Is hip resurfacing a good alternative to hip replacement?
Answer From Mark Spangehl, M.D.
Hip resurfacing has lost favor with many surgeons because it can increase the amount of potentially harmful metal ions in the bloodstream. It also has a risk of bone fracture just below the metal cap placed on the top portion of the thighbone — particularly in women with poor bone quality.
Unlike traditional hip replacement, hip resurfacing doesn't completely replace the "ball" of the hip with a metal or ceramic ball. Instead, the bone is reshaped and capped with a metal prosthesis. The hip socket is fitted with a metal cup. As these metal surfaces rub together, there is the potential for wear and release of metal ions. Low levels of metal ions usually don't cause a problem, but higher levels may be problematic.
The socket prosthesis for a traditional hip replacement is usually lined with a thick layer of hard plastic, so there isn't any metal-on-metal contact. While the components of an artificial hip may eventually wear out, most people can expect their joint replacements to last for 20 years or longer.
Hip replacement is usually postponed until later in life, so the life span of the prosthesis more closely matches the remaining life span of the person. Subsequent hip replacement surgeries can be more difficult and more commonly have poorer results than initial hip replacements.
Hip resurfacing originally was seen as a stop-gap option for younger people with serious hip problems, because it would leave more bone available for a hip replacement in the future.
Currently, however, hip resurfacing is generally recommended only in instances where there is severe deformity and few other options. The best candidates appear to be younger men with good quality bone.
March 22, 2017
- Canale ST, et al. Hip resurfacing. In: Campbell's Operative Orthopaedics. 12th ed. Philadelphia, Pa.: Mosby Elsevier; 2013. http://www.clinicalkey.com. Accessed Oct. 28, 2016.
- Hip resurfacing. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=A00586. Accessed Oct. 28, 2016.
- AskMayoExpert. Hip replacement. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2016.
- Erens GA, et al. Total hip arthroplasty. http://www.uptodate.com/home. Accessed Oct. 28, 2016.
- Questions and answers about metal-on-metal hip implants. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=A00625. Accessed Oct. 28, 2016.
- Spangehl MJ (expert opinion). Mayo Clinic, Phoenix/Scottsdale, Ariz. Oct. 31, 2016.