Hip Resurfacing for Young and Active Patients

This is a common perception, actually — in the first six to eight weeks we don't want the patient to bend beyond 90 degrees, talking about hip replacements, to reduce the chances of dislocation so the capsule heals well. That's the 90 degree rule for hip replacement.

KL is just the WHO classification of osteoarthritis — it's not very good. Diagnosis is a clinical one: patients complaining of typical pain — pain while walking, pain while taking stairs, pain while sitting cross-legged — with definitive tenderness on the joint line, is almost confirmatory. That's the real gold standard, not the X-ray. X-ray is the baseline test, but it's not the criterion for deciding which patient should undergo surgery — a grade four KL arthritis patient with minimal pain treated well with physical therapy may not be a candidate for joint replacement, while a grade three patient who has tried all conservative measures without relief could be. It's a paradox, so X-ray grading alone isn't the gold standard. On location: for osteophytes, the location of weight-bearing matters more, but for me it's typically joint space reduction that matters most, because it indirectly shows the articular cartilage is gone — and that's irreversible.

Medical therapy is the first line of treatment — it should be tried first, and once pain is not relieved with medical therapy and physical therapy, and the patient is having difficulty in activities of daily living, then the patient becomes a candidate for surgery.

The survivorship of newer implants, taking an average value, is more than 20 to 25 years, though there's a range. To measure success there's a prerequisite: we presume the patient has taken care of the joint, followed the precautions, physical therapies and exercises they've been told — the value I've mentioned is the average assuming that's been taken care of.

It's a permanent, non-removable procedure — it doesn't need to be removed. The follow-ups: the first milestone is at two weeks, to remove the stitches, then six weeks post-surgery, then three months, six months, and then annually.

It preserves more of the natural femoral head and uses a metal-on-metal bearing surface rather than the standard components used in total hip replacement.

Young, athletic patients who wish to continue high demand activity after surgery and are not willing or able to reduce their activity level.

Because of a higher risk of breakage under repeated high impact loading.