November 29, 2021 by John Fernandez
Hip Resurfacing: A Better Option for Young, Very Active Patients
Hip resurfacing, a term not as familiar has hip replacement, is a specialized type of surgery to replace a damaged hip joint. But this procedure is usually an option for those who are younger and more physically active than the typical patient who undergoes traditional, total hip replacement.
Actually, hip resurfacing is a type of hip replacement surgery – with one primary difference. During resurfacing, the surgeon makes an incision to access the hipbone and thighbone. Then, the femoral head is trimmed and capped with a smooth metal covering. The surgeon also removes the part of the damaged bone with the hipbone socket, replacing it with a metal shell.
In traditional hip replacement, the surgeon removes your femoral head completely, instead of just capping it with a metal covering.
Capping the bone instead of cutting it out allows you to keep your native hip biomechanics. The metal-on-metal surfaces are more durable than the plastic used in total hip replacement. These factors make hip resurfacing an ideal option for hip reconstruction in young to middle aged men who regularly perform high levels of physical activity — in some cases these patients are amateur athletes or extremely dedicated “weekend warriors” who run, cycle, play soccer or other intense sporting activities, explains Charles Lawrie, M.D., a board-certified, fellowship-trained orthopedic surgeon at Baptist Health’s Miami Orthopedics & Sports Medicine Institute. Hip resurfacing may be an option for select women as well, but is contraindicated in most due to mismatch between their bone size and the resurfacing implants.
Dr. Lawrie is one of the leading orthopedic surgeons in the country that is fully certified and trained to perform hip resurfacing, which is intended for certain patient candidates. Additionally, he is involved in designing and developing technology and implants for hip and knee replacement to improve patient outcomes.
“The patients that are appropriate for the surgeries are very high-activity people,” said Dr. Lawrie. “These include mostly guys in their 30s, 40s, 50s, and early 60s who are still playing competitive sports like soccer, tennis, water sports, power-lifting and triathlons. Women who are of larger stature, and are past their child-bearing years, may also be candidates. “
Why is hip resurfacing a good option for these active patients? Essentially, the resurfacing’s “metal-on-metal” structure has the potential to last longer, and there is research data demonstrating patients are able to get back to high level sporting activity at a higher rate after hip resurfacing compared to total hip replacements said Dr. Lawrie. It also conserves more bone than traditional hip replacement, allowing for younger patients to have less-complicated, future hip surgeries, if needed.
“As long as it’s done well, the metal-on-metal should last forever,” explains Dr. Lawrie. “So, it’s works well in a young patient. The metal on metal also cannot break. And the bone density around the implant actually gets stronger over time.”
Clinical data on physically active patients who have undergone total hip replacement (THR) versus hip resurfacing (HR) strikingly favors those who underwent hip resurfacing. Here is a breakdown of such data from Washington University in St. Louis:
At 5 years, postoperatively:
Running 32% THR vs 73% HR
Sport 56% THR vs 86% HR
Heavy Work 16% THR vs 28% HR
At 10 years, postoperatively:
Running 19% THR vs 53% HR
Sport 52% THR vs 86% HR
Heavy/Manual Work 13% THR vs 20% HR
“Hip resurfacing is a good option for the younger, active patient,” says Dr. Lawrie. “There is still concern and hesitation for doing hip replacements in younger patients for a variety of reasons, and this surgery provides a reasonable alternative to hip replacement that has some potential unique advantages for those active patients.”