The complications of hip resurfacing are similar to those detailed elsewhere surrounding total hip replacement surgery. In addition to all those, there can be a slightly increased early complication rate in hip resurfacing compared to more traditional hip replacements.
Perhaps the most common complication following hip resurfacing surgery is fracture. While this can occur at the time of surgery, the major concern is when this occurs post-operatively. Fracture is most common in the first six months of surgery and the risk is increased within the first three months. It can occur as a consequence of poor bone quality but also can occur if there is any damage sustained to the femoral neck at the time of the procedure. Typically if this occurs intra-operatively a decision may be taken to convert to a total hip replacement at that stage.
Fracture is an uncommon complication of hip resurfacing but is more common following resurfacing than following a traditional total hip replacement. The management of the fracture depends totally on the nature of the injury, the time since surgery and how well the metal/metal bearing is functioning at the time the fracture occurs. In some circumstances it may be possible to use a stemmed implant with a large metal head to articulate with the existing acetabular component but on the whole, and in most circumstances, it is likely that a formal revision of the hip resurfacing to a total hip replacement is likely to be required involving removal of the acetabular component alongside the exchange of the fractured femoral head and neck to a stemmed implant.
Thus the patient and surgeon need to be clear that the potential benefits of using a hip resurfacing technique, with slightly increased risks over a more traditional hip replacement, would outweigh those theoretical risks. For all these reasons the number of patients in which the procedure is truly indicated is, in my opinion, relatively small.
© Andrew R J Manktelow – September 2011