HSS Journal ®

, Volume 8, Issue 3, pp 283–286 | Cite as

Adoption of Hip Resurfacing Arthroplasty at Hospital for Special Surgery: a Cohort Study

Current Topics Concerning Joint Preservation and Minimally Invasive Surgery of the Hip



Hip resurfacing arthroplasty (HRA) is an alternative to traditional total hip replacement (THR) that allows for the preservation of femoral bone. It is a more technically difficult procedure that has led some researchers to report an unsatisfactory learning curve (Berend et al., J Bone Joint Surg Am Suppl 2:89–92, 2011; Mont et al., Clin Orthop Relat Res 465:63–70, 2007).


The purpose of this study was to investigate the adoption of HRA at our institution, examining the clinical results, revision rate, and modes of failure. Additionally, a comparison of three different implant systems was performed.


A retrospective review of a consecutive series of HRA performed at our institution between the years 2004 and 2009 was carried out. A total of 820 HRA with a minimum of 2 years of follow-up were included in the study. The majority of included patients were males (70%), with osteoarthritis (92%). The average age was 49.8 years, and the mean BMI was 27.5 kg/m2.


The average Harris hip score improved from 61 to 96.5 postoperatively. Thirteen revisions (1.6%) were performed for femoral neck fracture, femoral head osteonecrosis, acetabular loosening, metal reactivity/metallosis, and metal allergy. The overall Kaplan–Meier survival curve with revision surgery as an endpoint showed 98.5% survival at 5 years. There were no observable differences in clinical scores or revision rates between the different implant systems.


HRA can be successfully adopted with a low complication rate, given careful patient selection, specialized surgical training, and use of good implant design.


hip resurfacing arthroplasty results complications learning curve 


  1. 1.
    Amstutz HC, Le Duff MJ. Eleven years of experience with metal-on-metal hybrid hip resurfacing: a review of 1000 conserve plus. J Arthroplasty. Sep 2008;23(6 Suppl 1):36-43.PubMedCrossRefGoogle Scholar
  2. 2.
    Amstutz HC, Le Duff MJ, Campbell PA, Wisk LE, Takamura KM. Complications after metal-on-metal hip resurfacing arthroplasty. Orthop Clin North Am. Apr 2011;42(2):207-230, viii.PubMedCrossRefGoogle Scholar
  3. 3.
    Amstutz HC, Takamura KM, Le Duff MJ. The effect of patient selection and surgical technique on the results of Conserve(R) Plus hip resurfacing--3.5- to 14-year follow-up. Orthop Clin North Am. Apr 2011;42(2):133-142, vii.PubMedCrossRefGoogle Scholar
  4. 4.
    Beaule PE, Le Duff M, Campbell P, Dorey FJ, Park SH, Amstutz HC. Metal-on-metal surface arthroplasty with a cemented femoral component: a 7-10 year follow-up study. J Arthroplasty. Dec 2004;19(8 Suppl 3):17-22.PubMedGoogle Scholar
  5. 5.
    Berend KR, Lombardi AV, Jr., Adams JB, Sneller MA. Unsatisfactory surgical learning curve with hip resurfacing. J Bone Joint Surg Am. May 2011;93 Suppl 2:89-92.PubMedCrossRefGoogle Scholar
  6. 6.
    Daniel J, Pynsent PB, McMinn DJ. Metal-on-metal resurfacing of the hip in patients under the age of 55 years with osteoarthritis. J Bone Joint Surg Br. Mar 2004;86(2):177-184.PubMedCrossRefGoogle Scholar
  7. 7.
    De Haan R, Pattyn C, Gill HS, Murray DW, Campbell PA, 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. Oct 2008;90(10):1291-1297.PubMedCrossRefGoogle Scholar
  8. 8.
    Glyn-Jones S, Pandit H, Kwon YM, Doll H, Gill HS, Murray DW. Risk factors for inflammatory pseudotumour formation following hip resurfacing. J Bone Joint Surg Br. Dec 2009;91(12):1566-1574.PubMedCrossRefGoogle Scholar
  9. 9.
    Grammatopolous G, Pandit H, Kwon YM, et al. Hip resurfacings revised for inflammatory pseudotumour have a poor outcome. J Bone Joint Surg Br. Aug 2009;91(8):1019-1024.PubMedCrossRefGoogle Scholar
  10. 10.
    Jolley MN, Salvati EA, Brown GC. Early results and complications of surface replacement of the hip. J Bone Joint Surg Am. Mar 1982;64(3):366-377.PubMedGoogle Scholar
  11. 11.
    Khan M, Kuiper JH, Edwards D, Robinson E, Richardson JB. Birmingham hip arthroplasty: five to eight years of prospective multicenter results. J Arthroplasty. Oct 2009;24(7):1044-1050.PubMedCrossRefGoogle Scholar
  12. 12.
    Langton DJ, Joyce TJ, Jameson SS, et al. Adverse reaction to metal debris following hip resurfacing: the influence of component type, orientation and volumetric wear. J Bone Joint Surg Br. Feb 2011;93(2):164-171.PubMedCrossRefGoogle Scholar
  13. 13.
    Mont MA, Seyler TM, Ulrich SD, et al. Effect of changing indications and techniques on total hip resurfacing. Clin Orthop Relat Res. Dec 2007;465:63-70.PubMedGoogle Scholar
  14. 14.
    Nunley RM, Zhu J, Brooks PJ, et al. The learning curve for adopting hip resurfacing among hip specialists. Clin Orthop Relat Res. Feb 2010;468(2):382-391.PubMedCrossRefGoogle Scholar
  15. 15.
    Pandit H, Glyn-Jones S, McLardy-Smith P, et al. Pseudotumours associated with metal-on-metal hip resurfacings. J Bone Joint Surg Br. Jul 2008;90(7):847-851.PubMedCrossRefGoogle Scholar
  16. 16.
    Shimmin AJ, Bare J, Back DL. Complications associated with hip resurfacing arthroplasty. Orthop Clin North Am. Apr 2005;36(2):187-193, ix.PubMedCrossRefGoogle Scholar
  17. 17.
    Su EP, Sheehan M, Su SL. Comparison of bone removed during total hip arthroplasty with a resurfacing or conventional femoral component: a cadaveric study. J Arthroplasty. Feb 2010;25(2):325-329.PubMedCrossRefGoogle Scholar
  18. 18.
    Vendittoli PA, Ganapathi M, Roy AG, Lusignan D, Lavigne M. A comparison of clinical results of hip resurfacing arthroplasty and 28 mm metal on metal total hip arthroplasty: a randomised trial with 3-6 years follow-up. Hip Int. Jan-Mar 2010;20(1):1-13.PubMedGoogle Scholar

Copyright information

© Hospital for Special Surgery 2012

Authors and Affiliations

  1. 1.Hospital for Special SurgeryNew YorkUSA
  2. 2.Clinical Orthopaedic SurgeryWeill Cornell Medical CollegeNew YorkUSA
  3. 3.Orthopedic SurgerySt. Joseph’s Regional Medical CenterPattersonUSA

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