In a recent Wall Street Journal article, 06/04/09, N. Tergesen writes a column on “Doubt’s Raised Over New Type Of Hip Surgery”. Outcomes Of Resurfacing Don’t Beat Replacements. Ms. Tergesen reviews some recent literature that found that results of surface replacement are not better than those of current contemporary total hip replacements, but also accurately points out the increased risk of fracture in female patients and that the long-term outcomes of surface replacement is still unknown. While this procedure was reintroduced in the last decade as an alternative to hip replacement that would allow for increased activity and better range of motion, there is no data to support those claims. Contemporary total hip replacement with larger bearing surfaces match the range of motion of surface replacement and provide an extension of the long-term results that have been well documented in the literature. The heritage on which surface replacement is built is checkered with many studies showing inferior results long-term of surface replacement to conventional total hip replacement. I think those contemplating surface replacement should take into account the lack of long-term data, the more recent studies that show no apparent difference in functional outcome or return to activity, and the fact that surface replacement is accomplished through a larger incision with more extensive soft tissue dissection and particularly during the learning phase of the procedure, is associated with a higher complication rate.

Having said that, surgeons who have extensive experience with surface replacement, have been able to duplicate the complication rate of hip replacement and realistically offer this as a viable alternative in the young active male. It is important to review this debate at nonbiased sites on line such as The American Academy of Orthopaedic Surgeons or the American Association of Hip and Knee Surgeons and not rely on information from manufacture’s web sites that are typically biased in the direction of their implant.

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    Dr. Barrett,

    As a surface replacement patient (06/2007), I have appreciated all your articles regarding the various studies and ongoing debate regarding re-surfacing vs. large head replacement. Your articles display a high level of objectivity. They have certainly contributed to my being a reasonably well informed patient.

    In my case the re-surfacing has so far been an unqualified success!

    Norm Jensen
    Boise, Idaho

  2. Jim Lane

    Dr. Barrett,

    As a fireman and athlete in need of surgery at 50, it appears that the pool of surgeons doing resurfacing is fairly limited. Is it a comfort issue with the procedure or is the orthopedic community just divided on its usefullness compared to a big ball total hip. I myself am on the fence as I seek out more info, thanks for the blog,

    Jim Lane
    Lummi Island

  3. Dr Hitesh Gopalan U

    Dear Sir,

    I am a young hip and knee surgeon in Cochin, Kerala,India. We have been following the AAOS guidelines on hip resurfacing. A recent article published in JBJS B, August 2009 by Ollivere cites early term revision rates as high as 2.85% aand 96% of patients had metallosis..

    Do you think 3% revision rate at 5 years is high..?

    Do you do hip resurfacing nowadays..?During the Ranwat conference in India in 2009, Peter Sharkey was totally against hip resurfacing.Do you think there is a decline in the no.of surgeons undertaking hip resurfacing..?

    Looking forward for your answer

    Dr Hitesh Gopalan

  4. Dr. William Barrett

    Dear Dr. Gopalan:
    Thank you for your comment. While early on there was quite a bit of enthusiasm in the United States for surface replacement, the demand for this has dropped and so has its usage. I think at high volume centers that are experienced with surface replacement, the early complication rate is acceptable, and we await long-term followup results.
    My concern about surface replacement is the relatively high early complication rate with femoral neck fracture in particular. I am also dubious about the touted benefits with regards to range of motion and function. There are no two prospective randomized studies demonstrating that the activity level is no different between patients with surface replacement and patients with large head total hip replacent. There is a potential advantage of bone preservation in the proximal femur, but this is countered by the possibility of increased bone volumetric loss on the acetabulum.
    Therefore, at this time, I am not currently doing surface replacements and feel further followup is needed before it can be recommended in general.
    William Barrett