OKOJ, Volume 7, No. 1

Surface replacement is currently recognized as a viable alternative to conventional total hip arthroplasty for young patients with end-stage osteoarthritis of the hip. The procedure involves either a hemiresurfacing of the femoral head or a total surface replacement of both the femoral head and the acetabular surface. Indications for hip surface replacement include degenerative conditions that irretrievably destroy the articular surface of the hip, resulting in pain and disability. Common conditions include osteoarthritis, posttraumatic arthritis, femoral head osteonecrosis, as well as degenerative sequelae of childhood hip disorders such as slipped capital femoral epiphysis or developmental hip dysplasia. This article presents a concise description of our metal-on-metal hip resurfacing arthroplasty using the Conserve®Plus implant.

Hip resurfacing arthroplasty has progressed beyond the evaluation stage and is now being offered as an alternative to standard total hip replacement for young and active patients. Excellent short-term results for hip resurfacing arthroplasty have been demonstrated in several major clinical series. In this video presentation, Dr. Beaulédemonstrates techniques for proper femoral implant positioning and sizing for metal-on-metal hip resurfacing in patients with advanced arthritis. Because the femoral head-neck junction is preserved with hip resurfacing, surgeons cannot rely on prosthetic femoral design to optimize patient outcomes. For metal-on-metal hip resurfacing, restoring the anterior femoral head-neck offset by removing prominent osteophytes will minimize the risk of impingement and optimize femoral component sizing, which in turn helps preserve acetabular bone stock.

Dr. Vail uses hip resurfacing components that are not currently approved for use by the US Food and Drug Administration (FDA). Although the individual components have approval for use by the FDA, putting the femoral and acetabular components together is an off-label indication for usage of this device at this point in time. Dr. Vail demonstrates and narrates a total hip resurfacing procedure using a metal-on-metal articulation and a posterior approach. He describes the approach to the hip in detail and provides tips and pearls for implanting the device as he progresses through the surgical procedure.