Hip Resurfacing

Hip resurfacing is a relatively new procedure but well established procedure, which was developed initially by Mr Derek McMinn in Birmingham. 

There are now results to around 10 years and the early results are encouraging.  The hip resurfacing procedure has been recognised by the National Institute For Clinical Excellence as an option for young active patients with significant arthritis of the hip. 

 There are possible advantages in performing hip resurfacing where, instead of cutting away the neck and head of the femur, the head is left in-situ and a metal covering is cemented over it.  An un-cemented metal liner is impacted into the acetabulum (cup) part of the hip which has a special coating to promote the in-growth of bone, this leads to the cup becoming firmly fixed.

 Along with preservation of femoral bone, other advantages of resurfacing are that, with a metal on metal bearing surface there is no polyethylene wear debris produced.  This may mean that osteolysis (a condition where the body’s own defences break down bone, possibly in relation to wear debris) will not occur.  Additionally the risk of dislocation and leg length difference following this procedure is significantly reduced when compared with conventional hip replacement. 

It is generally felt that hip resurfacing is more suitable for younger patients, who wish to follow a more active lifestyle after their joint replacement surgery.

There are some uncertainties and risks surrounding hip resurfacing procedures. 

Firstly the operation in my hands is more invasive, as the procedure to resurface the hip involves a greater surgical dissection than a standard hip replacement.  Additionally there are some recognised risks associated with resurfacing hip replacements.  Firstly, in the long term, there is a risk of breakage (fracture) of the neck of the femur (thigh bone), which would require further (revision) surgery in the future.  It is for this reason that resurfacing procedures should only in my opinion be offered to younger patients. In particular older females who are at risk of osteoporosis (thinning of the bone) may be better with a more conventional hip replacement.

There are some concerns regarding the effect of metal wear debris produced from the metal on metal bearing surfaces, and I would not recommend this procedure be performed on women who wish to go on to have children after the procedure has been performed.  I would offer these patients an alternative hard on hard bearing such as a ceramic on ceramic articulation.

The only other uncertainty is the lack of long term follow up, but with widespread clinical use now approaching 10 years, with good reported results, the resurfacing procedure has now been established and has a definite place in the management of arthritis of the hip.