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Third-generation metal-on-metal hip resurfacing showing good early results in U.S.

Polar contact of femoral head to cup may make the latest version of hip resurfacing successful.

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NEW YORK — A recently approved, metal-on-metal hip resurfacing prosthesis is showing good early results, according to a Denver orthopedist.

"This is the third evolution of hip resurfacing, and I think that this time we got it right," said Robert D. D'Ambrosia, MD, at the Orthopedics Today New York 2006 — A Comprehensive CME Course, held here. He presented his anecdotal experience with the Birmingham Hip Resurfacing System (Smith and Nephew Orthopaedics). "We have been happy with the first 20 that we have done in the past 6 months, and we haven't had any complications at this time."

D'Ambrosia said that the wear problems that plagued early versions of hip resurfacing components have been addressed. "They had equatorial contact, you didn't get much fluid integration and you had a significant amount of wear," D'Ambrosia, who is chief medical editor of Orthopedics, said.

Indications for the hip resurfacing include young, active patients with good bone stock. Contraindications include women of childbearing age, obesity and patients with poor bone or leg length discrepancies over 1.5 cm.

Some of the criticisms of the resurfacing system are limited femoral sizes, a cylindrical head profile, the use of nonpressurized, low-viscosity cement, and the requirement of larger incisions and exposures. Limitations to the procedure include, no femoral offset, the inability to lengthen extremities more than 1 cm, and the importance of the morphology of the proximal femur, D'Ambrosia said. "If you have low offset or a leg length discrepancy of greater than 1 cm, then this is not the procedure you should use."

D'Ambrosia said the resurfacing procedure should be addressed with caution. "It is less ideal for MIS, it is not for patients with a varus neck shaft angle, and for any patients with complex morphology or pathology like a congenital hip or Legg Perthes, this is probably not good."