The benefits of hip resurfacing include:
- A viable treatment for younger, more active patients
- Early intervention
- Bone conserving procedure
- More reliably restored native hip joint biomechanics4
- Lower infection rates5
- Lower incidence of dislocation4
- Improvements in activity levels and hip scores, particularly in younger patients4,6
- Ease of femoral revision
Return to sport and leisure activities
Resurfacing of the femoral head allows for better restoration of the anatomy4,7 and may be more natural under stressed gait conditions such as high walking speeds, push-off forces and hill walking when compared to conventional THR8,9. Expert surgeons allow their hip resurfacing patients to return to a wider variety of sport and leisure activities without restriction as compared to total hip replacement, and return to activity is commonly much earlier in the postoperative recovery phase4, 10,11. Patients report a high level of activity including running4,6, 8 ,13,13 and these levels of activity may be maintained into the second decade after primary surgery13,14,15,16.
Reduces the risk of dislocation
Hip resurfacing allows the safe use of large-diameter head components, which offers an immediate advantage for the patient in terms of stability, and significantly reduces the risk of dislocation that is associated with THR4. In the UK National Joint Registry (NJR) the incidence rate of revision for dislocation within the first postoperative year is estimated at 2.5 to 4.5 times less for hip resurfacing than for THR and remains low at later time points5.
More conservative than THR
Hip resurfacing is a more conservative procedure than THR, with no requirement to ream deep into the femoral shaft, which may reduce exposure to bacteria. The UK NJR shows that a hip resurfacing procedure is 1.3 to 1.9 times less likely to be revised within one year for infection than a THR5 . The benefits of reducing the risk of infection are far-reaching: revision for infection is associated with twice the costs and length of stay in hospital as compared to revision for aseptic causes17, and is associated with a higher level of complication, reoperation and morbidity17. Hip resurfacing also has a lower risk of mortality when compared to THR18,19.
Revision of hip resurfacing
Revision following a conventional THR is invariably more challenging, more expensive and takes longer than the primary procedure, despite the many specialist techniques to address the problems at revision surgery. Retention of the femoral neck and an uncompromised femoral shaft means that revising a hip resurfacing is essentially conversion to a primary total hip replacement, with similar technology, expense and potentially the same postoperative recovery to a conventional primary THR. This is more appealing to younger patients who are more likely to require a repeat surgery in their lifetime.
Lower risk of mortality
Resurfacing devices are used more commonly in younger, more active patients and there are numerous confounding risks for mortality rates; nevertheless, there is a growing body of evidence supporting the observation that mortality rates are lower for hip resurfacing when compared to THR. The Australian Joint Registry reported in 201920 that hip resurfacing patients have 1.5 times and 1.8 times higher rates of survival beyond 15 and 18 years respectively compared to THR patients after adjusting for age and gender (Figure 3). Published studies also describe lower mortality rates in the long term when a hip resurfacing implant is used, especially in male patients under 55 years of age at surgery21,22,23.
Figure 3: Cumulative percent survival of patients receiving hip resurfacing or THR20
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