Hip resurfacing arthroplasty: current status and future perspectives

Abstract

Hip resurfacing arthroplasty (HRA) is a concept of hip replacement that allows treating young active patients with a femoral bone preserving procedure. The proposed advantages of resuming an active lifestyle with increased frequency and duration of sports activities have been shown to be realistic. The 30-year cost-effectiveness in young male patients has been shown to be higher in resurfacing compared to conventional total hip replacement (THA). However, prognosticators of an inferior outcome have also been identified. The most important patient related factors are secondary osteoarthritis as the indication for surgery such as post-childhood hip disorders or AVN, female gender, smaller component sizes and older age (>65 years for males and >55 years for females). In addition, surgical technique (approach and cementing technique) and component design are also important determinant factors for the risk of failure. Moreover, concerns have surfaced with respect to high metal ion concentrations and metal ion hypersensitivities. In addition, the presumed ease of revising HRA has not reflected in improved or equal survivorship in comparison to a primary THA. This highlights the importance of identifying patient-, surgery-, and implant-related prognosticators for success or failure of HRA. Rather than vilifying the concept of hip resurfacing, detailed in depth analysis should be used to specify indications and improve implant design and surgical techniques.

Musculoskeletal System

“…It is desirable because of its femoral bone conserving properties and its ability to better preserve the biomechanics of the hip, resulting in higher postsurgery activity levels when compared to conventional THA. [53][54][55] Modern implants use metal-on-metal components with a cemented femoral stem and cementless press-fit acetabular cup ( Figure 5-12). Complications include infection, femoral neck fracture or notching, avascular necrosis of the femoral head, component loosening, hypersensitivity to metal ions, and higher incidence rates of revision than for THA.…”

Empirical Comparison Of Discrete Choice Experiment And Best-Worst Scaling To Estimate Stakeholders' Risk Tolerance For Hip Replacement Surgery

“…Potentially relevant attributes related to THA and HRA were identified on the basis of multiple National Joint Replacement Registries and systematic reviews [26, 28,29,[34][35][36][37][38][39]. All attributes were judged by two medical researchers for their impact on a possible decision in choosing between THA and HRA.…”

“…Four attribute levels were chosen for all five attributes on the basis of literature reviews and registries [26, 28,29,[34][35][36][37][38][39]. Revision rates were based on the reported outcomes for men between 45 and 65 years in the Australian annual National Joint Replacement Registry and the National Joint Replacement Registry of England and Wales [26,28].…”

“…These registries are members of the International Consortium of Registries and are the largest registries available with the longest follow-up times. The levels for each of the benefits were based on systematic reviews [35][36][37][38][39] and the Alberta Hip Improvement project [29,34], as presented in Table 1.…”

Analysis of retrieved hip resurfacing arthroplasties reveals the interrelationship between interface hyperosteoidosis and demineralization of viable bone trabeculae

“…Although resurfacing is not a new trend in hip arthroplasty, it remains controversial 1. On the one hand, hip resurfacing arthroplasty (HRA) has potential advantages that make it a promising option for selected patients.…”