Good overview article on resurfacing, complications, outcomes, etc

[IslandCatt]

Here's a link to the full article.
http://emedicine.medscape.com/article/1358168-overview#a30

These were the key take away points for me.

Failure:
"The primary modes of failure in resurfacing are femoral neck fracture and femoral implant loosening. Femoral neck fracture is a unique complication of resurfacing. Its reported incidence after hip resurfacing is approximately 1.3% (range, 0%-10%). The mean time for femoral neck fracture is 15 weeks after surgery. In women, the fractures are more likely to have been preceded by a prodromal phase of pain and limping. The relative risk of fracture is twice as high in women as in men. The most common reason for revision was fracture of the femoral neck, mostly occurring within the first 6 months."

Contraindications:
"Absolute contraindications for hip resurfacing include advanced age and postmenopausal status with osteoporosis, impaired renal function, and known metal hypersensitivity. Other contraindications include deficiency of the femoral head or neck bone stock, femoral neck or head cysts, severe hip dysplasia, and a small or bone-deficient acetabulum. A hip with deficient femoral head bone stock after fracture or other conditions (eg, rapidly progressive osteoarthritis, or disappearing bone disease) cannot be resurfaced. Hip resurfacing cannot correct large inequalities in limb length or change horizontal femoral offset; accordingly, arthritic hips that are at least 1 cm shorter than the contralateral limb or that have low horizontal femoral offset may be better managed with a standard THA or extended offset stemmed implants. "

Long-term complications:
"Blood and urine metal ion levels, metallosis, capsular lymphocytic aggregation, and hypersensitivity are still major concerns with metal-on-metal articulation. "

Lifestyle Outcomes:
"Patients who undergo hip resurfacing have superior kinematics and higher activity scores than those who undergo standard THA. They walk faster and have better hip abduction and postoperative range of motion in gait analysis. The physiologic pattern of femoral head loading after resurfacing facilitates better stress transfer by producing compressive forces rather than hoop stress. This may improve bone mineral density, prevent stress shielding, preserve the proximal femoral bone stock, and avoid periprosthetic bone loss. Hip resurfacing, by accommodating a large femoral head, is associated with a lower dislocation rate than conventional THA is. Finally, hip resurfacing may yield better proprioception than conventional THA because of preservation of proximal femoral bone. "

Noise:
"Some patients may experience a noise after resurfacing; one study showed a 23% prevalence of clicking and a 4% prevalence of squeaking after metal-on-metal resurfacing. It is unclear if these joint noises are related to impingement, subluxation, or microseparation of the components. "

[Dannywayoflife]

Interesting article. With regards to femoral component loosening that sounds like a surgeon error problem to me. Derrick McMinn has never had a femoral loosening since switching to cement on the femoral side that was around 16-18 years ago. Other devices use a different cement technique so it may happen with other devices but I'd think that with the BHR IF it happens it would be due to the surgeon.
Also the femoral neck fracture can often be attributed to surgeon error. By either notching the neck or disturbing the blood supply. One surgeon I spoke to told me he'd just had a femoral neck fracture at 6 weeks as it turned out he'd give the individual the all clear to try and run 6miles at 4 weeks!!! So id chalk that up to surgeon error to!