Advantages and Disadvantages
The potential advantages of hip resurfacing compared to THR include less bone removal (bone preservation), a reduced chance of hip dislocation due to a relatively larger femoral head size (giving the patient an anatomically correct femoral head size), and easier revision surgery for any subsequent revision to a THR device because a surgeon will have more original bone stock available The potential disadvantages of hip resurfacing are femoral neck fractures (rate of 0-4%), aseptic loosening, and metal wear. Due to the retention of the patient's complete femoral neck other advantages exist: Surgeon induced discrepancies in leg length (as could happen with THR) are now minimized. Also, the toe-in or toe-out faults that could occur interoperatively with THR are now over because the femoral neck that determines foot direction is left undisturbed with hip resurfacing.
On March 12, 2012, The Lancet published a study, based on data from the National Joint Registry of England and Wales, finding that metal-on-metal total hip replacement implants failed at much greater rates than other types of total hip replacement implants and calling for a ban on all metal-on-metal hips. The analysis of 402,051 hip replacements showed that 6.2% of metal-on-metal hip implants had failed within five years, compared to 1.7% of metal-on-plastic and 2.3% of ceramic-on-ceramic hip implants. Each 1mm increase in head size of metal-on-metal hip implants was associated with a 2% increase of failure. Surgeons of the British Hip Society are recommending that large head metal-on-metal implants should no longer be performed.
On February 10, 2011, the U.S. FDA issued a patient advisory on metal-metal hip implants, stating it was continuing to gather and review all available information about metal-on-metal hip systems. On June 27-28 2012 an advisory panel will meet to decide whether to impose new standards, taking into account the The Lancet findings.
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