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Researchers note high revision rates for metal hip resurfacings in women

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UK researchers caution against performing metal-on-metal hip resurfacings in women and recommended that preoperative measurement should be used to indicate the procedure in men based on registry results.

 

Ashley W. Blom

“Resurfacing failure rates in women were unacceptably high. In view of these findings, we recommend that resurfacing procedures are not undertaken in women,” Ashley W. Blom, PhD, professor of orthopaedic surgery at the University of Bristol School of Clinical Sciences in Bristol, United Kingdom, stated in a press release. “Our findings show that resurfacings with smaller head sizes are prone to early failure and in particular that resurfacing in women has much worse implant survival, irrespective of head size.”

After analyzing 434,560 primary total hip replacements – 31,932 of which were resurfacings – in the National Joint Registry for England and Wales between 2003 and 2011, Blom and colleagues found the 5-year revision rate for 55-year-old women with 42-mm and 46-mm resurfacing heads was 8.8% and 6.1%, respectively.

Men with small femoral heads had poor implant survival, according to Blom and colleagues. While only 23% of men in the registry had large femoral heads, the researchers noted implant survivorship was comparable in these patients to other surgical options. Researchers found that 55-year-old men with 46-mm resurfacing heads had a 4.1% revision rate and men with a 54-mm head saw a 2.6% revision rate, according to the abstract. In hip replacements with 28-mm cemented metal-on-polyethylene heads, the revision rate was 1.5% for women and 1.9% for men, according to the abstract.

Reference:

Smith AJ, Dieppe P, Howard P, et al. Failure rates of metal-on-metal hip resurfacings: analysis of data from the National Joint Registry for England and Wales. Lancet. Published online before print Oct. 2, 2012. doi:10.1016/S0140-6736(12)60989-1.

Disclosure: The authors received funding from the National Joint Registry for England and Wales for this study.