Hip Resurfacing

The concept of hip resurfacing rather than replacement of the hip joint has been around for a number of years. It involves, as the name would suggest, replacing only the gristle surfaces of the ball and socket of the joint with a metal cap and cup rather than removing the whole of the ball of the joint as is required in a total hip replacement.

The advantages of resurfacing the hip joint include firstly the need to take away much less bone than with a conventional hip replacement, this is important particularly in the younger patient who may require revision surgery at some point in the future. Secondly it involves the use of very hard bearing surfaces that resist wear and therefore confer long life on the artificial joint and thirdly the larger metal head of a resurfaced joint gives the hip biomechanical advantages over the smaller head of a conventional hip replacement, allowing a greater range of movement and improved stability.

In the 1970-80's a number of hip replacement surgeons developed metal against metal joints and resurfacings, but due to the difficulties in the accuracy of manufacturing they were largely a failure and the technique fell out of favour. However it was recognised that if the manufacturing process was optimised that metal against metal joints could perform very well and possibly better than the 'gold standard' hip replacements available. Using these 'state of the art' manufacturing processes the Birmingham Hip Resurfacing (BHR) was developed which has now been implanted in over 30,000 people worldwide and has a reported success rate of 98% at up to 9 years after implantation.

Hip resurfacing surgery is ideally intended for the younger more active person and therefore is not suitable for all patients with hip arthritis, and may actually be inappropriate for your particular condition. We will discuss this with you at your consultation and suggest the most appropriate implant for you and your lifestyle.

Hip Resurfacing v Total Hip Replacement

Comparing Hip Resurfacing with conventional Total Hip Replacement surgery is rather unfair. This is because the two types of implant, although used to treat the same condition, do so in patients of different ages and therefore of very different levels of activity and demands.

Considering the Charnley Total Hip Replacement as the 'Gold Standard' in conventional hip replacement surgery, this shows 96% survivorship at seven years. These are typically implanted into older patients with often much lower activity levels than would be expected in a younger patient considered for Hip Resurfacing.

Published clinical results in Hip Resurfacing patients with an average age less than 50 show 97.4% survivorship at six to seven years. These results are much better than the results of the Charnley device if one considers the extra demands that are placed on the resurfacing. Given that various studies have measured the number of steps taken by a young active person to be in the region of 4 to 5 million per year and for an older person to be less than one million, it can be seen that the rate of failure of a resurfacing might be expected to be greater than for a conventional hip replacement, but this is not the case.

The Birmingham Hip Resurfacing demonstrates results as good as and probably better than the very best results achievable with conventional hip replacements. In fact the results of conventional hip replacements in patients under 50 years of age are disappointingly low survival rates at 10 years.

Unlike with conventional hip replacements we do not know how the results of Hip Resurfacing will look 15 to 20 years after they are implanted. However all the indications are very promising and suggest the long-term results will be significantly better than those of the 'Gold Standard'.