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  Mark Spangehl, M.D.

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Question

Hip resurfacing: An alternative to conventional hip replacement?

What are the pros and cons of hip resurfacing as an alternative to hip replacement?

Answer

from Mark Spangehl, M.D.

Unlike traditional hip replacement, hip resurfacing doesn't replace the "ball" of the hip with a metal or ceramic ball. Instead, the damaged hip ball is reshaped and capped with a metal prosthesis. The damaged hip socket also is fitted with a metal prosthesis — similar to what is used in a conventional hip replacement.

With newer materials, the artificial joint implants used for total hip replacement are lasting longer and may last for decades, although long-term data aren't yet available for newer implants. This isn't an issue for older people who receive a hip replacement late in life. But hip resurfacing might be a better choice for younger people because the procedure leaves more bone intact, which can make it easier to perform a total hip replacement if needed later.

Resurfacing generally results in a bigger hip ball than what is typically used in a conventional hip replacement, which may reduce the risk of dislocation. But newer implants used for conventional hip replacement now offer the option of a larger hip ball, similar in size to what results from hip resurfacing procedures.

Hip resurfacing is technically more difficult and generally requires a larger incision than what is used for a conventional hip replacement. And the risk of complications is slightly higher with hip resurfacing — even when controlling for factors such as your age, sex and activity levels. Hip resurfacing results in a metal ball on a metal socket, and in a small number of people, these metallic moving parts may cause pain, immune system reaction (hypersensitivity) or, rarely, tissue destruction.

Hip resurfacing isn't recommended for people who have:

• Osteoporosis
• Impaired kidney function
• Known metal hypersensitivities
• Diabetes
• Large areas of dead bone (avascular necrosis)

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