(0.1% HRA, 0.7% THR)

In Hip resurfacing, the femoral neck may fracture during the first 6 months of healing. I have never seen it occur thereafter, even with significant falls. The femoral head can gradually collapse within the first year. Both of these problems combined are called early femoral failure. When I first started doing resurfacing my rate was about 2.5%. We have extensively studied this problem and found a solution. These fractures are related to weak bone and excessive patient weight. We now always measure bone density before surgery with a DEXA scan.

Patients with weak bone or BMI >30 are paced on crutches longer and/or are prescribed a bone strengthening medicine for 6 months. Using this protocol, we have reduced the early femoral failure rate to 0.1% in the last 1000 cases. These fractures can occur gradually as a stress fracture due to early over activity, or from a minor fall during the first 6 months after surgery. If this occurs, we need to revise the femoral side to a stemmed THR.

Femoral trochanteric and shaft fractures occur after stemmed THR. The reported rate is 0.7% in one major study. At this moment I cannot quote my personal rate because we are still compiling the data. Trochanteric fractures are repaired with a clamp, while shaft fractures usually require revision to a longer stem plus cables. We have not studied bone-strengthening agents in THR patients.