Historical Review

The history of hip resurfacing has previously been described in the literature [1-3], and the recent success of the procedure came after a long evolution driven by the need to find a viable conservative prosthetic solution for young and active patients with end-stage arthritis. The origin of hip resurfacing is commonly attributed to Smith-Petersen [4], who was followed by subsequent designs referred to as "double cups" in which the joint bearing was replaced by two adjacent congruent surfaces sliding against each other. The popularity of the concept led to the development of numerous designs worldwide [5-13].

1 Joint Replacement Institute at Orthopaedic Hospital, 2400 South Flower Street, Los Angeles, CA 90007, USA

2 Los Angeles Children's Hospital, Los Angeles, CA, USA

The poor mid- and long-term performance of these early resurfacing designs nearly led to the demise of the concept itself when, in fact, technological factors such as the lack of adequate component fixation and particularly the metal-on-polyethylene bearing materials were causing rapid failure rates [14,15]. However, the resurfacing concept was kept alive in a few centers because of the results of hemiresurfacing fixed with acrylic, in which aseptic loosening of the device has not been observed in 25 years of experience in the senior author's series [16,17]. This observation originated the idea that a low-wear metal-on-metal (MOM) bearing material was the likely key to the success of total resurfacing.

The need to accommodate a femoral head of a large diameter led to the choice of cobalt-chromium-molybdenum, which combined low wear and strength with a reduced thickness, for the acetabular component, so that the procedure became bone conserving for the acetabulum as well as for the femoral head and neck. Currently, only metallic devices can be manufactured with thin-walled one-piece cementless sockets and excellent wear properties, especially for large femoral heads [18,19], making MOM the bearing of choice for resurfacing.

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