Video Review of the 3rd Annual Hip Resurfacing Course

I just returned home from the 3rd annual hip resurfacing course in Baltimore, MD on Sept. 4 -5, 2009. The course is presented each year to help new surgeons learn about hip resurfacing, to update existing hip resurfacing surgeons about changes in the field of resurfacing and to allow experienced hip resurfacing surgeons to network with other resurfacing surgeons.

I am honored to be allowed to attend the course and to meet some of the most experienced hip resurfacing surgeons in the world. The knowledge shared during the course includes new information and opinions about different surgical approaches, hip devices, patient selection and medical studies. Hip Resurfacing has been performed for 12 years now. It is considered to have a good history and is no longer considered a new procedure. Hopefully, the medical community will start to accept hip resurfacing and stop referring to it as a new technology. The presentations at the course felt very positive in support of hip resurfacing. Hip resurfacing accounts for approximately 7 – 10% of hip replacement surgery worldwide. There has been some bad press recently about hip resurfacing not being a good option for women and that it creates high metal ions. Both of these myths were discussed at length during the course. Patient selection is still very important to a good outcome and longevity of a hip resurfacing. Patient selection, however, is made individually on a patient by patient basis and not by generalizations. Whether you are young or old, male or female, a doctor must look at your personal bone quality, your hip condition and your lifestyle to determine if you are a hip resurfacing candidate. Medical studies have been completed to show men have approximately a 2% revision rate from hip resurfacing while women have approximately a 4% revision rate. It is thought women normally have smaller bones, softer bones after menopause and placement problems such as dysplasia which contribute to their higher revision rate. So again, it is a decision that must be made for each individual case by an experienced surgeon whether a woman is a good hip resurfacing candidate. Women with large bones normally have the same excellent outcome as men. The size of the femur bone seems to make a difference since the femur neck is weaker in a smaller woman. The overall opinion of the experienced hip resurfacing surgeons, contrary to the negative media articles, is that women are still excellent candidates for hip resurfacing and they should be considered on a case by case basis. The supposedly high level of metal ions resulting from hip resurfacing is still an issue presented as a negative result by the media and many anti-resurfacing surgeons. There have been a small number of patients with high metal ions after resurfacing, but in general this has been the result of a misplaced hip resurfacing device. The proper placement and angles of the acetabular cup is very important in hip resurfacing. If an acetabular cup is placed at too high of an angle, it can cause the two bearing surfaces of the cup and the femur cap to rub improperly in one area of the bearing surface. The increased friction of the two bearing surfaces can cause high metal ions. It was the opinion of many surgeons that if very high metal ions were present and the cup was placed at an incorrect angle, the resurfacing should be revised to a THR. The high metal ions can cause damage to the surrounding tissue and bone near the hip device. The theme throughout the hip resurfacing course is that surgeons need to be well trained to learn hip resurfacing surgical techniques and how to place the acetabular cup at the proper angle. There were many discussions by many surgeons about how to teach and train new hip resurfacing surgeons. There was talk about the development of better instruments to help place the acetabular cup and the use of computer assisted surgery to do so. Others also suggested developing better x-ray or other methods of checking or assisting the placement of the acetabular cup during surgery. Since acetabular cup placement seems to be one of the most important issues in a successful hip resurfacing surgery, it again emphasizes that a patient needs to select a surgeon that is very experienced. Of course, some surgeons can be successful after a few surgeries while others require more. The number is not magical, but the experience is. A surgeon that just does a few hip resurfacings now and then does not seem to have the same expertise as one who does a large number on a regular basis. It was suggested that when there is a group of hip replacement surgeons working together, that one of the team specialize in hip resurfacing so he becomes more experienced and does them on a regular basis. There were a number of discussions about mid head devices such as the BHMR and shorter stems. The development of new types of hip resurfacing devices continues and surgeons will be doing trials to test new types of devices. Many surgeons felt the development of these types of devices will allow the young patient the best outcome over his lifetime by first receiving a hip resurfacing, then if a revisions were ever required, it would be a bone conserving BMHR or similar device.  If when the patient was much older and ever needed another revision, to go to a full THR. They look at hip replacement as a three step evolution if revisions are required to make each step less traumatic to a patient’s bone loss. The first step to keep almost all of their femur bone, second step to remove a minimum amount of femur bone and thirdly, if needed, a total hip replacement removing a larger portion of the femur bone. Developments in hip resurfacing continue and the trend to smaller incision size, better acetabular cup placement, methods to check cup angles during surgery and better instrumentation continue. More information exchange, more medical studies and better teaching methods were all suggested. Hip Resurfacing is here to stay and is no longer a new procedure still in a trail, or test stage. Many US surgeons have done hundreds of surgeries now and many overseas surgeons have done thousands. The best advice given during the conference is that “A Well Done Resurfacing Works Well” to quote Dr. De Smet of Belgium. Surgeon experience is still the most important aspect of a successful hip resurfacing.