Welcome to the South West London Hip Clinic

• In traditional hip replacements the femoral neck and head at the top of the thighbone is removed and the stem is fixed inside the shaft of the femur. In hip resurfacing the neck and head of the femur are retained.  A metal cap is fixed onto the head of the femur and a metal cup is inserted into the socket, providing a metal on metal articulation. Claims have been made that patients can be more active following hip resurfacing, but there is little in the way of evidence to support this. Hip resurfacing is no less of an operative procedure as far as the patient is concerned, even requiring a rather more extensive exposure to get the implant in. The same risks apply that exist with total hip replacement and there are some risks unique to hip resurfacing. Because the femoral neck is retained, there is a risk of neck fracture, requiring revision surgery. In some patients the femoral neck becomes thinner with time and this may have long-term implications.  There are concerns regarding the long term local and general effects of the metal wear debris which these bearings produce.

• The Australian and English Joint Registry data is starting to show that overall hip resurfacing is performing less well than conventional total hip replacement, especially in female patients.  One resurfacing implant has been withdrawn from the market as a result of the high failure rate identified.  We are beginning to understand that accurate placement of hip resurfacings is extremely important, and even small degrees of inaccuracy cause a great increase in wear rate and metal debris production, which cases pain and requires revision.  The results for young male patients seem to be as good as those for conventional joints.

• It was originally thought that revising a resurfacing to a conventional hip would be straightforward.  Unfortunately this does not seem to be the case.  The re-revision rate is high and the functional results after revision are nothing like as good as what would be expected after a primary hip replacement .

• We are currently not recommending hip resurfacing in the light of the concerns regarding this procedure.  This is a procedure which may be worthwhile in some patient groups, especially young men, but more research is needed.  If the operation is done it should be undertaken by experts in the field, with technology available to ensure very accurate placement of the implant,

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