Is hip resurfacing right for me?
The key purported benefits of hip resurfacing are preservation of proximal femoral bone stock (should revision surgery be required in the future), a decreased risk of dislocation, and the possibility of increased activity levels given the metal on metal bearing surface.
Several clinical studies have shown that patient selection is an important factor in avoiding complications as the early failure rate can be substantial if appropriate candidates for the procedure are not selected. Among the most commonly reported modes of early failure include femoral neck fracture. Two recent articles showed an early revision rate ranging from 2.7% to 5.6%; this early failure rate is higher than what would be expected following standard total hip arthroplasty.
Factors that have been shown to be associated with a better outcome include:
- Higher bone density
- A normally shaped femoral head
- Normal hip biomechanics
- Absence of bone defects in the femoral head (e.g., Avascular necrosis)
Failures have been associated with:
- Patients with a history of prior hip surgery
- Female sex
- Smaller size as there is decreased area for fixation
The best candidates for the procedure appear thus to be young, large, non-obese males with a diagnosis of osteoarthritis and without a history of prior surgery whose hips, as pointed out by one author "have only a loss of articular cartilage and a relatively normal femoral head and neck." Further, despite the claim that patients may be able to participate in higher level athletics, one author pointed out that high activity levels "are likely to shorten the life of the implant in a manner similar to the way in which those activities affect a (standard) total hip arthroplasty."