Shimmin: Hip resurfacing still has a role

WAIKOLOA, Hawaii — Despite design issues for small sizes and limited understanding of the effects of edge loading with these implants, hip resurfacing can yield positive results and should continue to play a role in the treatment of patients, according to a presenter here at Orthopedics Today Hawaii 2016.

“Hip resurfacing has better functional outcomes than total hip replacement, and with a better understanding of [femoroacetabular impingement] FAI and functional pelvic mobility, I think this will further improve outcomes with hip resurfacing,” Andrew M. Shimmin, MBBS, FRACS, said in his presentation.

Shimmin noted osteoarthritis is a disease of the hip joint, rather than the whole femur, and that modern metal-on-metal resurfacing has showed that resurfacing of the femoral head is safe and has a low risk of avascular necrosis. When looking at individual patients, he noted young men had better long-term survivorship with hip resurfacing compared with conventional hip replacement.

“Young males have better survivorship at 14 years with a metal-on-metal hip resurfacing than a conventional hip replacement based on registry data,” Shimmin said.

Andrew M. Shimmin

Hip resurfacing also has a lower revision rate for recurrent dislocation when compared with total hip replacement (2% vs. 25%), Shimmin said, and hip resurfacing has better functional outcomes when measured with modern tools.

“Hip arthroplasty at any other time has excellent functional outcome, but hip resurfacing has superior functional outcomes if we measure these with a modern objective and subjective assessment tool,” he said.

Shimmin noted all of the positive points on hip resurfacing were despite design issues of small sizes, and a poor understanding of coverage arcs and the effects of edge loading and wear.

“There was no consideration in the early days of the second generation of resurfacing given to doing concurrent FAI surgery,” he said. “Of course in the ‘90s, femoral acetabular impingement [was] not the focus of orthopedic practice. So now, I think a modern resurfacing operation does include dealing with the impingement-related pathology.” – by Casey Tingle

Reference:

Shimmin AM. No stem! Role of hip resurfacing. Presented at: Orthopedics Today Hawaii 2016; Jan. 10-14, 2016; Waikoloa, Hawaii.

Disclosure: Shimmin receives royalties from Corin and MatOrtho, and receives consulting fees from Corin, MatOrtho and Smith & Nephew.