Mechanism of failure eleven years following a Buechel Pappas hip resurfacing

Hip resurfacing is gaining popularity as an acceptable treatment option for young active patients with hip osteoarthritis. The Buechel-Pappas hip resurfacing system has a titanium alloy femoral and acetabular component with a polyethylene liner. The titanium nitride coating of the femoral component has been shown to have a very low wear rate during in vivo laboratory studies. Although it has been on the marketplace since 1989, we could find no followup results in the literature. We report a rare case of Buechel-Pappas hip resurfacing which presented with catastrophic failure at 11 years follow-up. The polyethylene liner was worn through, and there was severe metallosis with extensive titanium debris. The head of the femur was however viable, suggesting that the failure of the procedure was due to the bearing surface.