A middle aged man approached us for revision of his failed ASR Hip resurfacing done elsewhere. This has happened within one and half years of the index hip resurfacing. He had approached me also earlier for a hip procedure. I told him that he was not a suitable candidate for hip resurfacing as the anatomy was abnormal from Perthes disease. However he was adamant and consulted another surgeon in the city. This surgeon performed a hip resurfacing ignoring all the relative contra-indications.
The hip affected by Perthes disease had a large head diameter(coxa magna) with a large head neck ratio. This will lead to a large dia acetabulum with increased bone loss from the acetabulum and an oversized femoral component which can only be fitted with an excess cement mantle. This will lead to early loosening Case selection in hip resurfacing is of vital importance as illustrated here.
A Hip resurfacing is bound to fail if it is done for the wrong indication. As one can see from the post op x rays, the neck is short. Size of the resurfacing cup and head are huge and improperly aligned. This has lead to edge loading and probably increased metal ion concentration in the blood and metal reaction in the hip joint. There is also bone resorption in the inferior or bottom part of the neck.
Hip resurfacing will fail early as in this case by poor patient selection.
Failed hip resurfacing x ray
