Medical researchers internationally are concerned about the use of hip resurfacing techniques being used in women. Regardless, hip implant device makers and some American doctors have aggressively promoted hip resurfacing, since it became available in the U.S. in 2006, several years after it went into use overseas.
Hip resurfacing is targeted to physically active, middle-age patients, who are expected to outlive the normal 15-to-20-year life span of a full replacement joint. The procedure preserves more of a patient’s own thigh bone than traditional replacement; however, but, studies are emerging in countries where resurfacing has been used longer than in the U.S., such as Sweden and Australia, that indicate a higher failure rate for women over men who undergo the resurfacing procedure. Also, a British study revealed that those women are likelier to require a second corrective operation soon after the first as compared with women who underwent conventional full replacement hip surgery.
Researchers at Rush University Medical Center in Chicago found hip resurfacing complications were more frequent in women of all ages as well as men over the age of 55. “This procedure is not ideal for everyone,” said Dr. Craig J. Della Valle, who led that study. Meanwhile, doctors have long known that resurfacing retains more of a patient’s thigh bone, but that bone must remain strong for years, which is why the procedure is not advised for patients in their 60s. The drawback is particularly significant for younger women because of menopausal bone weakening.
The Rush findings were based on a review of short-term outcomes for the first group of patients in the U.S. to receive a resurfacing device known as the Birmingham hip resurfacing system made by Smith & Nephew. The study found of 32 of the first 537 hip resurfacing patients to receive the device after its approval in 2006, about six percent, suffered serious complications in the first year; 14 required corrective surgery. The most frequent cause involved femur fracture, which occurred in four of the 160 female patients reviewed. All four were between the ages of 42 and 59.
A study released in September by the Royal College of Surgeons of England found 3.7 percent of the 2,360 women who underwent resurfacing there required a second surgery to repair the same hip within three years as compared to 1.6 percent or less for women receiving traditional replacements. Dr. Della Valle at Rush said, “We have to be careful both on the patient side and the doctor side about adopting new technologies.” Australia, Sweden, and England operate databases, known as registries, which regularly track the outcomes of orthopedic procedures and are publicly available. The U.S. does not have such a national tracking system.
Some U.S. orthopedic specialists refuse to perform resurfacing on any patient, citing no long-term data on durability. Also, the rate of problems seen in short-term studies typically increases over time. With traditional replacement hips, “based on data, I know what the results will be in 10 to 20 years,” said Dr. Thomas P. Sculco of the Hospital for Special Surgery, in Manhattan, who performs only traditional replacements. “I can’t give you 10-to-20-year data for hip resurfacing.” Also, some doctors feel American surgeons are eager to profit on patient demand and are performing resurfacings after only minimal training. When a resurfacing fails, the patient must undergo a full hip replacement, the very procedure resurfacing is meant to defer.
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