Hip Resurfacing Arthroplasty: The Facts

Mr Charnley introduced the “Birmingham” Hip Resurfacing to Central Essex over five years ago.  Since then he has performed many hip resurfacings and has accepted referrals from other surgeons and hospitals in Essex for this procedure.

Mr Charnley initially became interested in resurfacing ideas when a Hip Fellow in Paris in 1995.  On returning to the United Kingdom he visited designer surgeons, Derek McMinn and Ronan Treacy in Birmingham.

Mr Charnley also spent time in Ghent, Belgium with a Consultant who has also performed several thousand hip resurfacings.

Resurfacing hip arthroplasty is an alternative to total hip replacement, particularly for younger patients, and those with physically demanding sporting hobbies.

There are however certain evolving issues and outcomes as the world experience of these metal on metal hip replacements grows, (see below).

The idea of resurfacing the upper part of the thigh bone (femoral head) is really not a new concept. A variety of materials have been tried over the past 150 years, including ivory, gold, plastics and more recently metal.

Over a decade ago, Mr Derek McMinn in Birmingham, revisited the idea and using a metal resurfacing of the femoral head, in conjunction with a metal socket, has provided an alternative to a more "standard" total hip replacement.

Partial Resurfacing of the Hip (x-ray image).
X-ray of a Partially Resurfaced Hip
Please click here to view publications on this subject.

A Pelvic X-Ray Showing a Complete Resurfacing Hip Arthroplasty.

hip_resurfacing_arthroplasty_joint.jpg (13525 bytes)
A Resurfacing Implant

The “Theory” behind metal on metal resurfacing is that there is relatively low friction, which hopefully will provide a longer lasting solution than conventional metal on plastic total hip replacements.

Since Mr McMinn and Mr Ronan Treacy redesigned modern day resurfacing many thousands of patients have had successful arthroplasties, accepting some minor modifications in the design of the joint replacement.

Resurfacing is a particularly attractive option for young and active patients as the design permits a greater range of movement and a lower risk of dislocation.

The surgery saves bone on the femoral side but removes slightly more bone on the socket side.

Recent coverage in the press and on the television has followed reports both in the British Medical Journal and recommendations from the Medical Devices Agency that all large diameter metal on metal hip replacements should be followed up on an annual basis by their treating surgeon. This is because there has been concern with certain designs (some more than others), that metal ions are being released due to unexpected wear problems.

These metal ions may cause local soft tissue swellings and high doses of metal ions may cause systemic problems.

Around the hip in certain patients there has been destruction of both bone and muscle leading to challenging revision surgery. Further concerns are also related to the use of metal on metal hip replacements in women of childbearing age.

Mr Charnley's current opinion based on the orthopaedic literature both published and presentations, from large reference centres, is that hip resurfacing is no longer an option in women of any age as this design of joint replacement does not perform as well as a standard total hip replacement. In female there have been problems as well with fractures and failures of fixation in relatively osteoporotic bone.

In comparison men with large anatomy and hard bone seem to have hip resurfacing results at ten years that match conventional hip replacement surgery.

It had been hoped that by combining large metal on metal hips with a total hip stem, in patients that were not suitable for hip resurfacing, identical low wear rates and stable joints could be achieved. Unfortunately this hope has not been achieved and excessive wear rates and metal ion release are also being found at four to five years post operatively in these patients.

One of the manufacturing company's, Depuy has launched, in 2010, a worldwide product recall of both its ASR hip resurfacing and its ASR XL total hip metal on metal prosthesis.

X-ray of Hybrid Metal on Metal Total Hip Replacement.
An X-ray of Hybrid Metal on Metal Total Hip Replacement

This page was last updated on 06/Mar/2012