Top Twelve Technical Pearls for Hip Resurfacing

Total hip resurfacing arthroplasty has emerged as an alternative treatment for patients with osteoarthritis, and the use of this procedure has increased in frequency during the past 5 years. Results from high-volume centers at midterm follow-up have been similar to outcomes of conventional total hip arthroplasty. However, there are concerns about complications, such as component loosening and femoral neck fractures, particularly early in a surgeon's learning curve. The purpose of this report is to describe patient selection criteria and 12 specific surgical techniques that may improve clinical outcomes, based on the experience of a high-volume surgeon and supported by published evidence. These techniques include preoperative radiographic evaluation, adequate joint exposure, determination of acetabular component size, acetabular exposure, sufficient seating of the acetabular component, removal of osteophytes, guide pin placement as well as assessment, progressive reaming, determination of the femoral component seating level, proper cementing, and evaluation of final alignment. The understanding and implementation of these indications, contraindications, and techniques may substantially reduce the complication rates of hip resurfacing.