Hip Resurfacing Arthroplasty: Past, Present and Future

Abstract

The history of hip resurfacing arthroplasty (HRA) has faced numerous challenges and undergone decades of evolution in materials and methods. These innovations have been translated to the successes of current prostheses and represent a surgical and mechanical achievement. Modern HRAs now have long term outcomes with excellent results in specific patient groups as demonstrated in national joint registries. This article reviews the key moments in the history of HRAs with specific emphasis on the lessons learnt, current outcomes and future prospects.

Keywords: Birmingham Hip Resurfacing; Ceramic on Ceramic Hip Resurfacing; Hip Resurfacing; Metal on Metal; Metal on Polyethylene Hip Resurfacing; Resurfacing Arthroplasty.

Figure 1.. Timeline of events

Figure 2.. (Obese) (A and B). Anteroposterior and lateral radiographs of the left hip demonstrating failure of a hip resurfacing arthroplasty performed 10 years ago in a 42 year old lady with a body mass index of >35 and a history of developmental dysplasia of the left hip. (C and D). Anteroposterior and lateral radiographs of the left hip demonstrating uncomplicated single stage revision of the failed hip resurfacing arthroplasty to an uncemented total hip arthroplasty using a 36mm ceramic femoral head on a highly cross-linked polyethylene liner. This patient has made an uneventful recovery and remains satisfied at follow-up.

Figure 3.. (METAL ON METAL) (A). Anteroposterior radiograph demonstrating a painful right hip resurfacing in a 71 year old gentleman implanted 13 years ago and a well-functioning left proximal femoral replacement following a periprosthetic fracture. B) and C) Metal artefact reduction magnetic resonance imaging demonstrating a large pseudotumour associated with the right hip resurfacing in the axial and sagittal planes. D) Postoperative anteroposterior radiograph following successful single stage revision to a cemented femoral stem and ceramic femoral head articulating with an uncemented acetabular shell with a cross-linked polyethylene liner.

Figure 4.. Pre- and post-operative radiographs of a 45 year old male with end-stage osteoarthritis of both hips successfully treated with bilateral hip resurfacing arthroplasties using the ADEPT® Hip Resurfacing System (MatOrtho Limited, current Orthopaedic Data)