Indications and results of hip resurfacing

Abstract

The best indication for hip resurfacing is a young active patient with severe hip arthritis, good hip morphology and reasonable bone quality. With revision of either component for any reason as the endpoint, there were 68 revisions in our series of 3,095 consecutive Birmingham Hip Resurfacings (BHR) (1997-2009), including all diagnoses in all ages. This equates to a revision rate of 2.2% and survivorships of 99, 97 and 96% at five, ten and 13 years, respectively. In patients under 55 years with osteoarthritis, the survivorship is 99 and 98% at ten and 13 years. These results provide medium-term evidence that BHR when performed well in properly selected patients offers excellent outcomes and implant survivorship. Small changes to implant materials and design can affect joint function and survivorship significantly as seen from the withdrawal of certain resurfacing devices recently from clinical use. The clinical history of one device cannot be extrapolated to other devices.

Fig. 1

These and several other young patients in our series who had extensive pre-operative cystic destruction of the femoral head often from long-term anti-inflammatory intake, or had severe avascular necrosis of the femoral head, have continued to have good hip function and unremarkable radiology 10–13 years after their resurfacing. There are others with such bone loss, who suffered femoral failures, as described in this paper. Based on our evidence we no longer perform or advise a resurfacing in the presence of this degree of femoral head damage

Fig. 2

The quality of life of this very active 49-year-old farmer was severely affected by primary osteoarthritis of his hip. Regular anatomy and reasonably good bone quality make him an ideal candidate for hip resurfacing. His high activity level and increased femoral offset makes resurfacing a more attractive option than a total hip replacement in his case

Fig. 3

3,095 consecutive BHRs performed between 1997 and 2009, revision of either component for any reason as the endpoint

Fig. 4

Gender differences in implant survivorship

Fig. 5

Implant survivorship of BHRs in different diagnoses

Fig. 6

Kaplan-Meier survivorship of BHRs in patients under the age of 55 years with symptomatic osteoarthritis