Hip resurfacing procedures are rarer than they used to be; Dr. Hansen explains why.
Today, medical advances offer safe and effective hip replacement surgeries for people with hip arthritis. Hip resurfacing and total hip replacement procedures are two surgeries used to correct hip joint dysfunction. Arthritis specialist and hip surgeon Dr. Dane Hansen discusses the differences between these two replacement procedures and explains why surgeons increasingly recommend total hip replacement over resurfacing procedures.
The difference between hip resurfacing and total hip replacement
“Both hip surgeries are full joint replacement procedures,” says Dr. Hansen. “Both surgeries treat the ball and the socket in the hip joint. But there are differences in the implant materials used and in the degree to which the joint anatomy is affected.”
- Hip resurfacing. “This is a bone-saving procedure designed for patients who want to maintain high-impact activities like running,” explains Dr. Hansen. “We place a metal shell inside the pelvis just as you would for a total hip replacement. However, instead of replacing the entire upper femur bone with an implant and stem, we shave away a portion of the ball on the femur, so it can accept a large metal cap. Using the cap preserves more bone within the hip joint. Because the resurfacing implants provide metal-on-metal contact—or what we call hard-on-hard bearing surfaces—they are theoretically longer-lasting. Two metal surfaces eliminate concerns about the plastic portion of a hip replacement wearing out.”
- Total hip replacement. “A total hip replacement also replaces both sides of the joint,” Dr. Hansen continues. “In contrast to a resurfacing procedure, a total hip replacement removes the ball and neck of the femur. An implant replaces the head of the femur with a hard ceramic or metal ball. The curved shell side of the hip joint is replaced with metal scaffolding that is fit with a hard plastic liner. The plastic creates a different bearing surface that has been historically more vulnerable to wear and tear over time.”
Dr. Hansen notes that the incisions for both procedures are quite similar. “Because we preserve more bone in hip resurfacing, it requires a slightly larger incision to provide the mobility to manipulate the bone,” he says. “Otherwise, the recovery protocols are essentially the same. With both procedures, patients can bear weight and walk right away after surgery.”
How advancing technology has influenced procedure preferences
“Historically, the main advantages of resurfacing were the metal-to-metal contact and maintaining the patient’s own femoral neck,” notes Dr. Hansen. “Patients could resume high-impact activities like running or basketball without restriction. By contrast, patients had a lot of activity restrictions following a total hip replacement. Total hip patients were instructed to avoid rigorous activity for fear that the plastic component of the implant would wear out. As a result, hip resurfacing was preferred for young active patients.”
However, as plastics technology advanced, so did the longevity of total hip implants. “The plastics durability in total hip implants has drastically improved over the last 15 to 20 years,” explains Dr. Hansen. “Plastic components used through the ’90s had a 15- to 20-year life expectancy. But new plastics introduced in the early 2000s show minimal signs of wear. Until long-term data is available, we don’t know the true longevity of these new hips. I tell my patients that we expect them to last for 30 years, and maybe more. These new plastics have reduced age-related concerns about traditional hip replacements and reduced the need for hip resurfacing procedures.
The amount of rigorous exercise recommended with today’s total hip replacements is a controversial subject among surgeons. “Some surgeons are adamant that total hip patients continue to avoid rigorous and high-impact activities,” says Dr. Hansen. “But there’s no data supporting this continued caution. We do know that the new implants hold up well under exercises like weightlifting and cycling—that are rigorous without being high-impact. I would not be surprised if research eventually confirms that current total hip implants hold up just as well as the metal-on-metal resurfacing implants.”
Factors contributing to decreasing use of hip resurfacing procedures
“Resurfacing is still used to treat some patients, but it is a lot less common than it used to be,” says Dr. Hansen. “I am not aware of any surgeons at Summit performing this procedure, and there are only a few surgeons offering it in the Twin Cities. There are a number of reasons for the declining use of resurfacing to treat hip joint issues.”
- Metallosis risks with metal-on-metal implants. “Following the introduction of metal-on-metal implants for hip resurfacing and total hip replacement, a condition called metallosis prompted massive recalls of these implants and revision surgeries to remove them,” says Dr. Hansen. “In some cases, the metal-on-metal contact caused metal debris from the implants to move into surrounding tissues. The debris caused swelling, fluid collection, and damage to muscle tissue around the hip. In addition, metal particles entered the bloodstream, elevating cobalt and chromium to dangerously high levels in the blood system. Metallosis was less common in resurfacing implants than it was in other kinds of metal hip replacement products, but it is still a risk and a compelling reason for surgeons to move away from resurfacing procedures.”
- Increased femur fractures in hip resurfacing patients. As researchers monitored resurfacing outcomes, they observed implant failures and femur stress fractures in female patients within 12 months of surgery. “The whole point of resurfacing is to leave that bone alone so that it’s stronger,” says Dr. Hansen. “But the smaller and more delicate the bone gets, the less stress it’s able to take and the more vulnerable it is to this acute complication. As a result, if your hip was below a certain size, resurfacing was not recommended. This restriction further narrowed the number of candidates for a resurfacing procedure.”
- Advances in total hip replacement implant materials. “While resurfacing complications arose, the longevity and function of total hip replacement implants continued to improve,” notes Dr. Hansen. “Today, there’s no longer a large number of patients for whom hip resurfacing makes sense. Occasionally, resurfacing is still done in young active patients, but they are a very small subset of hip patients.”
The future of hip joint implants
“Technology is always advancing,” says Dr. Hansen. “New, more durable plastics make total hip replacement a good option for a broader range of patients. With current technology, patients 50 years old or older can feel confident that their first total hip replacement will be the only one they’ll need. Obviously, the younger you are, the more likely you are to wear out even a modern hip replacement. But if a young patient has a trauma-related hip injury or a condition like hip dysplasia, juvenile rheumatoid disease, or bone death related to avascular necrosis, a hip replacement is a reasonable option. Every patient’s circumstances have to be evaluated independently. Here at Summit, my colleagues and I are constantly following medical advances and clinical trials to make sure our patients have safe and effective treatments to support them in living their best lives.”
When to seek treatment for your arthritis
Arthritis doesn’t have to spell the end of an active life. If you are experiencing worrisome symptoms or persistent pain, the renowned arthritis specialists at Summit Orthopedics can help. We work with you to confirm a diagnosis and develop an appropriate conservative treatment plan. If nonsurgical treatments fail to support your lifestyle goals, highly skilled orthopedic surgeons will consult with you and discuss appropriate surgical options. Summit is home to innovative joint replacement options. Our Vadnais Heights Surgery Center is one of only two surgery centers nationally to receive The Joint Commission’s Advanced Certification for Total Hip and Total Knee Replacement.
Start your journey to healthier joints. Find your arthritis expert, request an appointment online, or call us at (651) 968–5201 to schedule a consultation.
Summit has convenient locations across the Minneapolis-St. Paul metro area, serving Minnesota and western Wisconsin. We have state-of-the-art centers for comprehensive orthopedic care in Eagan, MN, Plymouth, MN, Vadnais Heights, MN, and Woodbury, MN, as well as additional community clinics throughout the metro and southern Minnesota.
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