Resurfacing Hip Arthroplasty: Evolution, Design, Indications, Techniques, and Results

Key Points

The success of the first generation of resurfacing implants was limited by inferior manufacturing processes and materials that were the best available at the time.
Improvements in the understanding of tribology; improvements in materials, design, and surgical technique; and insight of clinicians has led to the evolution of contemporary resurfacing designs that in many cases have limited the early failure mechanisms previously seen.
The current metal on metal resurfacing hip arthroplasty options do have limitations. The technique is challenging, results are not consistent, the number of patients ideally indicated for the procedure is limited, and the consequences of unanticipated wear mechanisms and local effects of metal ions remain unsolved.
Clinical reports of success with hip resurfacing in the most demanding cohort of joint arthroplasty patients (young active males) support its continued use and development for surgeons who perform the procedure routinely.
Wider adoption and resurgence of interest in this concept will require the development of new materials with a more favorable risk profile than existing materials.

Introduction

Modern total hip arthroplasty (THA) is considered one of the most successful surgical treatments ever developed. Its current form resulted from an evolution of ideas starting in the late 19th century. Resurfacing hip arthroplasty (RHA) is one adaptation that has been revisited several times along the course of this evolution. RHA was conceptualized and then championed as a technique that better replicated the normal anatomy of the hip and conserved host bone. In its early clinical application, RHA was met with unanticipated complications, including femoral fracture, osteonecrosis, materials failure, and implant loosening. Today, with the advent of bearing material improvements and better understanding of tribology as related to large diameter hip bearings, RHA remains a viable option for hip reconstruction in properly indicated patients with 10-year survival rates of greater than 90% in most series and approaching 95% in males. However, concerns associated with appropriate patient selection, risks associated with metal-on-metal (MOM) bearings, and the requirement for exacting surgical technique continue to limit wide adoption of the technology.

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