CLINIC: The Pros and Cons of Hip Resurfacing

Tue, 6 Dec. 2011 - 1:14 a.m. MT
Credit: ARA Staff - American Running Association


QUESTION:
In a few weeks I am having a hip resurfacing—as opposed to a hip replacement— operation. I have been told that there will be no restrictions on physical activity after the initial recovery. Do you have any feedback on this procedure?
 
Bob Wilhelm

ANSWER:
Hip resurfacing is less traumatic than hip replacement surgery. Since only the femoral portion should be involved, activity may not be affected in the same way that it is with total hip arthroplasty. Normal post-operative hip precautions such as extreme internal and external rotations of the joint are not as much of a factor. I feel that your primary recovery issues will be strengthening and maintaining range of motion.
 
Ron Kleinman, PT

ANSWER:
Hip resurfacing has been around for at least 25 years. It has some theoretical advantages. However, those advantages were never really confirmed in clinical practice. In my opinion, the only argument for a surface replacement over total hip arthroplasty is that if the hip resurfacing fails, it is easier to revise to a conventional total hip than to revise a conventional total hip to another conventional total hip. There was always an unacceptably high rate of loosening, avascular necrosis, and failure with the old resurfacing designs. One of my patients (age 45) had bilateral hip resurfacing at a major university, and both sides failed within two years and I had to revise them to conventional total hips. The older metal ball and plastic socket was inferior to the newer metal-on-metal designs of the last eight or so years.
 
There is still, in my opinion, an inevitable problem of avascular necrosis, where the bone underlying the prosthesis simply dies due to the disruption of the normal vascular supply by the metal cup. I think this is an unavoidable complication which will never be solved because of the intrinsic limitations of the anatomy. Most series report at least a 10 or 15% incidence of this complication.
 
I also caution you that I know of no published literature or scientific study that supports unlimited physical activity after any hip prosthesis, whether conventional total arthroplasty or resurfacing. While you can certainly do many things after major hip surgery, high impact activities such as running, jumping, basketball, and tennis definitely increase the chances of loosening. It’s true that Mike Ditka played handball after his total hips, but he also had both sides revised within a few years of the original surgery.
 
If you are less than 55 years old, then a surface replacement has a few theoretical advantages, however limited. If you are older than 55, I see absolutely no benefit to a surface replacement. A conventional total hip arthroplasty will be far more predictable and will allow you to do everything you can do with a surface replacement. I do not believe there is any functional advantage to a surface replacement whatsoever. The restrictions and limitations after surgery are exactly the same. I am curious what advantages your surgeon feels the surface replacement will give you; in my opinion, there is a mild but definite increase in potential complications for very little potential gain.
 
Klaud Miller, MD
 
(RUNNING & FITNEWS®  April / May 2007 • Volume 25, Number 3)
 
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