Hip Resurfacing: Evolution of the Conventional Hip Arthroplasty Concept

Hip resurfacing has been reintroduced in the late 1990s after the excellent results of the second generation of the metal on metal bearing. Hip resurfacing involves implanting on the femoral head a metallic femoral implant with an acetabular cup. Hip resurfacing has many advantages compared to a total conventional hip arthroplasty with a femoral stem: preservation of the femoral bone stock, respect of the biomechanics, no dislocation, physiological proprioception restored, facilitated surgical revision and possible resumption of sporting activities without any restriction. Indeed, even high-impact sports like running (or martial arts) are possible with hip resurfacing. The lack of leg length discrepancy after hip resurfacing is a major advantage over conventional hip prostheses. Finally, the absence of dislocation is one of the key elements because it is the main cause of revision for conventional prostheses in young and active patients.However, hip resurfacing requires a very precise surgical technique and a very experienced surgeon. The implantation of a hip resurfacing (and in particular its acetabular cup) requires a very precise position in frontal and sagittal planes. Hip resurfacing is intended for patients with good bone stock and primary osteoarthritis. Thus, the ideal indication is represented by primary osteoarthritis in men less than 65 years.The main hip resurfacing implants now have more than 15 years back with non-re-operation rates exceed 95%.