Perspective

Speaker: Young, active men are ideal for metal-on-metal hip resurfacing

Resurfacing produces more physiologic loading, less stress shielding and thigh pain than total hip replacement.

SAN DIEGO — Evidence supports metal-on-metal surface replacement as an alternative to hip replacement for young, active men, according to a presenter.

“Currently, there is no evidence to support an indication for a metal-on-metal total hip, but for young, active males with [osteoarthritis] OA who are of average or above stature and have a strong desire or need to return to a high activity level, either in their vocation or recreation, there is a substantial body of evidence supporting continued use of surface replacement as a reasonable alternative,” Robert L. Barrack, MD, said at The Hip Society Specialty Day Meeting.

Metal-on-metal (MoM) total hip replacement has several disadvantages. They include fewer liner options or modular complications, noise generation and increased cost, with no benefits to counter those issues, he said.

Robert L. Barrack, MD
Robert L. Barrack

“Initially, we thought we would have a lower wear profile [but], unless you use a smaller head, the wear rate and the complication rates go way up,” Barrack said.

In comparison, he said MoM hip resurfacing shows promise. There is a risk of metal reaction and there are narrow indications, increased costs and the incidence of neck fracture associated with the surgery, he said.

It is “the only hip arthroplasty [that] is truly nonmodular,” he said.

“There is more physiologic loading. There is less stress shielding and thigh pain,” Barrack said. “[A] higher percentage [of patients] do return to higher activity levels. Even in level 1 studies, there is equivalent 10-[year] to 15-year survival, but only in specific groups.”

Stratified registry data showed MoM hip resurfacing had equal or better revision rates among young men with OA vs. other techniques. Patients who undergo hip resurfacing, however, will only perceive an advantage if they usually perform high-level activities, Barrack noted.

“The indications are narrow,” he said. “I have restricted this virtually entirely to males under 60 [years of age]. They have to be average or above average stature because the smaller sizes are not available, and I actually do not offer it to people who are not high activity level.” – by Casey Tingle

Disclosure: Barrack reports he receives research support from Zimmer Biomet, Medical Compression Systems, NIH, Smith & Nephew, Stryker and Wright Medical; and receives IP royalties, other financial and material support and is a paid consultant for Stryker.

SAN DIEGO — Evidence supports metal-on-metal surface replacement as an alternative to hip replacement for young, active men, according to a presenter.

“Currently, there is no evidence to support an indication for a metal-on-metal total hip, but for young, active males with [osteoarthritis] OA who are of average or above stature and have a strong desire or need to return to a high activity level, either in their vocation or recreation, there is a substantial body of evidence supporting continued use of surface replacement as a reasonable alternative,” Robert L. Barrack, MD, said at The Hip Society Specialty Day Meeting.

Metal-on-metal (MoM) total hip replacement has several disadvantages. They include fewer liner options or modular complications, noise generation and increased cost, with no benefits to counter those issues, he said.

Robert L. Barrack, MD
Robert L. Barrack

“Initially, we thought we would have a lower wear profile [but], unless you use a smaller head, the wear rate and the complication rates go way up,” Barrack said.

In comparison, he said MoM hip resurfacing shows promise. There is a risk of metal reaction and there are narrow indications, increased costs and the incidence of neck fracture associated with the surgery, he said.

It is “the only hip arthroplasty [that] is truly nonmodular,” he said.

“There is more physiologic loading. There is less stress shielding and thigh pain,” Barrack said. “[A] higher percentage [of patients] do return to higher activity levels. Even in level 1 studies, there is equivalent 10-[year] to 15-year survival, but only in specific groups.”

Stratified registry data showed MoM hip resurfacing had equal or better revision rates among young men with OA vs. other techniques. Patients who undergo hip resurfacing, however, will only perceive an advantage if they usually perform high-level activities, Barrack noted.

“The indications are narrow,” he said. “I have restricted this virtually entirely to males under 60 [years of age]. They have to be average or above average stature because the smaller sizes are not available, and I actually do not offer it to people who are not high activity level.” – by Casey Tingle

Disclosure: Barrack reports he receives research support from Zimmer Biomet, Medical Compression Systems, NIH, Smith & Nephew, Stryker and Wright Medical; and receives IP royalties, other financial and material support and is a paid consultant for Stryker.

    Perspective

    Jourdan M. Cancienne

    With inferior survivorship, increased cost and the risk of potentially catastrophic adverse local soft tissue reactions, MoM total hip replacement (THR) bearings have been largely abandoned. The future of MoM hip resurfacing is less clear, with an increasing number of studies reporting promising early- and middle-term functional results in select patient populations. This research has primarily focused on two resurfacing designs. As Barrack mentioned, these studies have shown the advantages of low wear and dislocation rates, a more normal gait pattern and the ability to participate in higher intensity sporting activities compared to their counterparts with THR. However, patients and surgeons considering this procedure must carefully weigh the potential known disadvantages, including certain unique complications, such as femoral neck fracture and the largely unknown long-term risk of systemic metal-ion exposure. Further long-term clinical data are needed to establish clinical outcomes at more than 15 years follow-up to refine patient selection and identify and compare the means of implant failure to THR to guide future use of this procedure. For now, the procedure should be approached with caution and used only in select patients. The extrapolation of results of MoM THR to the resurfacing design should not be done given the lack of a modular femoral junction and no potential for trunnion corrosion.

    • Jourdan M. Cancienne, MD
    • University of Virginia
      Charlottesville, Va.

    Disclosures: Cancienne reports no relevant financial disclosures.