Hip resurfacing: For the right patient and surgeon

Hip resurfacing offers several advantages over traditional total hip replacement, such as femoral bone preservation, larger head size, higher activity level, and easier revision options. Now, that hip resurfacing has reached a mature state in its practice, there are substantial data that identifies patients who are most likely to benefit from these advantages. There are, however, risks that are inherent to the metal-on-metal articulation of a hip resurfacing implant. For example, there is a danger of edge loading with the hard-on-hard bearing, leading to excess production of wear debris (metallosis). Furthermore, there is the possibility of an immunologic reaction to the metal wear particles, leading to swelling, osteolysis, and potential tissue destruction. Several studies and national registries have found that male patients with a diagnosis of osteoarthritis, good bone quality, large bone size, and normal anatomy are the cohort who has the highest success rate with hip resurfacing. These patients will also likely achieve a higher activity level, making it worthwhile for them to accept the potential risks of a metal-on-metal implant. Hip resurfacing is also generally accepted to be a more technically difficult procedure than traditional hip replacement due to the need to expose the acetabulum while retaining the native femoral head and neck. Therefore, surgeons need special training to be facile with the procedure and sufficient surgical volume to advance beyond the learning curve. The metal-on-metal bearing is less forgiving than other materials and thus the placement of the implant needs to be more precise. Thus, hip resurfacing will have the greatest chance of success in the right patient and when performed by the right surgeon.