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Hip and knee surgery: Hip resurfacing in younger patients

Hip resurfacing is an increasingly attractive option in young people needing hip replacement ­ Mr Reza Jenabzadeh and Mr Fares Haddad look at the evidence

Hip resurfacing is an increasingly attractive option in young people needing hip replacement ­ Mr Reza Jenabzadeh and Mr Fares Haddad look at the evidence

Case history A 53-year-old presents with a long history of pain in his left hip. He describes an insidious onset of hip pain with no traumatic event of note. The pain radiates down his thigh and is exacerbated by exercise or walking long distances. The pain has been gradually worsening over the past year, despite the patient taking NSAIDs and losing weight. The pain wakes him at night and he has had to give up his hobby as a Sunday league football referee.

On examination our would-be referee walks with an uneven gait to counteract the pain. There is no true leg-length shortening, however Thomas' test does reveal a 5° fixed flexion, which gives an apparent leg length shortening. He cannot flex beyond 90° as he is limited by pain. Internal rotation at the hip is severely restricted by pain.

External rotation, hip abduction and adduction are also re-stricted. Distally the limb is fully neurovascularly intact. This patient has an arthritic hip that has failed to respond to conservative management. He would benefit greatly from operative intervention. In view of his relative youth, good bone stock and high activity levels, a hip resurfacing was performed.

It will take about one week to climb stairs with crutches and about six weeks to be able to drive. Within two months, patients are back at work, free of a stick or crutches, and sleeping on the operated side. Improvement continues for a year or more.It is unusual to consider hip resurfacing for people over the age of 65 because a conventional total hip replacement in this age group stands an extremely good chance of lasting them the rest of their lives.

Hip resurfacing has always been an attractive concept. The theoretical advantages include:

  • Femoral head is preserved (bone conserving).
  • Femoral canal is preserved and no associated femoral bone loss to compromise future revision. · Larger size of femoral head reduces the risk of dislocation.
  • Normal femoral loading and avoidance of stress shielding. Stress is transferred in a natural way along the femoral canal and through the head and neck of the femur. With the standard total hip replacement, some patients experience thigh pain as the bone has to respond and reform to less natural stress loading
  • Reduced risk of osteolysis loosening.
  • Use of metal has low wear rate with expected long implant lifetime.
  • Lack of long-term track record. Current device has only been used for seven years.
  • Higher risk of peri-operative fracture than standard total hip replacement.
  • Requires a greater soft tissue exposure in order to move the femoral head out of the way when preparing the acetabulum.
  • Long-term effects of a metal-on-metal bearing not well known ­ there is particular concern in women of childbearing age
  • Patient must have solid bone in femoral head to hold resurfacing component.

Fares Haddad is consultant orthopaedic surgeon specialising in knee and hip arthroscopy, reconstruction, joint replacement and revision ­ he is clinical director at University College London Hospitals

Competing interests None declared

Reza Jenabzadeh is specialist registrar in trauma and orthopaedics, University College Hospital, London

Competing interests None declared

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