Hip ResuRfacing 2011

In 1938 Marion Smith-Peterson placed a cobalt chromium cup on a reshaped femoral head to perform the first hip resurfacing.15 Also, in 1938, Philip Wiles performed the first total hip replacement.17 Both procedures revolutionized the treatment of hip arthritis. Most surgeons are opposed to hip resurfacing because it is difficult to perform and there is a high rate of success with total hip replacement. The early complication rate may be higher with resurfacing than total hip replacement. Total hip replacement provides very good long term results in elderly patients crippled with arthritis. Young patients present today for hip surgery hoping to perform physically demanding activities. They want a stable, durable, and highly functioning hip to match their active life style. Patients fear a difficult revision procedure if they undergo total hip replacement at a young age. The functional outcomes with hip resurfacing are superior to hip replacement. Young patients, therefore, must decide whether the theoretical and practical advantages of hip resurfacing outweigh its possible disadvantages. We describe two new innovations for hip resurfacing procedures and synthesize the most recent resurfacing data. Introduction Hip resurfacing is an attractive concept because it retains and shapes rather than replaces the natural bone. Hip resurfacing is the conservative surgical option. Total hip replacement requires resection of the entire femoral head and most of the neck. The “radical approach”, however, is the conventional practice. Compared to hip replacement, hip resurfacing promotes more consistent load transfer. Resurfacing preserves the size and shape, and natural feel of the hip. Total hip replacement has been described as “the operation of the century.”6 While this did refer to the previous century, the benefits of hip replacement are quite remarkable. Total hip replacement is the procedure of choice for most patients in need of a surgical solution for severe damage to their hip joint. Therefore, there are two valuable alternatives for hip arthritis–Hip Resurfacing and Hip Replacement. The questions requiring answers are 1) Is hip resurfacing safe? 2) Is hip resurfacing effective? and 3) What is new in hip resurfacing surgery?