The study identified several other serious complications, including nerve injury, joint dislocation, fracture of the proximal femur (just below the femoral neck), loosening of the metal component in the joint socket, and deep infection.

The rate of complications, however, was similar to that found in other studies involving only orthopedic surgeons who had extensive experience with hip resurfacing. As a result, the authors concluded that the FDA-mandated training succeeded in teaching generalists the skills needed to perform the technically challenging hip resurfacing procedure, alerting them to possible complications and ways to avoid those problems.


In a conventional total hip replacement, orthopedic surgeons remove the head of the femur, or the ball of the hip joint, and replace it with a metal stem inserted into the thigh bone. They fit the socket of the joint with a metal shell that typically includes a plastic liner. In hip resurfacing, the femoral head remains, but its surface is reshaped to accept a rounded cap with a short stem that sits in the femur. A thin metal cup is pressed into the hip socket. Both components are made entirely of cobalt chrome, a metal.

Hip resurfacing is generally recommended for younger, more active patients out of concern that the traditional artificial hip might wear out during their lifetime and require a second replacement, a far more complicated surgery.

"Hip resurfacing has certain advantages over the conventional total hip replacement," said Della Valle. "It preserves more bone because the head of the femur is retained. It enables the patient to return to high-impact sports because the metal components of the implant resist wear and tear and can withstand the forces associated with activities like running. Some studies have also shown that hip resurfacing carries a lower risk of dislocation because the size of the ball component is larger."

"But despite its benefits, risks remain," Della Valle added. "Our findings suggest that we need to be cautious. This procedure is not ideal for everyone."



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