Abstract
Hip resurfacing presents advantages and disadvantages compared to total hip arthroplasty. Dislocation and leg length discrepancy, common complaints with total hips, are unusual following resurfacing. Bone stock in the proximal femur is retained, and revision options on the femoral side of a resurfacing are much better.
Concerns persist regarding adverse tissue reactions to metal debris.
Conflicting data abounds regarding ultimate hip function, patient satisfaction, durability, etc. Yet all of these would be rendered irrelevant if resurfacing carried with it greater life expectancy. We would not speak of survivorship of the implant, but survival of the patient. Instead of quality of life, let us preserve life itself.
Beginning in 2010, the UK Registry reported improved mortality rates at 90 days and five years after hip resurfacing compared with total hip replacement. This persisted after multivariate analysis for several covariables, including age, gender, health status, type of device, provider, and country. Recently, the 2016 Australian Registry Mortality Supplement showed similar results, corrected for age and gender.
Analysis of UK data by the designing surgeons of the Birmingham device, and an independent group of Oxford statisticians confirmed the lower mortality rate in patients treated with resurfacing vs. total hip replacement. Possible reasons for these differences include greater post-operative activity, longer stride length, less fat and marrow embolism, or perhaps more internet-savvy, health-conscious patients seeking out a resurfacing procedure.
Mid-term data from the US is now starting to come in, and mortality benefits are being confirmed in a series of patients from a large, academic center. Should there be a confirmed mortality advantage of resurfacing over total hip replacement, more surgeons and patients would be interested in this procedure, and new materials and techniques may follow.
