Metal on metal hip resurfacing versus uncemented custom total hip replacement – early results

Nemandra A Sandiford1*, Sarah K Muirhead-Allwood1,2, John A Skinner2, Jia Hua2

The overall success of total hip arthroplasty has not been reflected in young, active patients. As a result the majority of contemporary research has been focused towards improving results particularly in the younger, more active patient demanding a high functional outcome. Total hip arthroplasty has previously been avoided in this group due to concerns of durability of prostheses and projected need for multiple revision procedures with progressive loss of bone stock.

Hip resurfacing has become more popular in this group following advances in engineering and metallurgy. Modern metal-on-metal bearings appear to offer excellent wear properties when compared to historical resurfacing designs, which were mainly metal-on-polyethylene. HR seems to be an attractive concept which offers durable bearing surfaces with low wear, bone conservation and simple revision options particularly on the femoral side.

The results of our study suggest that the functional outcome of HR is not superior to custom uncemented THA in the short term and should therefore not be used as the sole basis for deciding which of the procedures to undertake in individual patients. It may be that the potential ease of revision and femoral bone conservation in this group is a driver for the choice of implant especially if both treatments are effective with a high degree of patient satisfaction.

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