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Is there value in bone preservation?
Many patients just don’t like that their entire femoral head is amputated with a THR when it can mostly be preserved with a hip resurfacing.
From a non-emotional standpoint, it only matters if a revision is required. Therefore, this benefit is more important the younger you are. In patients under 50, THR has a 20% ten-year and 50% 20-year failure rate according to joint registry benchmarks which measure average surgeon outcomes. In the typical THR patient with a mean age of 70, the 10-year failure rate is only 5% in major joint registries. Therefore, the younger you are the more likely you need one or more revision surgeries in your lifetime.
Exactly what needs to be replaced in a revision depends on the failure mode. If only the socket needs to be done, then the amount of additional bone loss in revision is the same for a failed THR or Hip resurfacing. However, revision on the femoral side is much more involved if a THR stem needs to be removed. Often the top third of the femur needs to be split in half to extract the femoral stem.
If a resurfacing femoral component fails, cutting it off at the neck is the same that is done for a primary THR.
Hip resurfacing is less likely to require revision, and more femoral bone is retained to facilitate the revision surgery if it is required. Therefore, the younger the patient is, the greater the advantage to have a primary hip resurfacing.