The Journal of Bone and Joint Surgery. British volumeVol. 87-B, No. 2 CorrespondenceFree AccessResurfacing arthroplasty of the hipH. HAMILTONH. HAMILTONPort Arthur Clinic, Ontario, Canada.Search for more papers by this authorPublished Online:1 Feb 2005https://doi.org/10.1302/0301-620X.87B2.0870278AboutSectionsPDF/EPUB ToolsDownload CitationsTrack CitationsPermissionsAdd to Favourites ShareShare onFacebookTwitterLinked InRedditEmail Sir,We read with interest the editorial by Villar1 in the March 2004 issue entitled ‘Resurfacing arthroplasty of the hip’.In it he states that “What is of no doubt however, is that metal-on-metal hip resurfacing arthroplasty has a part to play in modern orthopaedic surgery and that the change from a metal-on-polyethylene design was for the better”. Based on small studies of four or less years duration, with or without roentgen stereophotogram-metric analysis, this is a bold statement.Charnley’s resurfacing operation used polytetrafluorethylene and not polyethylene. Charnley was so disenchanted with the procedure that he added an Appendix B to his book entitled “Low friction arthroplasty of the hip”2 to try to discourage the resurfacing fad of the 1970s and 1980s. Perhaps those attracted to the ‘new resurfacing’ should read this appendix.In 1995, Murray, Carr and Bulstrode3 posed the question, “Which primary total hip replacement”? and warned, “If clinical results are not available, a new implant should only be used if it is included in a properly conducted clinical trial”. I question the wisdom of an editorial that in any way suggests a less cautious approach. References 1 Villar R. Resurfacing arthroplasty of the hip. J Bone Joint Surg [Br] 2004;86-B:157–8. Link, Google Scholar2 Charnley J. Low friction arthroplasty of the hip: theory and practice. Berlin: Springer-Verlag, 1979:357–8. Google Scholar3 Murray DW, Carr AJ, Bulstrode CJ. Which primary total hip replacement? J Bone Joint Surg [Br] 1995;77-B:520–7. Link, Google ScholarbjjxThe Journal of Bone and Joint Surgery. British volumeJ Bone Joint Surg Br0301-620XThe British Editorial Society of Bone and Joint Surgery10.1302/0301-620X.87B2.0870278Author’s replyVILLAR R. N. FRCSCambridge Hip and Knee Unit, Cambridge, UK.22005February 1, 2005Sir,I am most grateful to Mr Hamilton for his comments. He is correct in stating that Charnley’s resurfacing used polytetrafluorethylene and not polyethylene and I apologise for this error. Murray, Carr and Bulstrode’s warning in 19951 about using new implants without properly conducted clinical trials remains true. However, in the same paper they state “we do not believe that surgeons should be forced to use only established implants; this might prevent the development of new implants that in the long term will have superior results”. And Murray was indeed a co-author of the recent paper entitled ‘Roentgen stereophotogrammetric analysis of the Birmingham hip resurfacing arthroplasty’2 which described satisfactory stability of the femoral component.The editorial reflected my view that the results of resurfacing arthroplasty allow for cautious optimism although there clearly, as indicated, remain many unanswered questions. The current models represent a considerable improvement on previous designs and the change from metal-on-polyethylene to metal-on-metal seems to have many advantages.1. Murray DW, Carr AJ, Bulstrode CJ. Which primary total hip replacement? J Bone Joint Surg [Br] 1995;77-B:520–7. Link, Google Scholar2. Glyn-Jones S, Gill HS, McLardy-Smith P, Murray DW. Roentgen stereophotogrammetric analysis of the Birmingham hip resurfacing arthroplasty. J Bone Joint Surg [Br] 2004;86-B:172–6. Link, Google ScholarFiguresReferencesRelatedDetails Vol. 87-B, No. 2 Metrics Downloaded 115 times History Published online 1 February 2005 Published in print 1 February 2005 InformationCopyright © 2005, The British Editorial Society of Bone and Joint Surgery: All rights reservedPDF download