewed the evidence for surgical technique, outcomes, and complications related to modern metal-on-metal hip resurfacing arthroplasty, highlighting the importance of patient selection for excellent surgical outcomes 4.

Complications and Risks

• Femoral neck fracture is a common indication for revision in HRA, particularly in older patients and those with inflammatory arthritis 3, 5.
• Other complications reported in HRA include infections, acetabular radiolucency, and metal ion cardiotoxicity 2, 5.
• A systematic review of HRA in patients with inflammatory arthritis found improved functional outcomes, including increased University of California at Los Angeles score, Harris Hip Score, and Range of Motion 5.

Surgical Technique and Efficacy

• Surface hip arthroplasty has attractive features for young, active patients, including conservative treatment and preservation of femoral bone 6.
• The procedure is more anatomic and physiologic than stem-type hip replacements, with increased stability due to the near-normal diameter of the femoral component 6.
• However, the results of conventional total hip replacement using contemporary designs and bearing materials have also improved, making it essential to assess the safety and efficacy of resurfacing to refine indications and technique 6.