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Hip resurfacing: a 40-year perspective.

Harlan C Amstutz¹, Michel J Le Duff

¹Joint Replacement Institute at Saint Vincent Medical Center, The S. Mark Taper Building, 2200 West Third Street, Suite 400, Los Angeles, CA 90057 USA.

HSS Journal : the Musculoskeletal Journal of Hospital for Special Surgery

|October 2, 2013

Summary

Hip resurfacing arthroplasty has evolved significantly. Modern metal-on-metal designs, combined with improved surgical techniques, offer excellent long-term survival rates, preserving bone stock effectively.

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Area of Science:

Orthopedic Surgery
Biomaterials Science
Implant Design

Background:

Hip resurfacing arthroplasty aims to preserve bone by resurfacing the femoral head.
Finding suitable bearing materials for hip resurfacing has been challenging.

Purpose of the Study:

To present a surgeon's unique experience with hip resurfacing since its early development.
To comparatively analyze the performance of successive hip resurfacing designs.

Main Methods:

Analysis of 10-year Kaplan-Meier survivorship data for different hip resurfacing designs.
Comparison of polyethylene and metal-on-metal bearing materials.
Evaluation of cementless versus cemented acetabular components.
Assessment of surgical technique's impact on outcomes.

Keywords:

hip resurfacing history long term survivorship

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Main Results:

Early hip resurfacing designs with polyethylene bearings had a 10-year survivorship below 62%.
Current metal-on-metal hybrid designs with advanced surgical techniques exceed 92% 10-year survivorship.
Exceptional 99.7% 10-year survivorship was achieved with specific implant sizes and bone quality.
Cementless acetabular components demonstrated superior fixation compared to cemented designs.

Conclusions:

Metal-on-metal bearings are currently the most successful for hip resurfacing, offering low wear and enabling thin acetabular components.
Adverse local tissue reactions (ALTR) are linked to device design and surgical technique, not solely the bearing material.
Proper acetabular component design and precise socket orientation can prevent abnormal wear patterns and associated toxicity.
Future improvements in hip resurfacing durability may come from porous coatings (tantalum/titanium) and specialized surgeon training.