There has been a big hype about hip resurfacing. Later there was a big hype against metal-on-metal and therefore also against hip resurfacing which consists out of metal. By the the way there was no hype against knee resurfacing recently even though it is the same material. For me as a specialized hip surgeon it is possible to detect the details in some conclusions, recommendations and overwhelming scientific results.
The problems with stemmed big head metal-on-metal implants should be separated from discussions about resurfacing. That means findings of the National Joint Registry for England and Wales were not aiming into the direction of metal-on-metal bearings in general but only stemmed THRs in the beginning. Afterwards they restricted implants with survival rate less then 95% after 10 years.
Also problems with failed resurfacing implants by some manufacturers should not be mixed up with other models and the method and success of resurfacing in general. Reason for failures came out of major changes in production procedures and design. The original implant unchanged since 1997 is still on the market, for example in the US as well.
Next problem is to find out the right conclusions out of described revision rates. Hip resurfacing is a demanding operative technique, more demanding than total hips. Patient preselection is necessary also. The learning curve is long. Some implants like the ASR and the DUROM failed in one way or the other. Revision is easier in resurfacing than in total hips especially in cemented total hips. Decision for revision may be made faster in resurfacing because its just easier to do. Many surgeons tried only a couple of hip resurfacings per year, many with mixed results, and quit later. These aspects play a big role and influence the registries and statistics. It is surprising that we still got excellent data under those circumstances. For the future we await even better results because of increased excellence. Smaller numbers of resurfacing beginners with long learning curves and consecutive negative impacts are expected.
Out of my experience I have 3 simple recommendations to be successful with hip resurfacing.
- The right patient
- The right surgeon
- The right implant
If you follow this track you are safe as with total hips and the results are often even better than the results of total hip replacements. Actually hip resurfacing was only developed to help younger patients to buy some years before total hip replacement and now it has become a competitor.
Many fear the outcomes of ceramic-on-ceramic in the future. Maybe we are confronted with similar misleading information about this issue as well. Again we have to keep an eye on scientific results.