Joint Resurfacing

Joint resurfacing is when an orthopedic surgeon removes as little damaged cartilage and bone as possible from the ball and socket hip joint and then covers the ball with a metal cap, unlike a total hip replacement which removes the bone (making up the ball of the ball and socket hip joint) and damaged cartilage in the socket then replaces the whole joint with a prosthetic hip, or artificial joint.

The benefits of joint resurfacing include:

• Easier revisions – most resurfacing and joint replacement procedures last between 15 and 20 years. However, when a revision is needed, many orthopedic surgeons believe it is less complicated and easier on the patient to revise a resurfacing because it conserved more of the original joint.
• Less chance for dislocation – because the whole joint is not removed and the prosthetic is closer to the size of the natural joint, it is less likely the joint will become dislocated.
• Higher activity level – people who undergo joint resurfacing vs. total joint replacement preserve more bone stock. This may contribute to the difference in activity level between hip resurfacing and total hip patients at 6 months postoperatively with the higher activity level being present in the resurfacing group. Higher impact activities and sports like running and tennis may be allowed for patients with experience in the events after 6 months of recovery.

You may be a candidate for joint resurfacing if:

• You have an accurate diagnosis of advanced arthritis in the affected joint
• You have had treatment for or excluded other potential sources for pain (such as from tendonitis, bursitis, the low back, or abdomen)
• Have tried and failed at conservative treatment options like weight loss, medications, injections, or physical therapy
• Are younger than 60 years of age. This is a safe general recommendation since there is an overall higher failure rate in older people.
• Physically fit and strong with generally healthy bone
• The ideal candidate is a relatively young man with normal anatomy and primary osteoarthritis. A woman past childbearing age with larger bone structure allowing for a larger metal cap (equal to or greater than 48 mm) for resurfacing may qualify as well.

Is Hip Resurfacing Safe?

• This procedure is best suited for patients with a diagnosis of osteoarthritis and larger bone structure.
• It is a good procedure for the younger male patient that places a higher demand on the hip joint.
• The 10-year survivorship of hip resurfacing in younger males with osteoarthritis is 98%.
• Women older than age 65 are higher risk for complications requiring revision than younger female patients with bone structure that can support metal caps 48 mm or larger.
• The procedure involves removal of less bone than a total hip replacement but requires a longer incision to enable better visualization to perform this surgery.
• The rate of femoral neck fracture (fracture of bone below the metal cap) is approximately 0.5%
• Good kidney function is essential to prevent the build-up of metal ions from the metal-on-metal hip articulation.
• Metal-on-metal hip replacements have not been shown to increase the likelihood of cancer.

REFERENCES:

• • De Smet K, Campbell PA, Gill HS: Metal-on-metal hip resurfacing: a consensus from the Advanced Hip Resurfacing Course, Ghent, June 2009. J Bone Joint Surg Br 2010;92(3):335-336.
• • Nunley RM, Della Valle CJ, Barrack RL: Is patient selection important for hip resurfacing? Clin Orthop Relat Res 2009;467(1):56-65.
• • Seyler TM, Marker DR, Boyd HS, Zywiel MG, McGrath MS, Mont MA: Preoperative evaluation to determine candidates for metal-on-metal hip resurfacing. J Bone Joint Surg 2009;91(6):32-41.
• • Visuri T, Pukkala E, Paavolainen P, Pulkkinen P, Riska EB: Cancer risk after metal-on-metal and polyethylene-on-metal total hip arthroplasty. Clin Orthop Relat Res 1996;(329 Suppl):S280-9.