Total Resurfacing for Osteonecrosis of the Hip

With the resurgence of metal-on-metal bearings, there is renewed interest in total hip resurfacing. A cementless acetabular component used for resurfacing with a wall thickness of fewer than 5 mm is comparable in size to acetabular components used for total hip replacement. The fixation of a porous-ingrowth acetabular component used for resurfacing has been shown to be reliable and durable. There are few clinical reports of total hip resurfacing that stratify results by diagnosis. However, available evidence indicates that the pain relief, function, and activity after total hip resurfacing for osteonecrosis are superior to the results reported for hemiresurfacing and similar to the results of total hip replacement. Femoral-side failure is the main issue occurring with total resurfacing for osteonecrosis, and the femoral side failure rate is higher than that of hemiresurfacing. There are no simple guidelines for the extent of femoral head necrosis that are compatible with successful resurfacing. Refined patient selection and surgical technique can improve the outcomes and durability of total hip resurfacing for osteonecrosis.