Metal-on-Metal Hip Resurfacing: A Skeptic’s View

Contemporary metal-on-metal hip resurfacing is the third attempt by its proponents to eliminate a diaphyseal femoral component. I have multiple objections with the resurfacing concept and believe even the premises for the use of resurfacing invalid. There is a high rate of success with circumferential bead or mesh-coated uncemented stemmed femoral components at 10 to 20 years and there have been no long-term adverse consequences of femoral stress shielding with a diaphyseal component. More acetabular bone may be removed with resurfacing, negating its “conservative” premise. One computer simulation suggested the range of hip motion might be considerably less with resurfacing compared with conventional hip arthroplasty. There are a very limited number of patients for whom hip resurfacing is truly indicated, and the femoral head may be unsuitable for resurfacing in 40% of selected patients. Resurfacing is technically more difficult than conventional hip arthroplasty. Early complications and revision for femoral neck fractures are more likely with resurfacing. Blood and urine metal ion levels, capsular lymphocytic aggregation, and hypersensitivity are concerns with metal-on-metal articulation. Metal-on-metal hip resurfacing should only be used by a limited number of hip surgeons. The risks and complications of metal-on-metal hip resurfacing outweigh any possible advantages.

Level of Evidence: Level V, economic and decision analyses. See the Guidelines for Authors for a complete description of levels of evidence.