In the world of prosthetic hips, what was
old is new again. A procedure known as hip
resurfacing, once tried two to three decades
ago, is experiencing a resurgence in the U.S.,
thanks to improved technology. The new technique has several advantages over
standard total hip replacement (THR) and is an
attractive alternative to many people, said
Peter Brooks, M.D., a Cleveland Clinic
orthopedic surgeon, according to Cleveland
Clinic’s Men’s Health Advisor.
"I think it’s probably preferable in the
right patient," he said. "They absolutely love
it. They love the concept."
However, the procedure isn’t for people with
weak bones or kidney problems, so it may not be
ready to supplant THR as the gold standard in
hip prostheses. What’s the difference?
In hip resurfacing, a surgeon shaves the head
of the femur (the large thigh bone) where it
connects to the hip socket (acetabulum). A
metallic cap covers the femoral head, guided by
a small, short stem drilled into the bone. The
capped bone fits into a metallic cup inserted
into the acetabulum.
A THR requires the removal of the entire
femoral head and neck, replaced with a metallic
device with a ceramic or metallic head and a
long, thick metal stem that’s driven deep into
The hip resurfacing devices of the 1970s and
early 1980s, which used a metallic femoral head
and a thin plastic socket, had a high failure
rate, and by the mid-1980s, hip resurfacing had
largely fallen out of use. A new metal-on-metal
resurfacing device has been used in tens of
thousands of patients worldwide for more than a
decade, but it received U.S. Food and Drug
Administration approval only in May 2006. Other
devices are awaiting FDA approval.
Whereas THR replaces the entire femoral head
and neck, resurfacing preserves bone and targets
only the problem area: the arthritic surface of
the femoral head and acetabulum.
The long stem of a THR alters the natural
biomechanics of the hip, resulting in a gradual
thinning of the bone at the top of the femur
that makes a follow-up THR difficult.
Resurfacing preserves the normal hip mechanics
and femoral thickness, delays the need for a THR
and can easily be converted to a THR should it
fail, Dr. Brooks said.
The larger head of the hip resurfacing system
makes it more difficult to dislocate, and
resurfacing patients generally do not have to
follow all the precautions-such as avoiding
bending forward more than 90 degrees or crossing
their legs-that their THR counterparts must do
to prevent dislocation in the weeks after
Dr. Brooks’ patients also have reported that
resurfacing feels more natural than a THR.
"I have a number of patients who have a hip
replacement on one side and hip resurfacing on
the other, and they uniformly prefer the hip
resurfacing," he said.
Despite these pluses, resurfacing has
drawbacks. In about 1 to 2 percent of cases, a
fracture may develop at the femoral neck, just
below where the new metal cap ends. The
fractures, which usually occur within four
months of surgery, sometimes can be repaired
with pins, but a THR may be necessary if the
fracture does not heal.
Because of the fracture risk, resurfacing is
not recommended for the elderly or people with
osteoporosis. Dr. Brooks, who has performed
about 60 resurfacings, said the majority of his
resurfacing patients are in their 40s and 50s,
but some are in their 60s.
Additionally, the resurfacing device can
produce potentially toxic metallic ions. Healthy
kidneys excrete the metals from the body, but
people with impaired kidney function may
encounter problems and should not undergo
Finally, the resurfacing operation generally
takes more time and is more difficult to perform
than THR surgery, and it requires a slightly
larger incision. The procedure is relatively
new, and only 400 to 500 U.S. surgeons,
including Dr. Brooks, are formally trained to
What to expect
Dr. Brooks’ resurfacing patients take a few
steps on crutches the day after surgery and
usually can go home three days after the
procedure. Most patients remain on crutches for
six weeks, at which point they return for a
check-up, and don’t see the doctor again until
the one-year mark.
Patients are allowed to do non-impact
exercise-walking, biking and swimming-after six
weeks, but they must avoid heavy lifting and
impact activities such as jogging. After a year,
they can do whatever exercise they’re fit to
handle, he said.
What you can do
- Seek an experienced surgeon, and ask
your surgeon how many resurfacings he or she
- Six weeks after your surgery, do only
non-impact exercise-such as walking, biking
and swimming-and avoid heavy lifting.
- Help maintain bone health by getting at
least 1,200 mg of calcium-about two
eight-ounce glasses of skim milk-a day if
you’re over 50, and at least 400-600
international units (IUs) of vitamin D
daily, preferably from D-fortified skim milk
and fatty fish such as salmon.