HSS Journal ®

, Volume 8, Issue 3, pp 275–282 | Cite as

Hip Resurfacing: a 40-Year Perspective

  • Harlan C. AmstutzEmail author
  • Michel J. Le Duff
Current Topics Concerning Joint Preservation and Minimally Invasive Surgery of the Hip



Saving bone by resurfacing the femoral head is not a new concept and the appeal for this type of hip replacement has remained despite the difficulties to find a bearing material suitable for this procedure.


In this article, the unique experience of a surgeon who has been performing hip resurfacing since its early development is presented, along with a comparative analysis of the performance of successive designs.


The overall 10-year Kaplan–Meier survivorship of the early designs with polyethylene bearings did not exceed 62% while that of the current Conserve®Plus metal-on-metal hybrid design implanted with second generation surgical technique is in excess of 92%. Further exceptional, in the 10-year survivorship, 99.7% has been achieved with femoral size of 46 mm and good bone quality. Cementless acetabular components provide better enduring fixation than cemented designs.


Metal-on-metal is currently and fortunately the only highly successful bearing material that can combine low wear rates and the manufacturing of a thin acetabular component to preserve bone and still accommodate the large femoral head of a hip resurfacing. The adverse local tissue reactions (ALTR) associated with metal-on-metal devices are not a bearing material issue per se but one of the device design and surgical technique. Almost all of ALTR and the rare events of systemic toxicity are due to abnormal wear patterns which can be prevented by proper acetabular component design and precise socket orientation in both the coronal and sagittal planes. Further improvements of the long-term durability with hip resurfacing can be anticipated with the use of recently developed trabecular bone-like tantalum or titanium porous coatings and with proper training of the surgeons interested in performing hip resurfacing arthroplasty.


hip resurfacing long term survivorship history 



One or more of the authors (HCA and MDL) certifies that he or she has or may receive payments or benefits from a commercial entity (Wright Medical Technology) related to this work. The institutions of the authors have received funding from Wright Medical Technology, Inc. In addition, funding for this study was provided by the Saint Vincent Medical Center Foundation, Los Angeles.


  1. 1.
    Amstutz H, Beaulé P, Dorey F, Le Duff M, Campbell P, Gruen T: Metal-on-metal hybrid surface arthroplasty—surgical technique. J Bone and Joint Surg, 88 A(suppl 1 part 2): 234–249, 2006.CrossRefGoogle Scholar
  2. 2.
    Amstutz, H.; Grigoris, P.; and Dorey, F.: Evolution and future of surface replacement of the hip. J Orthop Sci, 3(3): 169–86, 1998.PubMedCrossRefGoogle Scholar
  3. 3.
    Amstutz, H., and Le Duff, M.: Background of metal-on-metal resurfacing. Proc Inst Mech Eng [H], 220(2): 85–94, 2006.Google Scholar
  4. 4.
    Amstutz, H., and Le Duff, M.: Evolution of hip resurfacing. In Hip Resurfacing: Principles, Indications, Technique and Results, pp. 1–15. Edited by Amstutz, H. C., 1–15, Philadelphia, Elsevier, 2008.Google Scholar
  5. 5.
    Amstutz, H.; Le Duff, M.; Campbell, P.; and Dorey, F.: The effects of technique changes on aseptic loosening of the femoral component in hip resurfacing. Results of 600 Conserve Plus with a 3–9 year follow-up. J Arthroplasty, 22(4): 481–9, 2007.PubMedCrossRefGoogle Scholar
  6. 6.
    Amstutz, H. C.: Surface replacement arthroplasty. In Total Hip Arthroplasty, pp. 295–332. Edited by Amstutz, H. C., 295–332, New York, Churchill Livingstone, 1991.Google Scholar
  7. 7.
    Amstutz, H. C.; Campbell, P.; Kossovsky, N.; and Clarke, I. C.: Mechanism and clinical significance of wear debris-induced osteolysis. Clin Orthop, (276): 7–18, 1992.Google Scholar
  8. 8.
    Amstutz, H. C.; Campbell, P.; Nasser, S.; and Kossovsky, N.: Modes of failure of surface replacements. In Hip Arthroplasty, pp. 507–534. Edited by Amstutz, H. C., 507–534, New York, Churchill Livingstone, 1991.Google Scholar
  9. 9.
    Amstutz, H. C.; Clarke, I. C.; Christie, J.; and Graff-Radford, A.: Total hip articular replacement by internal eccentric shells: the tharies approach to total surface replacement arthroplasty. Clin Orthop, (128): 261–84., 1977.Google Scholar
  10. 10.
    Amstutz, H. C.; Sparling, E. A.; Grigoris, P.; Campbell, P. A.; and Dorey, F. J.: Surface replacement: the hip replacement of the future. Hip International, 8(4): 187–207, 1998.Google Scholar
  11. 11.
    Amstutz, H. C.; Takamura, K.; and Le Duff, M.: The effect of patient selection and surgical technique on the results of Conserve® Plus hip resurfacing—3.5- to 14-year follow-up. Orthop Clin North Am, I42(2): 133–42, 2011.CrossRefGoogle Scholar
  12. 12.
    Ball, S.; Le Duff, M.; and Amstutz, H.: Early results of conversion of a failed femoral component in hip resurfacing arthroplasty. J Bone and Joint Surg Am, 89: 735–41, 2007.CrossRefGoogle Scholar
  13. 13.
    Banerjee, M.; Bouillon, B.; Banerjee, C.; Bäthis, H.; Lefering, R.; Nardini, M.; and Schmidt, J.: Sports activity after total hip resurfacing. Am J Sports Med., 38(6): 1229–36, 2010.PubMedCrossRefGoogle Scholar
  14. 14.
    Beaulé, P.; Dorey, F.; and Le Duff, M.: Fate of cementless acetabular components retained during revision of a femoral component of a total hip arthroplasty. Journal of Bone and Joint Surgery, 85-A(12): 2288–93, 2003.PubMedGoogle Scholar
  15. 15.
    Beaulé, P.; Le Duff, M.; Campbell, P.; Dorey, F.; Park, S.; and Amstutz, H.: Metal-on-metal surface arthroplasty with a cemented femoral component: A 7–10 year follow-up study. J Arthroplasty, 19(12): 17–22, 2004.PubMedGoogle Scholar
  16. 16.
    Campbell, P.; Mirra, J.; and Amstutz, H. C.: Viability of femoral heads treated with resurfacing arthroplasty. J Arthroplasty, 15(1):120–2, 2000.Google Scholar
  17. 17.
    Cooper, R. A.; McAllister, C. M.; Borden, L. S.; and Bauer, T. W.: Polyethylene debris-induced osteolysis and loosening in uncemented total hip arthroplasty. A cause of late failure. Journal of Arthroplasty, 7(3): 285–90, 1992.PubMedCrossRefGoogle Scholar
  18. 18.
    De Haan, R.; Pattyn, C.; Gill, H.; Murray, D.; Campbell, P.; and De Smet, K.: Correlation between inclination of the acetabular component and metal ion levels in metal-on-metal hip resurfacing replacement. J Bone Joint Surg Br., 90(10): 1291–7, 2008.PubMedCrossRefGoogle Scholar
  19. 19.
    Eswaramoorthy, V.; Biant, L.; and Field, R.: Clinical and radiological outcome of stemmed hip replacement after revision from metal-on-metal resurfacing. J Bone Joint Surg Br., 91(11): 1454–8, 2009.PubMedCrossRefGoogle Scholar
  20. 20.
    Garbuz, D.; Tanzer, M.; Greidanus, N.; Masri, B.; and Duncan, C.: The John Charnley Award: Metal-on-Metal Hip Resurfacing versus Large-diameter Head Metal-on-Metal Total Hip Arthroplasty: A Randomized Clinical Trial. Clin Orthop Relat Res., 468(2): 318–25, 2010.PubMedCrossRefGoogle Scholar
  21. 21.
    Gruen, T.; Le Duff, M.; Wisk, L.; and Amstutz, H.: Prevalence and clinical relevance of radiographic signs of impingement in metal-on-metal hybrid hip resurfacing. J Bone and Joint Surg Am., 93(16): 1519–26, 2011.CrossRefGoogle Scholar
  22. 22.
    Head, W. C.: The Wagner surface replacement arthroplasty. Orthop Clin North Am, 13(4): 789–97, 1982.PubMedGoogle Scholar
  23. 23.
    Ikeda, T.; Takahashi, K.; Kabata, T.; Sakagoshi, D.; Tomita, K.; and Yamada, M.: Polyneuropathy caused by cobalt–chromium metallosis after total hip replacement. Muscle Nerve 42(1): 140–3, 2010.PubMedCrossRefGoogle Scholar
  24. 24.
    Jasty, M.; Bragdon, C.; Jiranek, W.; Chandler, H.; Maloney, W.; and Harris, W. H.: Etiology Of Osteolysis Around Porous-Coated Cementless Total Hip Arthroplasties. Clinical Orthopaedics and Related Research, 308(NOV): 111–126, 1994.PubMedGoogle Scholar
  25. 25.
    Jolley, M.; Salvati, E.; and Brown, G.: Early Results and Complications of Surface Replacement of the Hip. J Bone Joint Surg [AM], 64(3): 366–377, 1982.Google Scholar
  26. 26.
    Kumar, M.; Shetty, M.; Kiran, K.; and Kini, A.: Validation of navigation assisted cup placement in total hip arthroplasty. Int Orthop., 36(1): 17–22, 2012.PubMedCrossRefGoogle Scholar
  27. 27.
    Langton, D.; Jameson, S.; Joyce, T.; Gandhi, J.; Sidaginamale, R.; Mereddy, P.; Lord, J.; and Nargol, A.: Accelerating failure rate of the ASR total hip replacement. J Bone Joint Surg Br., 93(8): 1011–6, 2011.PubMedCrossRefGoogle Scholar
  28. 28.
    Langton, D.; Sprowson, A.; Joyce, T.; Reed, M.; Carluke, I.; Partington, P.; and Nargol, A.: Blood metal ion concentrations after hip resurfacing arthroplasty: a comparative study of articular surface replacement and Birmingham Hip Resurfacing arthroplasties. JBJS Br, 91(10): 1287–95, 2009.PubMedGoogle Scholar
  29. 29.
    Le Duff, M., and Amstutz, H. C.: Sporting activity after hip resurfacing: Changes over time. Orthop Clin North Am, 42(2): 161–7, 2011.PubMedCrossRefGoogle Scholar
  30. 30.
    Mai, M. T.; Schmalzried, T. P.; Dorey, F. J.; Campbell, P. A.; and Amstutz, H. C.: The contribution of frictional torque to loosening at the cement–bone interface in Tharies hip replacements. J Bone Joint Surg Am, 78(4): 505–11, 1996.PubMedGoogle Scholar
  31. 31.
    Maloney, W. J., and Smith, R. L.: Periprosthetic osteolysis in total hip arthroplasty: the role of particulate wear debris. Journal of Bone and Joint Surgery. American Volume, 77A(September): 1448–1461, 1995.Google Scholar
  32. 32.
    Mao, X.; Wong, A.; and Crawford, R.: Cobalt toxicity—an emerging clinical problem in patients with metal-on-metal hip prostheses? Med J Aust., 194(12): 649–51, 2011.PubMedGoogle Scholar
  33. 33.
    Murray, W. R., and Van Meter, J. W.: Surface replacement hip arthroplasty: results of the first seventy-four consecutive cases at the University of California, San Francisco. Hip: 156–66, 1982.Google Scholar
  34. 34.
    Naal, F.; Maffiuletti, N.; Munzinger, U.; and Hersche, O.: Sports After Hip Resurfacing Arthroplasty. Am J Sports Med., 35(5): 705–711, 2007.PubMedCrossRefGoogle Scholar
  35. 35.
    Narvani, A.; Tsiridis, E.; Nwaboku, H.; and Bajekal, R.: Sporting activity following Birmingham hip resurfacing. Int J Sports Med., 27(6): 505–7, 2006.PubMedCrossRefGoogle Scholar
  36. 36.
    Oldenburg, M.; Wegner, R.; and Baur, X.: Severe cobalt intoxication due to prosthesis wear in repeated total hip arthroplasty. J Arthroplasty., 24(5): 825.e 15–20, 2009.CrossRefGoogle Scholar
  37. 37.
    Pazzaglia, U.; Apostoli, P.; Congiu, T.; Catalani, S.; Marchese, M.; and Zarattini, G.: Cobalt, chromium and molybdenum ions kinetics in the human body: data gained from a total hip replacement with massive third body wear of the head and neuropathy by cobalt intoxication. Arch Orthop Trauma Surg., 131(9): 1299–308, 2011.PubMedCrossRefGoogle Scholar
  38. 38.
    Rizzetti, M.; Liberini, P.; Zarattini, G.; Catalani, S.; Pazzaglia, U.; Apostoli, P.; and Padovani, A.: Loss of sight and sound. Could it be the hip? Lancet, 373(9668): 1052, 2009.PubMedCrossRefGoogle Scholar
  39. 39.
    Sandiford, N.; Muirhead-Allwood, S.; and Skinner, J.: Revision of failed hip resurfacing to total hip arthroplasty rapidly relieves pain and improves function in the early post operative period. J Orthop Surg Res., 5(1): 88, 2010.PubMedCrossRefGoogle Scholar
  40. 40.
    Schmalzried, T.: Metal–metal bearing surfaces in hip arthroplasty. Orthopedics., 32(9): E-publication, 2009.Google Scholar
  41. 41.
    Schmalzried, T. P.; Fowble, V. A.; and Amstutz, H. C.: The fate of pelvic osteolysis after reoperation. No recurrence with lesional treatment. Clin Orthop, (350): 128–37, 1998.Google Scholar
  42. 42.
    Smith-Petersen, M.: Evolution of mould arthroplasty of the hip joint. J. Bone Joint Surg, 30 B: 59–75, 1948.Google Scholar
  43. 43.
    Steens, W.; von Foerster, G.; and Katzer, A.: Severe cobalt poisoning with loss of sight after ceramic–metal pairing in a hip—a case report. Acta Orthop., 77(5): 830–2, 2006.PubMedCrossRefGoogle Scholar
  44. 44.
    Su, E.; Sheehan, M.; and Su, S.: Comparison of Bone Removed During Total Hip Arthroplasty With a Resurfacing or Conventional Femoral Component: A Cadaveric Study. J Arthroplasty Suppl, 25(2): 325–9, 2010.CrossRefGoogle Scholar
  45. 45.
    Tower, S.: Arthroprosthetic Cobaltism: Neurological and Cardiac Manifestations in Two Patients with Metal-on-Metal Arthroplasty: A Case Report. J Bone Joint Surg Am., 92(7): 2847–51, 2010.Google Scholar
  46. 46.
    Treacy, R.; McBryde, C.; Shears, E.; and Pynsent, P.: Birmingham hip resurfacing: A MINIMUM FOLLOW-UP OF TEN YEARS. J Bone Joint Surg Br., 93(1): 27–33, 2011.PubMedCrossRefGoogle Scholar
  47. 47.
    Vendittoli, P.; Lavigne, M.; Girard, J.; and Roy, A.: A randomised study comparing resection of acetabular bone at resurfacing and total hip replacement. J Bone Joint Surg Br., 88(8): 997–1002, 2006.PubMedCrossRefGoogle Scholar
  48. 48.
    Wera, G.; Gillespie, R.; Petty, C.; Petersilge, W.; Kraay, M.; and Goldberg, V.: Revision of hip resurfacing arthroplasty. Am J Orthop (Belle Mead NJ). 39(8): E78-83, 2010.Google Scholar

Copyright information

© Hospital for Special Surgery 2012

Authors and Affiliations

  1. 1.Joint Replacement Institute at Saint Vincent Medical CenterLos AngelesUSA

Personalised recommendations