Interventions for Improving Hip Resurfacing Outcomes in Women: A High-Volume, Retrospective Study

Abstract Background Women seeking surgical intervention for their hip disorders will often find total hip arthroplasty presented as their only option. Total hip arthroplasty, when compared with hip resurfacing arthroplasty, removes substantially more bone-stock, limits range-of-motion, exhibits increased dislocation risk, and presents greater overall 10-year mortality rate. Despite these risks, most surgeons continue to select against women for hip resurfacing because registries notoriously report inferior survivorship when compared to men and total hip arthroplasty. Methods We investigated the reasons for why resurfacing arthroplasty devices survive poorly in females to develop interventions which might improve hip resurfacing outcomes in women. Using these findings, we developed a series of surgical interventions to treat the underlying issues. Herein, we compare two study groups: women that received hip resurfacings before (Group 1) and after (Group 2) these interventions. Results Eight-year implant survivorship substantially improved from 89.6% for Group 1 to 97.7% for Group 2. Adverse-wear related failure, femoral component loosening, and acetabular component loosening were all significantly reduced in Group 2, which we attribute to the implementation of our relative acetabular inclination limit guidelines, use of uncemented femoral fixation, and selection of the Tri-Spike acetabular component for supplemental fixation, respectively. Kaplan-Meier implant survivorship curves, grouped into 2-year time intervals, show that the disparity in failure rates between men and women is diminishing. Conclusion When experienced surgeons use refined and proper surgical technique, women show promise as excellent candidates for hip resurfacing as an alternative treatment for their debilitating hip conditions.