Ceramic Hip Resurfacing

For more information, see also Hip Resurfacing and Hip Replacement.

What is Hip Resurfacing ?

Hip resurfacing an alternative to conventional Total Hip Replacement, used for the surgical management of established hip osteoarthritis. Hip resurfacing utilises a bone preserving prosthetic implant with exceptional wear, impact and dislocation resistance and is commonly recommended in younger and higher activity demand people who are experiencing symptoms that are not adequately controlled by non surgical therapies.

Hip resurfacing traditionally employs cobalt chromium alloy metal implants. Metal resurfacing devices have been used very sucessfully for greater than 20 years for the management of hip osteoarthritis. The results of metal hip resurfacing are exceptional, but only in appropriately selected candidates who meet strict suitability criteria. Generally, the best results for metal hip resurfacing are observed in people who demonstrate suitable bone density, size and shape. Metal hip resurfacing devices are therefore most commonly used in younger and higher activity demand male patients. 

What is Ceramic Hip Resurfacing ?

Ceramic hip resurfacing is where the resurfacing prostheses are manufactured from ceramic materials rather than a cobalt alloy metal. The ReCerf ceramic hip resurfacing (manufactured by MatOrtho) is very similar to the Adept metal hip resurfacing (also manufactured by MatOrtho), with the main exception being the material from which the implant is manufactured. The technique of implantation, the surgical procedure and recovery protocols are identical. From a surgeon's perspective, the operative technique and instruments used for the conduct of ceramic or metal hip resurfacing procedures are essentially identical.

Why consider Ceramic Hip Resurfacing ?

Although metal hip resurfacing has excellent outcomes, metal resurfacing implants are not suitable for many people. In particular, this relates to people with smaller sized hip joints, who do not meet the strict criteria applied for the safe use of metal hip resurfacing. For example, female hip joints are often too small for metal hip resurfacing devices and higher rates of metal allergy reactions are observed. Most women therefore do not meet the criteria for the safe use of metal hip resurfacing. For people who may benefit from a bone preserving implant design but are unsuitable for metal hip resurfacing, ceramic hip resurfacing is an alternative.

Ceramic hip resurfacing will not cause cobalt related metal allergy reactions. In suitably selected patients these reactions occur at a rate of approximately 0.5% with traditional metal hip resurfacing devices. Some people are however at much higher risk of metal allergy reactions and may therefore consider ceramic resurfacing technology.

If you meet the criteria for management with metal hip resurfacing, management with metal hip resurfacing implants may be recommended as the outcomes obtained from these devices are proven with a track record of well established outcomes.

What are the alternatives to Ceramic Hip Resurfacing ?

If your hip arthritis requires management by joint replacement surgery, the alternatives to ceramic hip resurfacing include conventional total hip replacement or metal hip resurfacing. Each of these methods have specific benefits and risks. The decision relating which implant is recommended depends on a number of factors. Your suitability for a particular procedure or prosthetic design will be evaluated and discussed as part of your clinic appointment.

What are the disadvantages of Ceramic Hip Resurfacing ?

As ceramic hip resurfacing has been introduced into clinical practice relatively recently, the clinical longer term outcomes are not yet documented. Whilst the ceramic material used for manufacturing the prosthesis (Biolox Delta) has been extensively used over a very long period of time with demonstrated exceptional wear and impact resistance in conventional total hip replacement applications, ceramics materials in hip resurfacing applications have not yet been proven. Extensive pre-clinical testing of the ReCerf ceramic hip resurfacing has however demonstrated favourable strength and wear resistance. The clinical performance of the ReCerf ceramic hip resurfacing is currently under evaluation within an international multicentre clinical study. The first ReCerf ceramic hip resurfacing was conducted in late 2018. Thus far the results are favourable, however it generally takes 10 years of follow-up data to be entirely confident with the clinical performance of a prosthetic implant.

At present many Australian health insurers do not provide rebates for ceramic resurfacing implants even if you have coverage for hip replacement (item code 49318). Whilst these health insurers may still assist with the costs associated with your hospital admission and your operating theatre fees, the prosthetic implant itself may not be covered by your premium. 

Figure: Example prosthesis designs for use in hip surgery. Left: Metal hip resurfacing. Centre: Ceramic conventional total hip replacement. Right: Ceramic hip resurfacing. Ceramic hip resurfacing is similar in design to traditional metal hip resurfacing however the implant is manufactured from the ceramic commonly used in many conventional total hip replacements.

This information has been written by A/Prof Patrick Weinrauch for the purposes of patient education. The details provided are of general nature only and do not substitute for professional recommendations based on an individual clinical assessment. © A/Prof Patrick Weinrauch. Brisbane Hip Clinic.