How a New System Is Transforming Hip Resurfacing Surgery

Hip resurfacing surgery offers several potential benefits over total hip arthroplasty (THA), including more natural biomechanics and a lower risk of dislocation, making it especially beneficial for younger, and more active patients, such as professional or high-performance athletes.

While most surgeons utilize a metal-on-metal implant, its bearing surface introduces some risk of excessive metal wear debris, which can lead to pain, inflammation, and bone loss.

An innovative metal-on-polyethylene implant offers the same advantages of a traditional hip resurfacing system, but without a metal-on-metal articulating surface.

A multisite Investigational Device Exemption (IDE) study is ongoing to evaluate the safety and clinical effectiveness of the system in patients with severe hip arthritis. William Macaulay, MD, chief of the Division of Adult Reconstructive Surgery at NYU Langone Health, and orthopedic surgeons Scott E. Marwin, MD, and Matthew Hepinstall, MD, are co-investigators on the study.

“This polyethylene system is a potential game-changer for select highly active patients with severe hip arthritis,” says Dr. Macaulay.

Decades in the Making

Hip resurfacing surgery emerged as an alternative to THA almost two decades ago. While it’s not appropriate for all patients, there is potential for better functional outcomes compared to THA.

“Hip resurfacing patients have historically functioned at a slightly higher level than those with modern THAs,” says Dr. Macaulay. “Most patients can return to full, unrestricted physical activity, including contact sports and running.”

According to Dr. Macaulay, prominent athletes including tennis player Andy Murray and hockey player Patrick Kane returned to professional-level sports soon after undergoing hip resurfacing surgery. This is partly explained by the fact that hip resurfacing has the lowest dislocation potential of all types of hip replacements.

“It’s a great option for professional or elite athletes,” says Dr. Macaulay. “Some patients have made cross-country trips for the surgery.”

Testing the System

The IDE study of the metal-on-polyethylene system is being conducted at nine orthopedic surgery centers across the country and one international site in Bermuda. At present, NYU Langone is the only participating site in the northeast.

The ongoing trial is open to healthy men and women with severe hip arthritis. To be eligible, participants must be under 65 years of age and have no other significant comorbidities. The study aims to recruit 238 participants, each of whom will be followed for two years.

“The ideal candidate is a young active adult with severe hip joint degeneration who wants to remain active,” he explains. “Good examples are surfers, tennis players, yoga instructors, and rock climbers.”

As a national leader in hip resurfacing surgery, Dr. Macaulay anticipates that NYU Langone will be the primary surgical training center for the metal-on-polyethylene system.

“Resurfacing is a technically demanding surgery,” he notes. “Historically, there has been a lack of proper education on how to use the system. We want to change that.”

Future Directions

Dr. Macaulay says that longer follow-up is needed to make any decision on the long-term safety and clinical effectiveness of the implant. However, the short-term findings, as well as prior studies conducted outside the U.S., suggest a multitude of benefits over traditional hip replacement surgery.

If these results hold up, he explains, the metal-on-polyethylene system could become widely commercially available as early as 2027.

“The study is not finished,” Dr. Macaulay says. “If the trial is positive, the device could hit the market by 2027 or 2028.”