This clinical case aims to explore the evolution of hip resurfacing techniques and the approach to revision surgery in the context of major bone loss, illustrated by the case of a 56-year-old man with a history of bilateral hip resurfacing, presenting with suspected occupational chromium poisoning.
Professor Reina is Head of Hip and Trauma department, of the University Hospital in Toulouse, France. He holds a PhD in Anthropobiology. He completed a fellowship in Oxford, UK and worked in Mayo Clinic, Rochester for research.
His main focus is hip & pelvis surgery. His clinical practice comprises conservative surgery, primary and complex revision total hip arthroplasty as well as trauma for complex acetabular fractures.
Board member of French Hip Knee Surgery, he is also member of the European Hip Society and the International Board of the American Association of Hip Knee Surgeons. He published more than 150 peer reviewed publications and book chapters, and lectured in various international conferences. His research interests integrate big data in orthopedics, modern care in hip surgery such as minimally invasive techniques, and musculoskeletal system’s ability to adapt to its environment (biomechanics and anthropological variability).
- 56 Y.O male
- Bilateral hip resurfacing (right side 2011, left side 2012)
- Completely asymptomatic, was still skiing last winter
- Referred because of a suspicion of professional chromium intoxication based on urine biology results
- On physical examination, he doesn’t complain of pain, and shows normal hip mobility
Imagery
What complication is found in this patient?
- ✔️Osteolysis reaction to metal debris released from the metal-on-metal bearing (pseudotumor)
What classification allows us to classify this pathology and what is its grade?
- ✔️Paprosky classification grade 3B
Is there still a place for resurfacing?
- ✔️Yes
Despite its decline in popularity, hip resurfacing continues to hold value in specific clinical scenarios. It remains a viable option for young, active male patients with good bone quality and adequate femoral head size (typically >50 mm), where bone preservation and a lower risk of dislocation are priorities. Resurfacing offers advantages such as the retention of more native bone, a more natural gait, and easier future revision. However, strict patient selection is essential due to the risks associated with metal-on-metal implants. Advances in implant design and material monitoring protocols have helped reduce complication rates in this subgroup, keeping resurfacing as a niche but useful technique in modern orthopedic practice.
A 10-year survival rate of 95.5% for hip resurfacing has been reported and substantial improvement in survivorship is expected by the introduction of modern bearings in hip resurfacing (Ceramics, cross-linked polyethylene)
Molloy J, Handford C, Coolican J, Molloy T, Walter W. Long-Term Outcomes of Birmingham Hip Resurfacing Arthroplasty: A Systematic Review of Independent Series with At Least 10 Years of Follow-up. JB JS Open Access. 2024 Mar 25;9(1):e23.00057. doi: 10.2106/JBJS.OA.23.00057. PMID: 38529209; PMCID: PMC10959564.
Fong S, Shah AK, Hecht CJ, Kamath AF. What is the long-term survivorship, complication profile, and patient reported outcomes after Birmingham hip resurfacing? J Orthop. 2024 Apr 16;55:134-148. doi: 10.1016/j.jor.2024.04.016. PMID: 38706587; PMCID: PMC11063114.
In this case, we decided to perform a revision implanting a custom-made 3D implant (ADLER) in order to compensate the bone defect, with a dual mobility cemented cup. The femoral part was managed by the implantation of a short stem (Optymis, MATHYS)
