Quick Return to Active Lifestyle for Select Patients
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Surgeons shave damaged bone from the femoral head, insert a metal hemisphere over the head, clear the acetabulum, and insert a metal shell into the socket.
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A newly enhanced arthroplasty procedure may offer better outcomes than total hip replacement (THR) for a select group of patients who are younger than the average hip replacement candidate (66 years, according to the American Academy of Orthopaedic Surgeons). "Complete hip resurfacing is a newer option in the US but has been used in Europe and Australia for almost 15 years," says UAB orthopaedic surgeon K. David Moore, MD. The Birmingham Hip Resurfacing (BHR) System, approved by the Food and Drug Administration in 2006, is a metal-on-metal artificial hip resurfacing system. Developed in Birmingham, England, by orthopaedic surgeon Derek J. W. McMinn and introduced into clinical practice in 1997, the BHR incorporates knowledge gained from earlier experience and improvements in articulating materials.
Hip resurfacing differs from THR in several ways. THR requires surgeons to remove the femoral head and a portion of the femoral neck, implant a large spike into the femur, and cap the spike with a metal cup to replace the femoral head. Excision of such large segments of bone limits future surgeries that may be required in younger patients. By comparison, hip resurfacing does not require removal of the femoral head and surgeons need only remove a small portion of damaged cartilage and bone.
"Hip resurfacing requires a longer incision, and the surgeon removes more tissue around the hip to expose the acetabulum without removing the femoral head," says Moore, who has been performing hip resurfacing since 2006. Surgeons shave damaged bone from the femoral head and insert a short-stemmed hollow metal hemisphere on to the exposed bone, covering the original femoral head. The surgeon then removes deteriorated tissue from the acetabulum and inserts a metal shell into the socket.
Metal-on-metal joint resurfacing may offer increased prosthetic longevity and range of motion compared with traditional THR procedures, Moore says. A recent British study of BHR shows a joint survival rate of 96.3% at 5 years (J Bone Joint Surg Br. 2008;90[9]:1137-1142). "These data are encouraging, but studies with longer follow-up will provide a clearer picture of how resurfaced hips hold up over time," he says.
The manufacturer indicates BHR is appropriate for men younger than 65 years and women younger than 55 years, but Moore notes the procedure is not suitable for all patients in these age groups.
In these younger patients, the major causes of degenerative joint disease are osteoarthritis, rheumatoid arthritis, traumatic arthritis, dysplasia, and avascular necrosis (AVN). AVN can leave patients with nonviable bone, which cannot support the femoral components used in resurfacing. "Bone quality determines the optimal patients," he says. "Patients in their 30s and 40s who lead active lives and may require revision surgery later in life are the best candidates for hip resurfacing.
"Direct-to-consumer marketing has contributed to a high demand for hip resurfacing procedures, but careful patient selection is crucial, Moore says. "BHR may be considered after a thorough evaluation of a patient's bone quality, overall health, and expectations. For a limited number of appropriately selected individuals, hip resurfacing offers the potential for a return to an active lifestyle with less pain and, with more original bone intact, and leaves the door open for total hip replacement."
For more information contact Dr. David Moore at 1-800-UAB-MIST or at mist@uabmc.edu.