Abstract
Surface replacement of the hip has become established as an alternative treatment to total hip replacement in the younger, active, male patient. By the very nature of preserving the femoral head and neck, there may be failures due to femoral neck fracture and femoral component loosening. Additionally, revisions of hip resurfacing for acetabular loosening may be necessary. Other scientific papers have described problems that may arise as a result of the metal-on-metal bearing either due to excess metal production or an immunologic-mediated reaction to the metal debris.
Grammatopolous et al. describe poor results of revisions of surface replacements due to massive tissue destruction at the time of revision surgery, persistent pain, and swelling. In my experience with hip resurfacing, this complication is extremely rare. In my series of 925 resurfacings with a minimum of 2 year follow up, 12 revisions (1.3%) have been performed. Of these revisions, only 3 (0.3%) were for complications related to the metal-on-metal bearing; 2 for edge-loading and excess metal production, and 1 for metal hypersensitivity. None of the revision cases have had abductor destruction, or nerve/vascular involvement. Reconstruction of the joint was carried out with standard and revision components; post-operative function of these patients has been comparable to that of a primary total hip replacement. With careful monitoring of the post-operative resurfacing patient, problems can be identified early and surface replacement conversion can be performed with excellent results.
