Polyethylene for hip resurfacing—worth a second look

James W. Pritchett


Background: In the 1970s and 1980s, hip resurfacing was largely unsuccessful, due to impingement, wear, and component loosening. Today, the availability of better technique and highly cross-linked polyethylene avoids the early causes of failure and provides a successful solution to younger, active patients with advanced osteoarthritis.
Methods: The author reviewed the results of 2,154 hip resurfacing arthroplasties he performed over a 21- year period. The procedures used a cementless titanium metal-backed acetabular implant and highly cross- linked polyethylene liner.
Results: At a mean follow-up period of 9.5 years (range, 5–21 years), the Kaplan-Meier survivorship was 97.5%, the mean Harris Hip Score was 97, and the UCLA activity score was 8. There were 32 deaths unrelated to the procedure and 35 patients were lost to follow-up. Complications leading to revision included femoral loosening (n=9), infection (n=3), femoral neck fracture (n=12), and these were revised successfully to total hip replacement. Another five patients underwent revision resurfacing for acetabular loosening. There was no evidence of wear through of the polyethylene and examination of retrieved polyethylene components showed a low wear rate from 0.003 to 0.07 mm per year.
Conclusions: Hip resurfacing today has proven to be a successful procedure with results as good as or better survivorship than total hip replacement and better function. It is a reliable procedure that meets the physical demands of younger, active patients.