Highest Published Success Rate in the World
for Hip Resurfacing

99% 17-year survivorship for Hip Resurfacing

• no differences by age, sex, and underlying diagnosis in the last 10 years
• over 5500 cases (Recap /Magnum minimum follow up 2 years)

97% 18-year survivorship for Metal-on-Metal Total Hip Replacement

I joined Midlands Orthopaedics in Columbia, South Carolina in 1994. My practice includes:

• Hip resurfacing
• Revision of failed hip resurfacing
• Outpatient joint replacement
• Unicompartmental (partial) knee replacement
• Large-bearing dual mobility hip replacements
• Uncemented total knee replacement
• Revision of failed hip and knee replacements

I lead the nation in hip resurfacing. I began performing metal-on-metal total hip resurfacing arthroplasty (HRA) in 1999. With the retirement of Dr. Harlan Amstutz, I now have the second (to James Pritchett in Seattle) longest track record of performing this operation in the United States. I have performed over 7000 HRA, which is the second-largest series in the world (to Ronan Treacy in Birmingham England).

In the rare case where patients are not resurfacing candidates, I perform large-bearing dual mobility total hip replacements (THR). My published track record is one of the best in the world. In unselected patient series of hip resurfacing, we have twenty-year implant survivorship of 84% with the Corin Hybrid system, 95% 17-year implant survivorship with the Biomet Hybrid system, and most recently 99% 15-year survivorship with the uncemented Biomet system in peer-reviewed scientific journals. Currently, 15-year survivorship is 99% in men and 98% in women.

For our large metal bearing total hips, survivorship is 98% at 18 years, however, this implant is no longer available and has been substituted with a ceramic/plastic/cobalt chrome dual mobility large bearing. Long-term data is not yet available for this implant.

I have pioneered many advances in hip resurfacing:

• The world’s first fully porous uncemented resurfacing components
• Prevention of early femoral failures (current rate of 0.15%)
• Elimination of acetabular fixation failures in dysplasia (none since 2007)
• The world’s only scientifically robust guideline for acetabular component positioning
• Intraoperative X-ray technique for achieving an accurate acetabular component position
• Elimination of adverse wear failures (pseudotumors) (none in hips done since 2009)
• Minimally invasive posterior approach (4inch incision)
• Outpatient surgery (no hospital stay)
• Successful revision surgery for hip resurfacing (96% 6-year survivorship)

Hip resurfacing is the best solution for near-normal reconstruction of the hip joint in severe arthritis. It is more complex to perform than standard hip replacement. Many excellent hip replacement surgeons have become interested in hip resurfacing in the last 10 years but have given up performing this operation because they encountered too many complications. This has led many experts to claim that “hip resurfacing does not work”. But a number of surgeons worldwide have been able to show superior results with HRA as compared to THR. Currently, there are probably less than 10 surgeons in the US who continue to perform significant numbers of these cases with good results. If you are interested in the higher functional potential of this operation, be careful to choose your surgeon wisely.

I also perform knee replacement using the latest techniques. Uncemented femoral components, uncemented tibial components in young patients with strong bone, antioxidant stabilized cross-linked polyethylene tibial bearings, more stable medial congruent liners, and robotic guidance systems to optimize kinematic alignment. Partial knee replacements are also possible in certain patients with arthritis limited to one compartment of the knee. These are now also available as outpatient surgeries in selected young healthy patients.

Although I practice in South Carolina, most patients are from out of state and even from overseas. Typically, a few days stay in Columbia is required. We have perfected remote perioperative patient management. Typically, only the immediate preoperative, the first postoperative follow-up at 4-6 weeks, and the second follow-up at 1 year are done in Columbia. Long-term follow-up is recommended remotely and is supported through this website.

I developed the first fully uncemented hip resurfacing device with Biomet. I have been using it since 2007 with an excellent track record. I also developed the Biomet Magnum large metal bearing total hip replacement system, one of the few of this class that has a high success rate, but this implant is no longer available. I was the lead investigator of the first US FDA trial of hip resurfacing leading to approval of the Hybrid Corin Cormet 2000 device in 2007.

Hip resurfacing has the lowest failure rate of any type of hip reconstruction surgery. With only 1% failure cumulative by 17 years, this represents the best outcomes in the world. What is even more noteworthy is that this has been achieved in a much younger than average group of patients (mean age 54 compared to mean for THR of 70) that typically has a higher failure rate.

An additional 2% of patients are not satisfied with their hip resurfacing outcome. In THR, this number is also significantly higher. The source of dissatisfaction is not clear. These are patients who don’t have a recognized failure but are still not happy with their hip. We suspect that many of these are likely to have a back problem causing referred pain to the hip.

There are other measures of “good outcome” after hip surgery other than high long-term implant survivorship. Hip resurfacing mainly gives the patient a more normal artificial hip that more closely mimics the natural hip. The function is better, dislocation risk is lower, bone is preserved, and even all-cause 10-year mortality has been shown to be lower with a hip resurfacing than a THR.

Failures due to wear/corrosion no longer occur with hip resurfacing. Although surgeons who are not resurfacing experts still cite this as their main “concern” with resurfacing. I have had 1% failures by 17 years with resurfacing, but none of these have been due to excess wear (also called pseudotumor, ion problems, metallosis) since 2009. In hip resurfacing, we have demonstrated that excess wear occurs due to acetabular component malposition. This is completely avoidable with the correct surgical technique. Meanwhile, the rate of corrosion of the THR connector between the head and stem of the implant is not known (estimates: 0.1-5% of cases by 10 years). The cause is not known. In my experience, this failure mode is extremely damaging to the hip joint.

Therefore, I recommend HRA for virtually all patients with severely arthritic hips. I do not recommend any artificial joint for people who have severe pain but not enough damage on X-rays, because they are more likely to be dissatisfied with surgery.

I recommend THR if:

• bone loss or deformity around the hip is too severe.
• patients are convinced that they are allergic to certain metals (skin sensitivity to metals does occur in 20% of people, but in my opinion, internal metal allergy does not exist)
• the patient is too large (BMI>35) because the operation is too technically difficult
• the bone density is extremely bad and a patient is not willing to take medication for this

Updated 10/2022