study indicating hip resurfacing more likely to fail, especially in women

[Rosie90]

I know that my surgeon in Hamilton, Ontario is no longer doing hip resurfacing.  Are doctors in Britain also moving away from hip resurfacing?  How significant is this UK study?


Edited by Patricia Walter  I am sorry, but you can't post studies in full due to copyright laws.

I made a detailed response below. Thanks for calling attention to the study.

Patricia Walter - owner/webmaster of Surface Hippy

[Pat Walter]

Hi
I am sorry, but I edited your post due to copyright laws.

You can't post studies in full due to copyright laws.

Here is the link

http://www.nlm.nih.gov/medlineplus/news/fullstory_129833.html

This study does not completely agree with the Australian National Registry.  They have grouped all women together.  Larger women have the same outcome as larger men.  Most Small men have the same, poorer outcome, as small women. 

You need to look at the stats of the National Registry to see the revision rates by sex, age and size of device.  It all makes a difference.  It is not good to just lump everyone together in generalities.  Hip resurfacing is still an option for women.  Use the top experienced surgeons and they will tell you whether you are a candidate or not.  Don't live by generalizations - get the real facts before making decisions about your body and health.

Read the full story and statistics here

http://www.surfacehippy.info/2012-aoanjr-hip-resurfacing-information.php

Patricia Walter - owner/webmaster of Surface Hippy

[Dannywayoflife]

I'd wager that the stats of the top surgeons are significantly better than those of any register. To me if your small boned or in anyway a difficult case its EVEN more important to go to the top surgeons!.

[rubyred]

I'm in agreement with Danny. I know that if any other surgeon with less experience had done my operation, it wouldn't have been a success. I have dysplasia and a pelvis that's small and wonky. It was a challenge even for Mr Treacy!

The experience of the surgeon, depending on individual's cases, is paramount to success.

[Tim Bratten]

I do not have access to the Lancet journal article, but in the abstract it says this:

"In men with smaller femoral heads, resurfacing resulted in poor implant survival. Predicted 5-year revision rates in 55-year-old men were 4·1% (3·3—4·9) with a 46 mm resurfacing head, 2·6% (2·2—3·1) with a 54 mm resurfacing head, and 1·9% (1·5—2·4) with a 28 mm cemented metal-on-polyethylene stemmed THR. Of male resurfacing patients, only 23% (5085 of 22076) had head sizes of 54 mm or above."

My first thought when I saw that they were comparing a 28 mm cemented metal-on-polythene with HR is that it did "better" after five years because of the extreme activity restrictions associated with this kind of implant!

In the abstract they blow off reporting on "only" 23% of the data (that's one in four!), which seems to me to indicate some kind of bias. I can only imagine that they don't mention results on this group because HR did better. Also, I wonder why they focus specifically on five year data (and not a longer period) since apparently longer term data was available. A lot depends on how you organize the data. For example, what if you divide the data into two groups: those above, say, 52 mm and those below? I wouldn't be at all surprised if their data showed that in the group above 52 mm HR did as well or better than the THR group. I bet the longer term data would be even more definitive (it seems to me that most failures in HR come from fracture or acetabular component problems both which show up in less than five years). Even more important, I hope the researchers were unbiased enough to factor out problems with the faulty ASR device. Since I don't have access to the article I can't say anything for sure.

Here´s my personal opinion about this: even given that five year revision rates of a 46mm head HR are more than double that of a 28mm metal on polythene THR, if I had this hip size I would be more than willing to take that risk for the much increased functionality of the HR. The problem with the 28 mm ball is that you can dislocate your hip bending over or kneeling down. And it is well established that such an implant does not last very long or work very well in younger patients.     

[Dannywayoflife]

Thats an excellent way to look at it Tim. I'd love to see the results of just the worlds say top 10 surgeons though and see how much difference there is between them and your run of the mill ortho! I'd wager that thered be a big difference for EVERY demographic