Dr. Su’s experience with hip resurfacing shows 1.3% complication rate

November 16, 2011
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The retrospective study, which analyzed 925 hip resurfacings
performed by Edwin Su, MD, between 2004 and 2009 with a
minimum follow-up of 2 years, looked at three implants:
Wright Medical’s Conserve Plus Total Resurfacing Hip System,
Biomet Orthopedics’ ReCap Femoral Resurfacing System and
Smith & Nephew’s Birmingham Hip Resurfacing System. Conserve
Plus and the Biomet ReCap were used as part of clinical
trials, while the Birmingham hip was used after FDA approval
of the implant in 2006. Clinical scores and radiographs were
obtained at 1 month, 3 months, 1 year, and every subsequent
year. The hips in the study had a minimum of 2 year follow
up, both radiographically and clinically.

“[The Conserve Plus hip] was not FDA approved by our
government between 2004-2008, so we had to petition for each
patient to have the device, limiting the numbers of patients
receiving that implant,” Su, from the Hospital for Special
Surgery in New York, said during his presentation at the
12th EFORT Congress 2011.

Su received training from some of the pioneers of hip
resurfacing, in both California and Europe, to gain the
experience necessary to perform the procedures. He used a
posterior approach during the procedures and was careful to
preserve the retinacular vessels and soft tissues to prevent
the need for reoperation. The implant specific guides were
used to ensure central positioning within the neck to
prevent notching, and cemented femoral fixation was used,
the study stated.

The study showed 12 revisions (1.3%) at a minimum followup
of 24 months. The K-M survival curve overall for the
procedure, using all 3 different implants, was 98.6% at 68
months. Su noted that these results compared favorably to
other published papers that describe short-term failure
rates of 8% and 13% for the procedure. The Conserve Plus
series had six revisions out of 157 cases (3.8%), which
involved two cup loosenings, three femoral loosenings and an
adverse metal reaction. The Birmingham series had six
revisions out of 748 cases (0.8%), and the ReCap had no
revisions.

Limitations for the study include the limited amount of data
collected for certain implants, such as the ReCap, which had
20 implants compared to the Conserve Plus (157 implants) and
the Birmingham series (748 implants). The Conserve Plus
series also had a longer follow-up compared with the
Birmingham series.

“For a surgeon contemplating adopting resurfacing, one must
be concerned about the learning curve,” Su said. “The
exposure is more difficult, it is more time-consuming, and
it is more sensitive to technical errors.” However, with
careful patient selection, proper surgical training, and a
good implant, the success rate can be excellent.

Reference:
•Su E. A single US surgeon experience with the adoption of
hip resurfacing using 3 different implants. Paper #1140.
Presented at the 12th EFORT Congress 2011. June 1-4.
Copenhagen.
•Berend KR, Lombardi AV, Adams JB and Sneller MA.
Unsatisfactory surgical learning curve with hip resurfacing.
J Bone Joint Surg Am. 2011; 93S:89-92.
•Mont MA, Seyler TM, Ulrich SD, et al. Effect of changing
indications and techniques on total hip resurfacing. Clin
Orthop, 2007;465:63-70
•Edwin Su, MD, can be reached at the Hospital for Special
Surgery, 535 East 70th Street, New York, NY, 10021;
202-606-1128; email: sue@hss.edu.
•Disclosure: Su provides consulting services for Smith and
Nephew Inc. on hip resurfacing products. Smith and Nephew
Inc. and Biomet Inc. have provided research support for
studies involving hip resurfacing.