When your hip arthritis gets so bad that you need to discuss replacement options, there are really only two options to consider: total hip replacement and total hip resurfacing.
We can put a stem of metal into your femur (total hip replacement) or we can place a “cap” onto your femur, leaving your femoral neck intact (total hip resurfacing). On the pelvic, or cup, side, we do a similar process of placing a metal cup for each of these two choices.
After most current total hip resurfacing implants were approved about 6 years ago for use in the U.S., people jumped at the alternative to total hip replacement. As data gathered by national joint registries in Australia and elsewhere accumulated, however, it was noted that women did not do as well as men with hip resurfacing. Resurfaced hips failed more frequently in women than traditional hip replacement.
At first the difference between male and female outcomes was attributed to the fact that the smaller femoral necks in women could not support the “cap” on the femoral head and would fracture. A recent study of resurfacing out of Great Britain, however, challenges this notion. The investigators state that even women with larger femurs still fail at a rate of up to 5 times other conventional hip implants.
Additionally, hip resurfacing by its definition involves a metal head against a metal cup; a so called “metal-on-metal (MoM)” joint. These MoM joints have been under the microscope as well because of some patients having bone wear away and early failure. These types of MoM reactions by the body seem to be more prevalent in women.
Resurfacing proponents claimed improved range-of-motion, improved “feel”, even the ability to run after surgery. These claims were pushed forth by industry and some providers alike. The reality is that the outcomes are similar between resurfacing and replacement procedures. Only one subgroup has a slight edge with resurfacing when compared to replacement: muscular men aged 45-55.
In view of recent data and as a fellowship-trained joint replacement specialist (who trained with one of the top resurfacing surgeons worldwide), hip resurfacing is not an option I would offer the majority of my female patients. I think there are too many unanswered questions and we have an excellent track record with total hip replacement.
Dr. David T Schroder is a board-certified orthopaedic surgeon, fellowship trained in total joint replacement, with The San Antonio Orthopaedic Group. He treats patients aged 11 years and up for most orthopaedic conditions, with the exception of spinal surgery. To schedule an appointment with Dr. Schroder, please call 210.281.9595.