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Who is suitable for hip resurfacing?

Which patients are more suitable for hip resurfacing than hip replacement?

Which patients are more suitable for hip resurfacing than hip replacement?

Metal-on-metal hip resurfacing has become extremely popular despite the lack of evidence of its benefit. It is currently difficult to define patient groups that are more suitable for resurfacing than for conventional total hip replacement (THR).

According to the Australian hip register, when revision rates (excluding infection) are compared to conventional THR, only male patients under 55 have a similarly low early revision rate at three to five years of about 2%. Female patients in general have a two-fold increased risk of early failure.

The highest risk for early revision is about 8% for females under 65 and all patients over 75: a risk of about four times higher than with conventional THR.

Patients have to be informed that after hip resurfacing there is a risk of femoral neck fracture (male 1%, female 2%), with a peak at about 15 months postoperatively. Patients with previous femoral osteotomies and in particular with acetabular dysplasia should probably not be offered resurfacing.

Concern remains about persistently elevated serum iron levels following metal-on-metal hip resurfacing. Most surgeons who offer resurfacing therefore regard female patients in childbearing age as unsuitable candidates because of the unknown teratogenic effect.

Recent reports have shown possible late hypersensitivity reactions in some patients after hip resurfacing.

So the jury is still out on hip resurfacing and therefore it does not seem justified to recommend widespread use of this procedure.

Younger and more active patients will have to accept a higher risk of earlier failure regardless of the type of hip replacement.

Mr Steffen Breusch is consultant orthopaedic surgeon at the New Royal Infirmary, Edinburgh

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