Hip Resurfacing Surgery Instead of a Hip Replacement Is Increasingly Popular
Advanced osteoarthritis of the hip that has not responded to the standard, conservative treatments is typically treated with hip replacement surgery. However, over the past several years a similar operation has been receiving increased interest as an alternative to hip replacement - it is known as hip resurfacing. The question is, does hip resurfacing offers advantages over standard hip replacement?
Standard hip replacement surgery has a long track record of being effective. There is no doubt about this -- in terms of improving quality of life, it is one of the most effective procedures in all of medicine. Most people who have hip replacements are in their 60's or older, and do not generally engage in a high-level of physical activity each day (sports, vigorous exercise, etc.). However, some surgeons feel that younger or more active people with hip disease may benefit from hip resurfacing surgery.
What is hip resurfacing?
It is a procedure that is similar to hip replacement. There are some differences in the surgical technique that may have advantages and disadvantages compared to a standard hip replacement. In hip resurfacing surgery, diseased bone is removed from the top (head) of the femur and a metal cap is placed over it. Diseased bone is also removed from the socket (in the pelvis) and a thin metal socket is inserted. This is known as metal-on-metal hip resurfacing.
The idea of hip resurfacing has been around for a long time. In the 1970's and 1980's it became popular, but was abandoned due to a high failure rate. Since then, advances have been made in the design of the metal implants and the technique, and there has been a better success rate at approximately 2 to 5 years after surgery so far. Long-term results are not yet available, and one of the main criticisms of this procedure is that we do not know how well it will hold up 15 or 20 years from now.
Here is some information on who makes a good candidate for hip resurfacing, and what some of the advantages and disadvantages are:
Reasons you may be a good candidate:
- Have isolated hip disease and good bone quality
- Under age 60 (although there is not a strict age requirement)
- Maintain a relatively active lifestyle
Reasons you may not be a good candidate:
- Have a leg length difference of more than 2cm (about ¾ inch)
- Woman of child-bearing age
- Known metal sensitivities
- Have compromised kidney function
- Have abnormal bone in the hip region
- Have inflammatory arthritis
Proposed advantages of hip resurfacing:
- Conserves bone in the femoral neck, which could be helpful if a revision procedure is needed in the future
- Improved function because of more precise biomechanical restoration of the hip
- Reduced dislocation rates
Proposed disadvantages of hip resurfacing:
- Outcomes are unknown greater than 5 years after surgery (although at the 5 year mark, results are similar to standard hip replacement)
- Higher risk of femoral neck fracture
- Metal ion exposure - this is not currently a major problem, but more data is needed to assess the long-term safety
A Shimmin, PE Beaule, P Campbell. Metal-on-Metal Hip Resurfacing Arthroplasty.
J. Bone Joint Surg. Am., Mar 2008; 90: 637 - 654.