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Is Patient Selection Important for Hip Resurfacing?

  • Symposium: Papers Presented at the Hip Society Meetings 2008
  • Published:
Clinical Orthopaedics and Related Research

Abstract

The optimal implant option for hip arthroplasty in the young, active patient remains controversial. There has been renewed interest for metal-on-metal hip resurfacing due to improved design and manufacturing of implants, better materials, enhanced implant fixation, theoretical advantages over conventional total hip arthroplasty, and recent Food and Drug Administration approval of two devices. Recent studies indicate satisfactory short- and midterm clinical results (1- to 10-year followup) with low complication rates, but there is a learning curve associated with this procedure, a more extensive surgical approach is necessary, and long-term results have yet to be determined. Proper patient selection may help avoid complications and improve patient outcomes. Patient selection criteria in the literature appear based predominantly on theoretical considerations without any consensus on stratifying patient risk. The most commonly reported complications encountered with hip resurfacing include femoral neck fracture, acetabular component loosening, metal hypersensitivity, dislocation, and nerve injury. At the time of clinical evaluation, patient age; gender; diagnosis; bone density, quality, and morphology; activity level; leg lengths; renal function; and metal hypersensitivity are important factors when considering a patient for hip resurfacing. Based on our review, we believe the best candidates for hip resurfacing are men under age 65 with osteoarthritis and relatively normal bony morphology.

Level of Evidence: Level V, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank all the other authors in the literature whose work made this project possible. Without their insight and dedication to reporting results, complications, and technical challenges, we would not be able to report on patient selection for hip resurfacing.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Washington University, 660 S. Euclid Avenue, Campus Box 8233, St Louis, MO, 63130-4899, USA

    Ryan M. Nunley MD & Robert L. Barrack MD

  2. Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA

    Craig J. Della Valle MD

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  1. Ryan M. Nunley MD
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  2. Craig J. Della Valle MD
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Correspondence to Ryan M. Nunley MD.

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Dr. Nunley has received institutional research support from Smith and Nephew.

Dr. Della Valle has received research support and consulting fees from Zimmer, and paid travel from Smith and Nephew and Stryker.

Dr. Barrack has received institutional research support, royalties, and consulting fees from Smith and Nephew.

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Nunley, R.M., Della Valle, C.J. & Barrack, R.L. Is Patient Selection Important for Hip Resurfacing?. Clin Orthop Relat Res 467, 56–65 (2009). https://doi.org/10.1007/s11999-008-0558-z

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