Total Joint Replacement Educational Series Part 3: Hip Resurfacing vs. Total Hip Replacement - What is the Better Option for Patients Who Have Hip Arthritis?
Background Information
As you may have seen on the news or in magazines, orthopaedic implant companies have been marketing a hip resurfacing procedure, which involves removing the arthritis from your hip and putting a cap on the "ball" (femoral head) part of your hip. A total hip replacement involves removing the femoral head and replacing it with a large metal head and a stem that goes down into your thigh bone. Although resurfacing has been marketed as a new procedure, it has actually been around for over 30 years.
SO WHAT IS FACT FROM FICTION?
POTENTIAL BENEFITS:
Total Hip Replacement Hip Resurfacing
X-ray of a hip replacement and a hip resurfacing. Hip replacements now use the larger heads that are similar in size to the hip resurfacing.
WHAT ARE THE POTENTIAL PROBLEMS?
As you may have seen on the news or in magazines, orthopaedic implant companies have been marketing a hip resurfacing procedure, which involves removing the arthritis from your hip and putting a cap on the "ball" (femoral head) part of your hip. A total hip replacement involves removing the femoral head and replacing it with a large metal head and a stem that goes down into your thigh bone. Although resurfacing has been marketed as a new procedure, it has actually been around for over 30 years.
SO WHAT IS FACT FROM FICTION?
POTENTIAL BENEFITS:
- The surface replacement theoretically removes less bone than a hip replacement, but only on the ball part of the joint
- The cup part (acetabulum) is the same as used for a total hip replacement
- May have a lower rate of dislocation compared to some types of total hip replacements secondary to the larger head, but the new total hip replacement systems also have the larger heads
- Revisions of the femoral component only (ball part) may be easier than the revisions of some types of hip replacements, but there are no differences on the cup side
- Metal on metal articulation, which may decrease wear, although the metal on metal articulation is now available in a total hip replacement
- Best candidates are patients under 50 years old with good bone stock and no cup deformations
Total Hip Replacement Hip Resurfacing
X-ray of a hip replacement and a hip resurfacing. Hip replacements now use the larger heads that are similar in size to the hip resurfacing.WHAT ARE THE POTENTIAL PROBLEMS?
- The contraindications to having a hip resurfacing:
- Severe bone loss and bone cysts
Normal Hip Resurfacing Hip Resurfacing with Fracture
- Small or bone deficient hip socket
- Age greater than 65
- Obesity
- There are very few studies about the long-term efficacy and safety of hip resurfacing and the long-term outcomes of subsequent revision surgeries
- Problems include femoral neck fracture, which is related to the surgical technique and the type of patient. There is no risk of femoral neck fracture with a total hip replacement, which removes this bone.
X-ray of a normal hip resurfacing and a hip resurfacing with a femoral neck fracture.
- Risk factors for femoral neck fracture with resurfacing include:
- Patient related issues with a surface replacement:
- Avascular necrosis before surgery
- Decreased bone mass
- Femoral head cysts
- Inflammatory arthritis like rheumatoid arthritis are not candidates for the resurfacing
- Two fold higher fracture rate in women
- Factors related to the surgical technique:
- HIP RESURFACING SHOULD ONLY BE PERFORMED BY SURGEONS WHO HAVE BEEN SPECIALLY TRAINED IN THIS PROCEDURE AND WHO ARE VERY EXPERIENCED
- Post-operatively there is an increased rate of avascular necrosis (loss of blood supply and death of the femoral head), which greatly increases the risk of femoral neck fracture and implant loosening
- Patients with a leg length discrepancy are not candidates for resurfacing
- Patients who have the hip resurfacing are likely to need the hip replacement in the future sooner rather than later, because the patients undergoing a resurfacing procedure tend to be young, active, and return to high activity levels afterward
- Keep in mind that it can be very difficult to convert the surface replacement to a total hip replacement
- More importantly, with the newer techniques that are available with total hip replacement, such as the metal on metal articulations and larger heads, the main benefits of hip resurfacing are now present in total hip replacements, but without the above risks!
It is my understanding that the hip resurfacing solution is logical for younger, more active adults precisely because their level of activity will ultimately require another surgery. I have been told that the second surgery would be the total hip replacement.
Can you clarify the extracted comment from above?
"Keep in mind that it can be very difficult to convert the surface replacement to a total hip replacement."
Patients should not think of hip resurfacing as a "temporary" step to eventual total hip replacement. A metal on metal total hip is comparable in every way to a hip resurfacing procedure and has as long a history as hip resurfacing. Recent marketing of hip resurfacing as a "conservative" approach to hip arthritis is very misleading. In fact, converting a hip resurfacing to a total hip can be quite demanding for both the surgeon and the patient!
As in all approaches, there are pros and cons to these different surgical interventions, and it is best to discuss with your orthopaedic surgeon. Most importantly, I tell all of my own patients that if they are considering the hip resurfacing, it is VERY important that they see a surgeon who has done many of these types of procedures since this is one hip surgery technique that is very, very surgeon dependent as far as good outcomes. The more that a surgeon has done the better they will be.....But definitely do not think of the resurfacing as "just" an in-between step before a total hip replacement.
Hopes that this helps!
Tony
I am going for a total hip replacement in few months, and the doctor is talking about two choices: ceramic on ceramic or metal on metal replacements. What is your opinion? I am 57, and I am an active person. I do cross country ski, cycling, dancing and walking. I really want to continue those activities.
Thank you.
I am 43 and in need of hip work. I have been told to have my hip resurfaced. I played soccer all my life, and I still ski, play tennis and ride both mountain and road bikes. What would you suggest? Is it okay to have metal on metal in my body?
Thanks for this forum. I am 33-years-old and have advanced osteo arthritis in my left hip. I have been to see Dr. Sparling in Vancouver, WA, who has apparently done hundreds of resurfacings. After looking at my x-rays, he indicated that the cystic structures around my femoral neck may preclude me from the resurfacing, but that he won't know until he gets in there to see it. I am an active skier and surfer and have now accepted that skiing may not be in my future but that small wave longboard surfing may be a good exercise for me.
My main concern, however, is that if I end up getting a THR, how many revisions can I reasonably expect to go through in my lifetime? Is it uncommon for people to have three or four revisions? What options are available once a revision is not possible?
Thanks again very much.