Editorials

Hip resurfacing

BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c3459 (Published 07 July 2010) Cite this as: BMJ 2010;341:c3459
  1. James M Simpson, fellow in hip surgery,
  2. Richard N Villar, consultant orthopaedic surgeon
  1. 1Richard Villar Practice, Spire Cambridge Lea Hospital, Cambridge CB4 9EL
  1. jm.simpson{at}rcsed.ac.uk

    Despite safety warnings, it remains an effective option in certain subgroups

    Metal on metal hip resurfacing is a type of hip replacement or arthroplasty where the head of the femur is preserved and shaped to receive a metal cap or resurfacing. This is distinct from a total hip replacement where the femoral head is excised and the prosthesis sits in the femoral shaft.

    Recent results for hip resurfacing in several national joint registries1 2 and the orthopaedic literature3 4 have raised concerns. On 22 April 2010 the Medicines and Healthcare products Regulatory Agency (MHRA) issued a device alert for all metal on metal hip replacements, most of which will be hip resurfacings.5 This, together with reports in the lay press, have raised concerns among patients and healthcare professionals.6 7

    Total hip replacement, as distinct from hip resurfacing, is one of the most successful surgical procedures in terms of quality adjusted life years, second only to smoking cessation in terms of cost-benefit analysis using these measures.

    Despite this, about one in 10 patients is dissatisfied with their outcome. The worst results in terms of implant survival have been seen in young, physically active men.8 The 2004 Swedish arthroplasty register reported that a 73.5% implant survival rate at 13 years in 3122 men under 50 years of …

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