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Hip Joint Resurfacing Gains Popularity Again

Posted on: 08/17/2006
Hip replacements come in different types, shapes, and sizes. Most people have a total hip replacement (THR) where both sides of the hip are removed and replaced by an artificial part. The socket, head of the femur (thigh bone), and stem down into the femur are all brand new.

But sometimes only one side (either the socket side or the femoral head side) needs replacing. In such cases, a hemiarthroplasty is done. Sometimes only the surface of the femoral head needs replacing. This is called hip resurfacing arthroplasty (HRA).

HRA has actually been around since the 1930s when the femoral head was capped with ivory, glass, or stainless steel. But there were problems and HRA fell out of use until the 1970s. Femoral resurfacing started up again then but bone loss and loosening occurred too often.

Advances today have allowed resurfacing again with new metal-on-metal implants. Just resurfacing the worn side of the joint saves bone and preserves normal bone stresses needed for normal joint function. Some experts say the resurfacing also saves more of the joint proprioception. Proprioception is the joint's sense of position.

There are a few problems with HRA. The surgeon can't adjust the patient's leg length when using an HRA. This type of adjustment is made for patients who have lost bone from fracture or osteoporosis. Fracture of the femoral neck is more common with HRA. This is more likely to happen if the surgeon is just learning how to do this operation.

Long-term studies of HRA with today's materials aren't available yet. Short-term results from a dozen studies show the best outcomes using metal-on-metal resurfacing in young patients (less than 60 years old). Women seem to have more problems than men after HRA. Overall the risk of dislocation is less compared with standard THRs. If the HRA fails for any reason, the patient can always get a THR instead.

Michael A. Mont, MD, et al. Hip Resurfacing Arthroplasty. In Journal of the American Academy of Orthopaedic Surgeons. August 2006. Vol. 14. No. 8. Pp. 454-463.

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