Hip resurfacing: principles, indications, techniques and results

Abstract

The Journal of Bone and Joint Surgery. British volumeVol. 91-B, No. 8 Book ReviewsFree AccessHip resurfacing: principles, indications, techniques and results Edited by H. C. Amstutz Pp. 258. Philadelphia: Saunders, Elsevier, 2008. ISBN: 978-1-4160-4724-7. £149.00C. KriklerC. KriklerSearch for more papers by this authorPublished Online:1 Aug 2009https://doi.org/10.1302/0301-620X.91B8.0911123AboutSectionsPDF/EPUB ToolsDownload CitationsTrack CitationsPermissionsAdd to Favourites ShareShare onFacebookTwitterLinked InRedditEmail Orthopaedic surgeons started to resurface the hip in the 1930s, but it is only within the last decade that hip resurfacing has become widely accepted within the hip arthroplasty community. Figures from the United Kingdom National Joint Register show that over the last five years, the concept has been employed in a little over 10% of hip arthroplasties in the United Kingdom. The author has probably been involved in the evolution of hip resurfacing for longer than any surgeon still in practice, having started with his THARIES metal-on-polyethylene resurfacing system in 1975. He turned to metal-on-metal bearings in the late 1980s, and this led to the introduction of the Conserve Plus system in 1996. It is therefore fitting that he should now produce a textbook on the subject.The book starts with a fascinating introduction into the history and evolution of hip resurfacing, though it is surprising that Philip Wiles’ hip, implanted from 1936 in London, has not been included. The basic science is well covered, with chapters on femoral head blood supply, mechanics, tribology and imaging. A particularly important chapter on outcome studies follows; the UCLA hip scoring system is described in detail, as is the SF-12, and the authors’ own surgery form. Gruen’s radiographic follow-up form is also presented. Other scoring systems which are widely used, such as the Harris and the Oxford, are not mentioned. The chapter on surgical technique is very specifically Amstutz’s own philosophy, describing his posterior approach and the Conserve instrumentation. There is no mention of the rationale behind other approaches, such as the Hardinge or Ganz techniques which may be less dangerous to the blood supply of the femoral head. These should at least be mentioned, even if not covered in detail.The chapter on surgical technique is followed by chapters on indications, results of the Conserve Plus, modes of failure, and reaction to wear products. This last chapter does mention the literature on hypersensitivity reactions, but does not discuss the more recent reports of pseudotumours. Finally, there are several chapters on the various aetiologies of hip disease in the young and the role of resurfacing in these conditions. It is often suggested that inflammatory arthritis is a contraindication to resurfacing, but this has not been my own experience and I was pleased to see that Amstutz supports resurfacing in this group. The last few chapters address assessment and management of the ‘failed resurfacing’. Groin pain has been described in some patients, but this is not mentioned here. The penultimate chapter is entitled ‘Rehabilitation and Activity’. This is not a guide to therapists, but a brief report of the activity levels enjoyed by some patients after hip resurfacing, and could have been included in the outcomes chapter. The last chapter consists of the authors own views of the future.The production standard of the book is high, with many illustrations. A CD ROM is included which contains a video of the surgical technique, the Wright Medical operative technique video for the Conserve instrumentation, and five patients demonstrating how successful the results can be. Overall this is a useful book, although it is a rather personal account of the experience of a single group under the leadership of the author. I am still awaiting the definitive book on resurfacing which will cover all the designs and philosophies from the various groups involved around the world, and some attempt at a dispassionate, long-term comprehensive review.FiguresReferencesRelatedDetails Vol. 91-B, No. 8 Metrics History Published online 1 August 2009 Published in print 1 August 2009 InformationCopyright © 2009, The British Editorial Society of Bone and Joint Surgery: All rights reservedPDF download