Total Hip Resurfacing as an Alternative to Total Hip Arthroplasty: Indications and Precautions

The concept of hip resurfacing arthroplasty is not new. Early designs by pioneers including Wagner, Freeman and Charnley failed mainly due to material, design and manufacturing flaws. Modern metal on metal hip resurfacing has become increasingly popular over the last decade however. Good early and intermediate results have been reported in young, active patients using this prosthesis. Theoretical benefits compared to conventional total hip arthroplasty (THA) include bone stock preservation, particularly on the femoral side, improved stability due to the large diameter bearing, improved range of motion and proprioception and technically less difficult revision to a total hip arthroplasty if necessary. This prosthesis must be used with strict indications however as the technique is more demanding than conventional THA and imperfect positioning of either the acetabular or femoral component are associated with complications. Unique complications thought to be due to hypersensitivity reactions have also been reported. This article outlines the evolution of hip resurfacing arthroplasty and discusses new designs, surgical techniques and potential complications, all of which the surgeon needs to be familiar with.