Video Review of the 3rd Annual Hip Resurfacing Course

I just returned home from the 3rd annual hip resurfacing
course in Baltimore, MD on Sept. 4 -5, 2009. The course is
presented each year to help new surgeons learn about hip
resurfacing, to update existing hip resurfacing surgeons
about changes in the field of resurfacing and to allow
experienced hip resurfacing surgeons to network with other
resurfacing surgeons.

I am honored to be allowed to attend the course and to meet
some of the most experienced hip resurfacing surgeons in the
world. The knowledge shared during the course includes new
information and opinions about different surgical
approaches, hip devices, patient selection and medical
studies.

Hip Resurfacing has been performed for 12 years now. It is
considered to have a good history and is no longer
considered a new procedure. Hopefully, the medical community
will start to accept hip resurfacing and stop referring to
it as a new technology.

The presentations at the course felt very positive in
support of hip resurfacing. Hip resurfacing accounts for
approximately 7 – 10% of hip replacement surgery worldwide.

There has been some bad press recently about hip resurfacing
not being a good option for women and that it creates high
metal ions. Both of these myths were discussed at length
during the course. Patient selection is still very important
to a good outcome and longevity of a hip resurfacing.
Patient selection, however, is made individually on a patient by
patient basis and not by generalizations. Whether you are young or
old, male or female, a doctor must look at your personal bone
quality, your hip condition and your lifestyle to determine
if you are a hip resurfacing candidate. Medical studies have
been completed to show men have approximately a 2% revision rate
from hip resurfacing while women have approximately a 4%
revision rate. It is thought women normally have smaller
bones, softer bones after menopause and placement problems
such as dysplasia which contribute to their higher revision
rate. So again, it is a decision that must be made for each
individual case by an experienced surgeon whether a woman is
a good hip resurfacing candidate. Women with large bones
normally have the same excellent outcome as men. The size of
the femur bone seems to make a difference since the femur
neck is weaker in a smaller woman. The overall opinion of
the experienced hip resurfacing surgeons, contrary to the
negative media articles, is that women are still excellent
candidates for hip resurfacing and they should be considered
on a case by case basis.

The supposedly high level of metal ions resulting from hip
resurfacing is still an issue presented as a negative result
by the media and many anti-resurfacing
surgeons. There have been a small number of patients with
high metal ions after resurfacing, but in general this has
been the result of a misplaced hip resurfacing device. The
proper placement and angles of the acetabular cup is very
important in hip resurfacing. If an acetabular cup is placed
at too high of an angle, it can cause the two bearing
surfaces of the cup and the femur cap to rub improperly in
one area of the bearing surface. The increased friction
of the two bearing surfaces can cause high metal
ions. It was the opinion of many surgeons that if very high
metal ions were present and the cup was placed at an
incorrect angle, the resurfacing should be revised to a THR.
The high metal ions can cause damage to the surrounding
tissue and bone near the hip device.

The theme throughout the hip resurfacing course is that
surgeons need to be well trained to learn hip resurfacing
surgical techniques and how to place the acetabular cup at the proper angle.
There were many discussions by many surgeons about how to
teach and train new hip resurfacing surgeons. There was talk
about the development of better instruments to help place
the acetabular cup and the use of computer assisted surgery
to do so. Others also suggested developing better x-ray or
other methods of checking or assisting the placement of
the acetabular cup during surgery.

Since acetabular cup placement seems to be one of the most
important issues in a successful hip resurfacing surgery, it
again emphasizes that a patient needs to select a surgeon
that is very experienced. Of course, some surgeons can be
successful after a few surgeries while others require more.
The number is not magical, but the experience is. A surgeon
that just does a few hip resurfacings now and then does not
seem to have the same expertise as one who does a large
number on a
regular basis. It was suggested that when there is a group
of hip replacement surgeons working together, that one
of the team specialize in hip resurfacing so he becomes
more experienced and does them on a regular basis.

There were a number of discussions about mid head devices
such as
the BHMR and shorter stems. The development of new types of
hip resurfacing devices continues and surgeons will be doing
trials to test new types of devices. Many surgeons felt the
development of these types of devices will allow the young
patient the best outcome over his lifetime by first
receiving a hip resurfacing, then if a revisions were ever required, it would be a bone conserving BMHR or similar
device.  If when the patient was much older and ever needed
another revision, to go to a full THR. They look at hip
replacement as a three step evolution if revisions are
required to make each step less traumatic to a patient’s
bone loss. The first step to keep almost all of their femur
bone, second step to remove a minimum amount of femur bone
and thirdly, if needed, a total hip replacement removing a
larger portion of the femur bone.

Developments in hip resurfacing continue and the trend to
smaller incision size, better acetabular cup placement,
methods to check cup angles during surgery and better
instrumentation continue. More information exchange, more
medical studies and better teaching methods were all
suggested.

Hip Resurfacing is here to stay and is no longer a new
procedure still in a trail, or test stage. Many US surgeons have done hundreds of surgeries
now and many overseas surgeons have done thousands. The best
advice given during the conference is that “A Well Done
Resurfacing Works Well” to quote Dr. De Smet of Belgium.
Surgeon experience is still the most important aspect of a
successful hip resurfacing.