By Dev K. Mishra, M.D.
President, Sideline Sports Doc
Clinical Assistant Professor of Orthopedic Surgery, Stanford University
- For people with debilitating hip pain from arthritis, a hip resurfacing may offer your best chance at resuming a very active athletic life.
- However, not everyone is a candidate for hip resurfacing. Results are much better in males than females.
- You will need to find an extremely experienced hip specialist who is specifically trained in hip resurfacing surgery.
“Wear and tear” of the cartilage in a joint is a common issue, especially in active people as they age. This type of arthritis is called osteoarthritis. As the cartilage wears away, it becomes frayed and rough, and the joint space between the bones decreases. This can result in bone rubbing on bone.
Osteoarthritis develops slowly and the pain it causes worsens over time. If you are an active person in your 40s or 50s and you have hip arthritis you’ve traditionally had a limited number of options. You could modify activity, lose weight, maintain proper exercise, or take medication. And when all else fails you could consider surgery.
A “total hip replacement” is an outstanding operation for individuals with hip arthritis, but the problem is that it’s not recommended for younger people. Also, almost all surgeons recommend against high-impact activity after a total hip replacement. And that’s where hip resurfacing enters the picture. This procedure may offer the chance to save the athletic life of the very active adult with hip arthritis.
Professional tennis player Bob Bryan recently returned to the pro tour only about five months after a hip resurfacing procedure. Andy Murray had a hip resurfacing only a few weeks ago.
Hip resurfacing uses a metal on metal artificial joint surface. There were many problems in the earliest days of metal on metal joint replacements, especially in young active males. There were frequent problems with adverse local tissue reactions, cyst formations, and high failure rates.
The newer designs of metal on metal hip resurfacing have shown radically improved results and safety profiles. The results have been particularly good for the Birmingham hip replacement (BHR). The BHR was designed by surgeon Derek McMinn in the United Kingdom and has been in use there for at least 20 years. It was approved for use in the United States in 2006.
Dr. McMinn’s published results showed that 98% of men and 90% of women had well-functioning replacements at 15 years. Men under the age of 50 had the best results at final follow-up.
Shorter-term outcomes have recently been published from surgeons at Washington University in St. Louis. These surgeons compared 5 to 10 year outcomes of patients undergoing Birmingham hip resurfacing to an age and activity matched group of patients undergoing traditional total hip replacement. The results for the BHR group were outstanding. There were very few complications, excellent clinical outcomes, and exceptionally high patient satisfaction. Nearly all patients achieved their goal of remaining extremely active, significantly more often than the group of standard total hip replacement patients.
Hip resurfacing is not for everyone. For a number of reasons results have been worse in women than men. It’s a technically demanding procedure and you need a highly trained hip replacement surgeon with specific expertise in hip resurfacing. The number of surgeons trained in this procedure is growing but you’d be wise to find someone who is a high-volume hip specialist.
But if you are a man in your 40s or 50s with debilitating hip pain from arthritis, a hip resurfacing might be the best way to save your athletic life.