Conversion of a failed hip resurfacing arthroplasty to total hip arthroplasty: pearls and pitfalls

Abstract

Surface replacement arthroplasty (SRA) remains a viable alternative to total hip arthroplasty (THA) in appropriately selected, active adults with degenerative hip disease. However, orthopedic surgeons are facing a number of scenarios where revision of one or both components of an SRA is indicated. Indications for revision vary and impact the potential outcomes of conversion of a SRA to THA. While clinical outcomes are generally favorable, a growing body of data illustrates patients who undergo conversion of a SRA to THA to be at increased risk of requiring a repeat revision surgery and experiencing functional outcomes inferior to that of a primary THA. The results of patients undergoing conversion of a SRA to THA highlight the need for careful patient selection, thorough preoperative counseling, and technical precision when performing a SRA. Furthermore, a systematic approach to the failed SRA is necessary to ensure optimal clinical results.

Keywords: Aseptic loosening; Femoral neck fracture; Metallosis; Surface replacement arthroplasty; Total hip arthroplasty.

Fig. 1

Revision of surface replacement arthroplasty to total hip arthroplasty. a Anteroposterior (AP) pelvis radiograph after left hip surface replacement arthroplasty (SRA). b Cross-table lateral radiograph of the left hip demonstrating 13° of anteversion in the acetabular component. c The patient felt a “pop” while performing yard work and subsequent radiograph demonstrates a posterior-superior SRA dislocation without fracture. The patient was successfully closed reduced in the emergency department, but went on to have additional instability events. d AP pelvis radiograph 6 weeks after full SRA conversion to total hip arthroplasty utilizing a dual mobility ceramic-in-polyethylene head, a highly porous metal multi-hole cup and a medial-lateral tapered cementless femoral stem