Updated: 6/9/2021

Hip Resurfacing

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Questions
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Evidence
25
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Images
https://upload.orthobullets.com/topic/5032/images/xray.hip.ap.shows resurfacing.small.jpg
https://upload.orthobullets.com/topic/5032/images/femoral neck fx_moved.jpg
https://upload.orthobullets.com/topic/5032/images/xray.hip.ap.shows resurfacing.jpg
https://upload.orthobullets.com/topic/5032/images/bhr.jpg
  • Introduction
    • History
      • prior versions of resurfacing failed in the past due to
        • larger femoral head on polyethylene -> increased volumetric wear -> high osteolysis rate
      • modern resurfacing techniques (approved by FDA in 2006) have made the following changes
        • metal-on-metal components
        • larger femoral head
      • very popular 10 years ago particularly in younger patients due to less femoral bone resection
  • Indications
    • Indications (controversial)
      • patients with advanced arthritis and good proximal femoral bone stock
        • best outcomes in younger males with good bone stock
      • patients with proximal femoral deformity making total hip arthroplasty difficult
    • Contraindications
      • absolute
        • bone stock deficiency of the femoral head or neck
          • e.g., cystic degeneration of the femoral head
      • relative
        • coxa vara
          • increased risk for neck fractures
        • significant leg length discrepancies
          • resurfacing does not allow leg length corrections
        • female sex of child bearing age (controversial)
          • due to fact that metal ions can cross placenta
        • renal failure
          • functional kidneys required to excrete metal ions
  • Advantages & Disadvantages
    • Advantages
      • preservation of femoral bone stock
      • better stability compared to standard small head (22- to 32-mm) THA
      • improved restoration of hip biomechanics with lower risk of limb length discrepancy
      • revision may be easier than an intramedullary THA
    • Disadvantages
      • lack of modularity with inability to adjust length or correct offset
      • requires larger exposure than conventional THA
  • Outcomes
    • Variable outcome findings in the literature (79% to 98% success rate)
    • Better results found in patients young, larger males with excellent bone stock treated for osteoarthritis than for dysplasia or osteonecrosis
    • Some case series have shown survival comparable to conventional THA, while others have reported higher rates of early revision
      • some products have been removed from the market due to early failure
    • More recent prospective trials have shown few differences between resurfacing and THA
  • Complications
    • Periprosthetic femoral neck fracture
      • incidence of 0% to 4% (more common than in THA)
      • most common early complication (within first 3 years) and frequent cause for revision in acute post-operative period (<20 weeks)
      • mechanism thought to be related to osteonecrosis
      • fracture pattern
        • vertical fracture line from neck down to lesser trochanter
      • risk factors
        • femoral neck notching
          • prevent by placing implant in slight valgus (rather than slight varus)
        • osteoporotic bone
        • large areas of preexisting AVN
        • femoral neck impingement (from malaligned acetabular component)
        • female sex
        • varus positioning of femoral component
      • presents as groin pain
      • treatment
        • convert to a primary THA
        • place cerclage wire above lesser trochanter to prevent fracture propagation during stem insertion
    • Implant loosening (aseptic)
      • early loosening of the cemented femoral resurfacing component
    • Heterotopic ossification
      • higher incidence of heterotopic ossification compared to THA (from wider exposure)
    • Metallosis
      • may have elevated metal ion levels (cobalt, chromium, and cobalt-chromium ratio)
      • found in blood and urine from metal debris
      • presentation and laboratory values may mimic infection
        • may present with elevated synovial WBC due to metal debris and corrosion
      • most cases related to edge loading of the implant
    • Dislocation
      • risk is <1% (lower than conventional THA)
    • Pseudotumor
      • risk
        • metal-on-metal implants (like resurfacing)
        • young
        • female sex
      • may be asymptomatic
      • symptomatic patients require revision surgery
      • risk
        • metal-on-metal implants (like resurfacing)
        • young
        • female sex
      • may be asymptomatic
      • symptomatic patients require revision surgery
    • risk
      • metal-on-metal implants (like resurfacing)
      • young
      • female sex
    • may be asymptomatic
    • symptomatic patients require revision surgery
Questions (15)
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(OBQ09.134) An active 40-year-old male undergoes hip surgery for arthritis. A post-operative radiograph is provided in Figure A. Each of the following are complications associated with this procedure EXCEPT:

QID: 2947
FIGURES:
1

Deep vein thrombosis

3%

(117/3829)

2

Femoral neck fracture

3%

(113/3829)

3

Aseptic loosening

1%

(37/3829)

4

Polyethylene debris

85%

(3251/3829)

5

Dislocation

8%

(289/3829)

L 2 C

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(SBQ07HK.98.2) Which of the following is the most common reason for reoperation following hip resurfacing in the first 6 months following the operation?

QID: 9093
1

Aseptic loosening of the acetabular component

2%

(40/1727)

2

Aseptic loosening of the femoral component

9%

(164/1727)

3

Fracture of the femoral neck

77%

(1333/1727)

4

Fracture of the acetabulum

1%

(11/1727)

5

Infection

10%

(172/1727)

L 2 C

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(SBQ07HK.98.1) Which of the following complications is the primary reason for early reoperation following the procedure shown in Figure A?

QID: 9092
FIGURES:
1

Edge loading leading to rapid polyethylene wear

3%

(61/1823)

2

Fracture of the femoral neck

77%

(1397/1823)

3

Pseudotumor formation

8%

(154/1823)

4

Infection

4%

(69/1823)

5

Groin pain from accelerated acetabular erosion

7%

(125/1823)

L 2 C

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(OBQ07.65) All of the following are absolute or relative contraindication to hip resurfacing arthroplasty EXCEPT?

QID: 726
1

1.5 cm femoral head bone cysts

6%

(192/3122)

2

Acetabular dysplasia

4%

(121/3122)

3

Coxa vara

3%

(93/3122)

4

Femoral neck bone stock deficiency

4%

(122/3122)

5

Age less than 50-years-old

83%

(2583/3122)

L 2 D

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(OBQ07.181) When discussing metal on metal hip resurfacing versus metal on polyethylene total hip replacement, the surgeon should inform the patient that all of the following are disadvantages of hip resurfacing EXCEPT?

QID: 842
1

Higher dislocation rate

68%

(2511/3675)

2

Higher periprosthetic fracture rate

3%

(99/3675)

3

Increased serum metal ion levels

3%

(114/3675)

4

Higher rates of osteonecrosis

5%

(170/3675)

5

Larger incision and surgical dissection

21%

(761/3675)

L 2 C

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(OBQ06.204) Which of the following is the most common cause of early revision surgery (<20 weeks) following a hip resurfacing arthroplasty?

QID: 215
1

Periprosthetic fracture

78%

(2151/2750)

2

Rupture of abductors

1%

(30/2750)

3

Dislocation

14%

(383/2750)

4

Heterotopic ossification

3%

(96/2750)

5

Post-operative stiffness

3%

(69/2750)

L 2 C

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Evidence (25)
VIDEOS & PODCASTS (4)
CASES (2)
EXPERT COMMENTS (26)
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