Letters to the Editor
I appreciate the correspondence by Dr. Kose and his interest in our recently published article.1 He makes a few points that I will comment on.
He mentions that the risk of survivorship of resurfacing in patients with sickle cell disease may not be as reliable as in other sources of avascular necrosis. This may be true, but we were unable to comment on this in our paper because none of our patients had sickle cell disease. We have no experience with resurfacing in that patient subgroup.
He also states accurately that hemiresurfacing is an unpredictable operation with ⅔ of the patients being satisfied at relatively short-term followup. I, of course, agree with this statement and we emphasize this in the last sentence of the Abstract, and in the concluding paragraph of the paper, where we wrote, “the real issue is how unpredictable a procedure are a surgeon and patient willing to accept to avoid a bearing surface.”1 We also stated earlier in that paragraph that the results are somewhat unpredictable and that patients must be advised of this preoperatively.
I disagree with the last paragraph of Dr. Kose’s letter that states we should concentrate on performing total hip arthroplasty, which has a much higher incidence of survival compared with resurfacing procedures. Many of these patients are teenagers or in their 20s (the youngest patient in this series was 12). If there is any chance of a successful operation in a young adolescent or a young man or woman in their 20s or 30s, a bearing surface should be avoided, especially if the operation does not compromise a future arthroplasty.
Although this operation is unpredictable, I think that if patients are advised appropriately, the unpredictability of this operation in the very young patient outweighs the negatives of a total hip arthroplasty that commits that patient to particulate debris for the remainder of his or her life. We continue to offer this operation to very young patients with large collapsed lesions that are not amenable to osteotomy or other joint salvage procedures. We advise the patients and their families of its unpredictability, and if they are unwilling to accept that unpredictability, then alternative treatment is given.
Again, I appreciate Dr. Kose’s comments.
Robert T. Trousdale, MD
Department of Orthopaedic Surgery
1. Adili A, Trousdale RT: Femoral head resurfacing for the treatment of osteonecrosis in the young patient. Clin Orthop 417:93–101, 2003.