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Hip Resurfacing 'Unacceptable for Women': Study

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By Peter Russell
WebMD Health News
Reviewed by Keith Barnard, MD

Oct. 4, 2012 – An operation known as hip resurfacing -- an alternative to hip replacement often recommended for younger patients ­- is prone to frequent failure and should not be used in women, a new study shows.

Researchers looked at data from 434,650 operations carried out in England and Wales between 2003 and 2011, of which 31,932 (7.4%) were resurfacings.

Metal Cap

Hip resurfacing is similar to hip replacement. In a replacement operation, though, the rounded top section of the thigh bone, known as the femoral head, is completely removed and replaced. During resurfacing surgery, the femoral head is ground down to an even surface and given a metal cap.

Hip resurfacings always have metal-on-metal bearings, while total hip replacements can have a variety of bearing options, such as ceramic, metal, or plastic. 

Researchers from the University of Bristol looked at the failure rate of resurfacing implants since the United Kingdom's National Joint Registry was set up in 2003. They used data from the next seven years to compare them with total hip replacements.

Seven-Year Failure Rate

They found that the predicted seven-year failure rate for a 55-year-old woman who had undergone hip resurfacing ranged from 8.54% to 11.67%. This failure rate was dependent on the size of the femoral head, with the smallest sizes more prone to early failure.

These failure rates were much higher than full replacements with a metal ball and a polyethylene socket, where the failure rate was between 1.81% and 2.25% over seven years.

Men also experienced higher failure rates with resurfacing surgery compared to total replacement. 

The findings appear in the online edition of The Lancet.

Unacceptable for Women, Researcher Says

Ashley Blom, MD, PhD, is a professor of orthopaedic surgery in the University of Bristol’s School of Clinical Sciences, and one of the paper's authors. "Resurfacing failure rates in women were unacceptably high. In view of these findings, we recommend that resurfacing procedures are not undertaken in women," she says.

Furthermore, "the National Joint Registry for England and Wales has the biggest joint replacement database in the world, allowing us to analyze over 30,000 hip resurfacings up to seven years after surgery. Our findings show that resurfacings with smaller head sizes are prone to early failure, and in particular that resurfacing in women has much worse implant survival, irrespective of head size," she says.

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