I would like to place my brief analysis below in a more visible place than this but am unable to do so. I believe that the succinct summary below may help those patients that are considering hip resurfacing make an informed decision.
My background:
46 years old, 6’2”, very athletic/fit, education includes medicine and data science, and unilateral severe hip arthritis.
Advantages to resurfacing:
1) Survivorship
A) International hip resurfacing register (Data collected from 27 high volume centers throughout the world) has survivorship at 20-22 years when a >50 mm femoral head was placed in a patient that is < 50 years old at approximately 93-95%. One could say that I have a selection bias as I am only using the data from the high-volume centers, but I would only allow a high-volume center to perform my operation, so this data set is most applicable to my situation.
B) The Swedish hip registry has survivorship at 24 years when a total hip replacement was placed in a patient that is < 50 years old at approximately 57%. This data did not use the highly cross-linked polyethylene liners. The older liners have approximately ¼ of the wear rate of the newer highly cross-linked polyethylene liners that are the current gold standard. So, in the future the survivorship should improve.
2) Theoretically easier to revise as a larger portion of the femur is spared.
A) Limited data on this but if the femoral component fails and the acetabular component is intact then the revision is ½ a total hip replacement. This type of revision would use a dual mobility component which has a lower risk of dislocation compared with a standard total hip replacement but might have greater wear
3)No activity restrictions/dislocation risk
A) Common cause of failure of a total hip replacement is dislocation.
B) Most surgeons advise against performing running & jumping with a total hip replacement, yet these are permissible activities 6-12 months after resurfacing.
Advantages to THR:
1)Easier to find a surgeon that can perform the operation well
A) Skilled surgeons can be found in every mid to large city in the USA as this operation is the gold standard treatment for end stage arthritis and is technically easier to perform than hip resurfacing.
2)No significant metal ions in bloodstream
A) If resurfacing is performed at a high-volume center most functioning/asymptomatic hip resurfacing patients have Cobalt and Chromium levels below 4. This level has not shown to be associated with any clinically significant neurological, oncologic, or cardiovascular diseases. Elevated systemic metal levels (below 4) likely pose a low but unquantified risk factor. This level has not shown to be associated with any clinically significant neurological, oncologic, or cardiovascular diseases. Elevated systemic metal levels (below 4) likely pose a low but unquantified risk factor.
Conclusion:I chose resurfacing over a total hip replacement. For my demographic (<50 Y.O, active, and of a large stature so my femoral head would be > 50 mm) this offers significantly better survivorship, possibly an easier revision should this become necessary, and no activity restrictions for the likely low but unquantified risk factor of systemically elevated metal ions. I am sharing my thought process as well as a limited amount of my research to help others with their decision. If one is older, smaller, less active, does not have access to a high-volume hip resurfacing center, or concerned about systemic metal ions then getting a total hip replacement might be a better choice than resurfacing.
Topic: Summary of my analysis of hip resurfacing (Read 2172 times)
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