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.