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Online ISSN 1827-1707
HIP AND KNEE RECONSTRUCTION
Endocenter Dresden, Dresden, Germany
Hip resurfacing arthroplasty, the rediscovery of an old therapeutic principle, currently gains increasing popularity as an alternative treatment method in advanced arthritis of young and active patients – the problem group of hip joint arthroplasty. Most important failure modes of historic metal-on-polyethylene hip resurfacing devices are removed or at least fundamentally improved by the low-wear metal-on-metal bearing, the cementless cup and improved surgical technique. For a significant period evolution of this procedure has been bedeviled by media involvement so that patient pressure, rather than scientific orthopedic study, has dominated hip resurfacing arthroplasty, study data are more and more appearing in recent years. Single surgeon and registry studies show now a short to mid-term survival rate of at least the Birmingham hip resurfacing (BHR) comparable to modern total hip replacements in the younger patient population and a satisfactory clinical outcome. However, the available clinical and radiological data base does not provide enough evidence to deliver a satisfactory long-term forecast. Hip resurfacing offers unique advantages, as preserving proximal bone stock, optimizing stress transfer to the proximal femur, restoring “normal” anatomy of the hip, providing a low wear bearing, and, owing to the large diameter of the articulation, offering inherent stability. But, however, despite the lack of clear evidence linking metal-on-metal total hip arthroplasty with long-term problems, there are lingering concerns over the local and possible systemic adverse effects of metal wear products and metal ion exposition. Therefore, additional investigations are necessary for estimation the value of this attractive procedure from medical as well as economic view.