Letters to the Editor
To the Editor:
Resurfacing arthroplasty, popular in the 1980s for treatment of coxarthrosis but largely abandoned owing to discouraging results, is again being considered with new refinements. Although clearly an alternative to primary total hip arthroplasty, especially in young patients as reported by Adili and Trousdale,1 this method of surgery should be preserved for carefully selected patients. There are reports showing early failure of replacement surgery in patients with sickle cell disease.2,3 Therefore, this kind of avascular necrosis should not be an indication. Adili and Trousdale also reported that survivorship (27.6% failures in a mean of 18 months) and patient satisfaction (62%) are not predictable. Thinking of long-term survivorship of the implant involves acetabular complications, just as in unipolar endoprostheses.2
Although revision of failed resurfacing is a relatively simple procedure (when compared with revision of primary total hip arthroplasty), the previous surgery will add to the risk of infection during conversion to primary total hip arthroplasty.
I think that causes of early failure should be investigated, and if there is a risk of early failure in resurfacing procedures, then total hip arthroplasty should be considered because it has a much higher incidence of survival.
K. Cagri Kose
Department of Orthopaedics and Traumatology
Ankara University Faculty of Medicine
1. Adili A, Trousdale RT: Femoral head resurfacing for the treatment of osteonecrosis in the young patient. Clin Orthop 417:93–101, 2003.
2. Berend KR, Lilly EG: Early acetabular protrusion following hemiresurfacing of the hip for osteonecrosis in sickle cell disease. J South Orthop Assoc 1:32–37, 2003.
3. Nelson CL, Walz BH, Gruenwald JM: Resurfacing of only the femoral head for osteonecrosis: Long-term follow-up study. J Arthroplasty 7:736–740, 1997.