Effect of changing indications and techniques on total hip resurfacing

Recently, improved metal-on-metal bearing technology has led to the reemergence of resurfacing as a reasonable option for total hip arthroplasty. During the course of a prospective multicenter FDA-IDE evaluation of metal-on-metal total hip resurfacings, we modified our indications and emphasized surgical technique where the femoral surface area was small due to femoral cysts and small component size. We assessed the influence of these changes on complication rates in the first cohort of 292 patients and the second of 724, and then compared these outcomes in the second cohort with historical reports of resurfacing. We had a minimum followup of 24 months (mean, 33 months; range, 24-60 months). After changes were made in the indications and technique, the overall complication rate decreased from 13.4% to 2.1% with the femoral neck fracture rate reduced from 7.2% to 0.8%. The outcomes of the second cohort compare with modern-day resurfacing devices and appear superior to historical results. The data suggest patients should be carefully selected and technique optimized to reduce complications. Long-term followup is required to see if these promising results will be maintained.