Article by Patricia Walter after attending the 2nd Annual Hip Resurfacing Course Oct. 2008 in LAUpdated 11/4/08
According to the registries and medical studies, the perfect hip resurfacing candidate is a male patient under 55 that is active, has good bone density and has a large femur neck. Of course, I am not a doctor, and am interpreting what I learned at the 2nd Annual Hip Resurfacing Course in LA on October 24 and 25, 2008. It seems many of the experienced hip resurfacing surgeons at the conference seemed to agree with this profile.
There are other experienced hip resurfacing surgeons that will also consider both older women and men as good candidates if they have good bone stock and an appropriate femur neck. Women seem to have more problems as survivors of hip resurfacing surgeries. Large boned women that use cups larger than 50 mm have the same survival rate as men. Smaller women requiring smaller cups have a much worse survival rate as do smaller men. See information from the 2008 Australian Orthopaedic Registry Below:
|The effect of femoral component head size is evident in both males and females. There is no significant difference in the risk of revision between males and females after adjusting for femoral component head size. Males and females with a femoral component head size greater than 50mm have a similar seven year cumulative percent revision (2.1% and 2.0% respectively). The same is seen for males and females with a femoral component head size less than 50mm (seven year cumulative percent revision is 5.5% and 7.3% respectively). The risk of revision for females with a femoral component head size less than 50mm is significantly higher than for females with a femoral component head size greater than 50mm ((age adjusted) HR=3.22; 95% CI (2.47, 4.21) p<0.001). A similar situation applies to males with a femoral component head size less than 50mm having a significantly higher revision rate compared to males with a femoral component head size greater than 50mm ((age adjusted) HR=2.69; 95% CI (1.91, 3.79) p<0.001). http://www.surfacehippy.info/aoanationalreg08.php|
Certain patients, according to Dr. Andrew Shimmin a faculty presenter at the Resurfacing Course, should also be avoided:
Patients with osteopenic bone should be avoided, for this reason women over 60 years old should be considered cautiously
Patients with inflammatory arthropathy or with large femoral head cysts
Patients with extensive AVN are also at higher risk
So most surgeons are very conservative in their selection of hip resurfacing patients knowing the results from the 2008 Australian Registry and information from current medical studies. If a potential patient is small or has a difficult hip problem, then it becomes even more important for them to choose a very experienced surgeon. People seeking hip resurfacing also need to realize that if one doctor won’t do a hip resurfacing for them, there may still be others that will.
The hip resurfacing doctors are very conservative and feel they have the patients best outcome in mind. They don’t want to take any chances that could result in a failed hip resurfacing that would require a second surgery to a THR.
So we as patients need to understand how conservative most resurfacing surgeons are. If a person really feels that they only want a hip resurfacing, then sometimes they will have to search until they find the experienced surgeons who will do difficult cases for people outside the norm for resurfacing. Most surgeons do admit that they will treat each person as an individual, look at your x-rays and specific medical situation before making their recommendation for either a hip resurfacing or total hip replacement.
A recent medical study and article about the general guidelines for hip resurfacing by Rush University Medical Center can be read here: