"Women are not good candidates for hip resurfacing."

Women are excellent candidates and have the same outcome as men. Most hip resurfacing surgeons and Smith-Nephew Richards (SNR - manufacturer of the dominant BHR implant) discriminate against women because past data showed that hip resurfacing durability was less in women. In various studies, women had higher failure rates due to fracture, metallosis, and cup loosening. Femoral loosening was also a problem seen in older women with weak bones.

In my earliest cases, I had a higher failure rate in women compared to men due to metallosis and cup loosening. One of the major contributing causes was that young women desiring hip resurfacing had a much higher rate of dysplasia diagnosis than young men or older patients. It is well known that dysplasia also carries a worse outcome with THR.

Although younger women had more failures with hip resurfacing than men, they still had fewer failures than if they had a THR instead. Therefore, the common recommendation to avoid women in hip resurfacing made no sense to me. Additionally, hip resurfacing allows better functional outcomes than THR. Therefore, a woman should be allowed to choose between hip resurfacing and a THR even if the hip resurfacing had a higher failure rate. Durability and function are two separate factors that a patient has a right to consider.

I never agreed with most other hip resurfacing surgeons on this issue and continued to offer hip resurfacing to women. I was able to do so because the Zimmer Biomet Magnum/Recap implant that I use has remained available in all sizes, while SNR withdrew the smaller sizes required for women and also placed a warning on the label which made it legally hazardous for surgeons to implant women even if they happened to have a larger joint. Meanwhile, I worked to modify the hip resurfacing procedure to lower the failure rate in women.

In the last 10 years, my outcomes have improved substantially from 89% to 99% overall 10-year implant survivorship. The results in men improved, but they improved even more in women; this finally closed the gap 10 years ago. This means, for the last 10 years, I have achieved better durability with hip resurfacing than all THR types for both men and women equally.

Women can have a highly functional, stable hip resurfacing, with the same low failure risk as men.