Review Question - QID 219877

Fracture of the femoral neck is the most common complication and reason for reoperation in the first 6 months following hip resurfacing (Answer 2).

Hip resurfacing is a potential arthroplasty option for select patients. Advocates of resurfacing hip arthroplasty cite preservation of the proximal femoral bone stock, improved stability due to the larger head size, and decreased activity restrictions (patients may run) as advantages. Disadvantages include metallosis due to the metal-on-metal bearing surface and femoral neck fractures, which are unique to resurfacing. The exact etiology of femoral neck fractures following resurfacing is unknown. Technical errors, such as notching of the femoral neck or possibly disruption of the blood supply to the femoral head during extensive soft-tissue exposure, may result in femoral neck fracture.

Matharu et al. analyzed a cohort of 3,076 patients who had undergone Birmingham Hip Resurfacings at a single institution. They found the prevalence of periprosthetic fractures was 1.1%, and the median time to fracture was 0.27 years. Among these patients, 71% underwent isolated femoral component revision. They concluded that most fractures occur early after hip resurfacing and require a femur-only revision.

Marshall et al. performed a systematic review comparing hip resurfacing to THA. They found that the average time to revision was 3.0 years for hip resurfacing versus 7.8 years for THA. They also found that dislocations were more frequent with THA than with resurfacing. They concluded that hip resurfacing has a higher revision rate, and at an earlier timepoint than THA.

Mont et al. reviewed hip resurfacing arthroplasty in 2006. The literature reports low failure rates at 1-5 year follow-up, but the authors cautioned that resurfacing devices must be used with caution because with uncertainty surrounding long-term safety and efficacy. They concluded that resurfacing arthroplasty should be performed by surgeons who have received training specifically in this technique in order to reduce complications.

Figure A demonstrates a left-sided hip resurfacing + right-sided hip osteoarthritis.

Incorrect answers:
Answer 1: Aseptic LYMPHOCYTE-dominant vasculitis-associated lesion (ALVAL) is a risk with metal-on-metal bearing surfaces, like those found in hip resurfacing.
Answer 3: Infection is a risk of both surgeries.
Answer 4: Inter-prosthetic dislocation is a risk of a dual mobility bearing, which hip resurfacing does not use.
Answer 5: polyethylene wear is not a risk of hip resurfacing, which uses a metal-on-metal bearing.