Question:I think I may need a total hip replacement. I asked my doctor about just having the new joint resurfacing surgery instead. She doesn't think that's a good idea. Should I press the issue?
Answer:Certainly you should talk with your surgeon again to find out what her thinking is on this subject. Some surgeons are skeptical about hip resurfacing these days. Even though it's been around for 30 years, there are enough problems to approach it cautiously.
Recent improvements in the design and fixation of the component parts has brought this technique back into the news. But there are some problems that haven't been addressed yet. You could end up with a failed hip resurfacing and need a total hip replacement (THR) after all.
Femoral fracture and leg length difference are two of these unresolved issues. Reports of femoral neck narrowing from stress shielding are common. Stress shielding is the resorption of bone near the implant. It's caused by a shift of load from the bone to the metal replacement parts.
Bone needs stress and load to keep forming new, stronger bone. Load will shift to wherever the stiffest, strongest force is present. In the case of joint resurfacing, that turns out to be the metal cap placed over the round head of the femur. X-rays show the neck of the femur shrivelling away to a thin stalk. Fracture of the femoral neck is a natural consequence of stress shielding in this area.
Resurfacing doesn't allow the surgeon to adjust the leg length as much as a THR does. Restoration of leg length is more accurate with THR. All things considered, your surgeon may not think you are a good candidate for joint resurfacing.Merrill A. Ritter, MD, et al. Failure Mechanisms of Total Hip Resurfacing. In Clinical Orthopaedics and Related Research. December 2006. No. 453. Pp. 110-114.
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