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Gaillard-Campbell DM, Gross TP. Femoral Fixation Methods in Hip Resurfacing Arthroplasty: An 11-Year Retrospective Comparison of 4013 Cases. J Arthroplasty 2019; 34:2398-2405. [PMID: 31248712 DOI: 10.1016/j.arth.2019.05.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/29/2019] [Accepted: 05/29/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The optimal femoral fixation method remains unclear. To evaluate the role of femoral fixation techniques in hip resurfacing, we present a comparison of 2 consecutive groups: group 1 (739 hips) with cemented femoral components; group 2 (3274 hips) with uncemented femoral components. METHODS We retrospectively analyzed our clinical database to compare failures, reoperations, complications, clinical results, and radiographic measurements. Groups were consecutive, so cemented cases had longer follow-up. However, all patients from both groups were at least 2 years out from surgery. Two-year clinical and radiographic data were compared. Longer-term comparison data as well as Kaplan-Meier implant survivorship curves specifically focusing on femoral failure modes were analyzed. RESULTS Kaplan-Meier 10-year implant survivorship using nontraumatic femoral failure as an end point was 98.9% for the cemented and 100% for the uncemented femoral component. The uncemented, group 2 cases showed a significantly lower raw failure rate (1.1% vs 4.6%), 2-year failure rate (0.8% vs 2.8%), 2-year femoral failure rate (0.4% vs 0.9%), and a lower combined rate of femoral complications and failures (0.6% vs 1.8%). In cases that did not fail, patient mean clinical scores, pain scores, and combined range of motion were all significantly better for group 2. CONCLUSION We have demonstrated that in the fully porous-coated ReCap device, uncemented femoral fixation is superior to cemented fixation at 11 years follow-up (0.0% vs 1.1% late femoral loosening) in this single-surgeon cohort. Early femoral fractures also reduced from 0.8% to 0.3%, but this may be partially or completely due to a new bone density management program. This study demonstrates better femoral implant survivorship for the uncemented device compared to the cemented femoral resurfacing component for this implant design.
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Affiliation(s)
| | - Thomas P Gross
- Research Department, Midlands Orthopaedics & Neurosurgery, Columbia, SC
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Elbuluk A, Fiaes K, Benson JR, Su E. Computer-assisted Navigation in Hip Resurfacing Arthroplasty: A Case Study utilizing the ReCap Femoral Resurfacing System. J Orthop Case Rep 2019; 9:93-97. [PMID: 31559239 PMCID: PMC6742869 DOI: 10.13107/jocr.2250-0685.1440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: The ReCap Femoral Resurfacing System has been associated with increased cases of revision surgery when compared to other hip resurfacing systems. However, computer-assisted navigation may have the potential to reduce the risk of post-operative complications by providing more accurate intraoperative measurements for acetabular component positioning. Case Report: The present case describes an active 46-year-old male presenting with severe osteoarthritis of the right hip who elected to undergo a ReCap resurfacing arthroplasty with navigation. Results demonstrated accurate acetabular component position and leg length measurements to within <1° and 1mm of standard radiographic measurements. Conclusion: These findings are the first to describe the use of navigation with the ReCap system and provide encouraging results for further clinical evaluation.
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Affiliation(s)
- Ameer Elbuluk
- Department of Orthopaedics, Hospital for Special Surgery, New York, NY 10021, United States
| | - Karlina Fiaes
- Department of Health Studies, Faculty of Applied Health Sciences, School of Public Health and Health Systems University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
| | - Jessica R Benson
- Department of Clinical Research, Intellijoint Surgical, Inc., 809 Wellington Road North, Kitchener, ON, N2H 5L6, Canada
| | - Edwin Su
- Department of Orthopaedics, Hospital for Special Surgery, New York, NY 10021, United States
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Levadnyi I, Awrejcewicz J, Gubaua JE, Pereira JT. Numerical evaluation of bone remodelling and adaptation considering different hip prosthesis designs. Clin Biomech (Bristol, Avon) 2017; 50:122-129. [PMID: 29100185 DOI: 10.1016/j.clinbiomech.2017.10.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 10/12/2017] [Accepted: 10/17/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The change in mechanical properties of femoral cortical bone tissue surrounding the stem of the hip endoprosthesis is one of the causes of implant instability. We present an analysis used to determine the best conditions for long-term functioning of the bone-implant system, which will lead to improvement of treatment results. METHODS In the present paper, a finite element method coupled with a bone remodelling model is used to evaluate how different three-dimensional prosthesis models influence distribution of the density of bone tissue. The remodelling process begins after the density field is obtained from a computed tomography scan. Then, an isotropic Stanford model is employed to solve the bone remodelling process and verify bone tissue adaptation in relation to different prosthesis models. FINDINGS The study results show that the long-stem models tend not to transmit loads to proximal regions of bone, which causes the stress-shielding effect. Short stems or application in the calcar region provide a favourable environment for transfer of loads to the proximal region, which allows for maintenance of bone density and, in some cases, for a positive variation, which causes absence of the aseptic loosening of an implant. In the case of hip resurfacing, bone mineral density changes slightly and is closest to an intact femur. INTERPRETATION Installation of an implant modifies density distribution and stress field in the bone. Thus, bone tissue is stimulated in a different way than before total hip replacement, which evidences Wolff's law, according to which bone tissue adapts itself to the loads imposed on it. The results suggest that potential stress shielding in the proximal femur and cortical hypertrophy in the distal femur may, in part, be reduced through the use of shorter stems, instead of long ones, provided stem fixation is adequate.
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Affiliation(s)
- Ievgen Levadnyi
- Lodz University of Technology, Department of Automation, Biomechanics and Mechatronics, 1/15 Stefanowski Str., 90-924 Lodz, Poland
| | - Jan Awrejcewicz
- Lodz University of Technology, Department of Automation, Biomechanics and Mechatronics, 1/15 Stefanowski Str., 90-924 Lodz, Poland; Warsaw University of Technology, Institute of Vehicles, 84 Narbutta Str., 02-524 Warsaw, Poland.
| | - José Eduardo Gubaua
- Federal University of Paraná, Laboratory of Computational Solid Mechanics, Curitiba, Brazil
| | - Jucélio Tomás Pereira
- Federal University of Paraná, Laboratory of Computational Solid Mechanics, Curitiba, Brazil
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Abstract
BACKGROUND The hip resurfacing concept was developed for young and active patients, especially for femoral bone stock preservation. However, concerns about metal-on-metal bearings with adverse reactions to metal debris have led to a drop off in hip-resurfacing procedures. QUESTIONS/PURPOSES The goal of this review is to evaluate our current knowledge of survivorship of second-generation hip resurfacing devices and elaborate international perspectives for product improvement. METHODS A comprehensive literature search provided information on national joint arthroplasty registers worldwide with a minimum of 3000 reported hip resurfacings. It culminated in the analysis of six registers. RESULTS Long-term data showed that available hip resurfacing device survivorship ranged from 95 to 99.7% with 10 years of follow-up, in selected patient populations. The criteria for success were well known, male gender, good bone quality, head component size greater than 48 mm, and cup inclination less than 45°. On the other hand, the recent recall of some hip-resurfacing devices has resulted in huge medico-legal problems and has discredited all implants. It has brought about the recent evolution of hip resurfacing. Femoral fixation is now available for cemented and cementless surfaces. Bearings are still always metal-on-metal, but new types have come on board. Newer designs suggest that ceramic-on-ceramic, cross-linked polyethylene, and oxinium may be applied in this configuration. CONCLUSIONS In 2015, the evolution of hip resurfacing is ongoing in terms of implant design, alternative bearings, and implant fixation with hopes of improving survivorship.
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Affiliation(s)
- Julien Girard
- Service d’Orthopédie C, Hôpital Salengro, Centre Hospitalier Régional Universitaire de Lille and Université Lille Nord de France, Place de Verdun, F-59000 Lille, France
- Service d’Orthopédie C, CHRU de Lille, 2 Avenue Oscar Lambret, 59037 Lille Cedex, France
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5
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Tice A, Kim P, Dinh L, Ryu JJ, Beaulé PE. A randomised controlled trial of cemented and cementless femoral components for metal-on-metal hip resurfacing: a bone mineral density study. Bone Joint J 2016; 97-B:1608-14. [PMID: 26637673 DOI: 10.1302/0301-620x.97b12.36110] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The primary purpose of this study of metal-on-metal (MoM) hip resurfacing was to compare the effect of using a cementless or cemented femoral component on the subsequent bone mineral density (BMD) of the femoral neck. This was a single-centre, prospective, double-blinded control trial which randomised 120 patients (105 men and 15 women) with a mean age of 49.4 years (21 to 68) to receive either a cemented or cementless femoral component. Follow-up was to two years. Outcome measures included total and six-point region-of-interest BMD of the femoral neck, radiological measurements of acetabular inclination, neck-shaft and stem-shaft angles, and functional outcome scores including the Harris hip score, the Western Ontario and McMaster Universities Osteoarthritis Index and the University of California at Los Angeles activity scale. In total, 17 patients were lost to follow-up leaving 103 patients at two years. There were no revisions in the cementless group and three revisions (5%) in the cemented group (two because of hip pain and one for pseudotumour). The total BMD was significantly higher in the cementless group at six months (p < 0.001) and one year (p = 0.01) than in the cemented group, although there was a loss of statistical significance in the difference at two years (p = 0.155). All patient outcomes improved significantly: there were no significant differences between the two groups. The results show better preservation of femoral neck BMD with a cementless femoral component after two years of follow-up. Further investigation is needed to establish whether this translates into improved survivorship.
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Affiliation(s)
- A Tice
- University of Ottawa/The Ottawa Hospital, Ottawa, Ontario, Canada
| | - P Kim
- University of Ottawa/The Ottawa Hospital, Ottawa, Ontario, Canada
| | - L Dinh
- University of Ottawa/The Ottawa Hospital, Ottawa, Ontario, Canada
| | - J J Ryu
- University of Ottawa/The Ottawa Hospital, Ottawa, Ontario, Canada
| | - P E Beaulé
- University of Ottawa/The Ottawa Hospital, Ottawa, Ontario, Canada
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D'Elía NL, Mathieu C, Hoemann CD, Laiuppa JA, Santillán GE, Messina PV. Bone-repair properties of biodegradable hydroxyapatite nano-rod superstructures. NANOSCALE 2015; 7:18751-18762. [PMID: 26505580 DOI: 10.1039/c5nr04850h] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Nano-hydroxyapatite (nano-HAp) materials show an analogous chemical composition to the biogenic mineral components of calcified tissues and depending on their topography they may mimic the specific arrangement of the crystals in bone. In this work, we have evaluated the potential of four synthesized nano-HAp superstructures for the in vitro conditions of bone-repair. Experiments are underway to investigate the effects of the material microstructure, surface roughness and hydrophilicity on their osseo-integration, osteo-conduction and osteo-induction abilities. Materials were tested in the presence of both, rat primary osteoblasts and rabbit mesenchymal stem cells. The following aspects are discussed: (i) cytotoxicity and material degradation; (ii) rat osteoblast spreading, proliferation and differentiation; and (iii) rabbit mesenchymal stem cell adhesion on nano-HAp and nano-HAp/collagen type I coatings. We effectively prepared a material based on biomimetic HAp nano-rods displaying the appropriate surface topography, hydrophilicity and degradation properties to induce the in vitro desired cellular responses for bone bonding and healing. Cells seeded on the selected material readily attached, proliferated and differentiated, as confirmed by cell viability, mitochondrial metabolic activity, alkaline phosphatase (ALP) activity and cytoskeletal integrity analysis by immunofluorescence localization of alpha-smooth muscle actin (α-SMA) protein. These results highlight the influence of material's surface characteristics to determine their tissue regeneration potential and their future use in engineering osteogenic scaffolds for orthopedic implants.
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Affiliation(s)
- Noelia L D'Elía
- Department of Chemistry, Universidad Nacional del Sur, INQUISUR-CONICET, 8000 Bahía Blanca, Argentina.
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Gross TP, Liu F. Current status of modern fully porous coated metal-on-metal hip resurfacing arthroplasty. J Arthroplasty 2014; 29:181-5. [PMID: 23680504 DOI: 10.1016/j.arth.2013.04.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 03/22/2013] [Accepted: 04/12/2013] [Indexed: 02/01/2023] Open
Abstract
Between March 2007 and July 2010, 1000 consecutive fully porous coated hip resurfacing arthroplasties (HRA) were performed by a single surgeon in 871 patients. The average length of follow-up was 3 ± 1 years. Three cases (0.3%) in three patients showed adverse wear related failures. Another 17 (1.7%) failures were identified at the time of this study. Using any failure of any component as the endpoint, the survivorship rate was 98.8% at two years and 97.4% at five years. Excluding the failed cases, all components were radiographically stable; there was only one partial femoral radiolucency seen. The clinical and radiological outcomes of this fully porous coated hip resurfacing were comparable to, if not better than, those reported by others using hybrid fixation methods at five years post-operatively.
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Wang W, Geller JA, Hasija R, Choi JK, Jr. DAP, Macaulay W. Longitudinal evaluation of time related femoral neck narrowing after metal-on-metal hip resurfacing. World J Orthop 2013; 4:75-79. [PMID: 23610755 PMCID: PMC3631955 DOI: 10.5312/wjo.v4.i2.75] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 01/23/2013] [Accepted: 02/06/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To track the short-term neck narrowing changes in Birmingham metal-on-metal hip resurfacing (MOMHR) patients.
METHODS: Since 2001, the Center for Hip and Knee Replacement started a registry to prospectively collect data on hip and knee replacement patients. From June 2006 to October 2008, 139 MOMHR were performed at our center by two participate surgeons using Birmingham MOMHR prosthesis (Smith Nephew, United States). It is standard of care for patients to obtain low, anteriorposterior (LAP) pelvis radiographs immediately after MOMHR procedure and then at 3 mo, 1 year and 2 year follow up office visits. Inclusion criteria for the present study included patients who came back for follow up office visit at above mentioned time points and got LAP radiographs. Exclusion criteria include patients who missed more than two follow up time points and those with poor-quality X-rays. Two orthopaedic residency trained research fellows reviewed the X-rays independently at 4 time points, i.e., immediate after surgery, 3 mo, 1 year and 2 year. Neck-to-prosthesis ratio (NPR) was used as main outcome measure. Twenty cases were used as subjects to identify the reliability between two observers. An intraclass correlation coefficient at 0.8 was considered as satisfied. A paired t-test was used to evaluate the significant difference between different time points with P < 0.05 considered to be statistically significant.
RESULTS: The mean NPRs were 0.852 ± 0.056, 0.839 ± 0.052, 0.835 ± 0.051, 0.83 ± 0.04 immediately, 3 mo, 1 year and 2 years post-operatively respectively. At 3 mo, NPR was significantly different from immediate postoperative X-ray (P < 0.001). There was no difference between 3 mo and 1 year (P = 0.14) and 2 years (P = 0.53). Femoral neck narrowing (FNN) exceeding 10% of the diameter of the neck was observed in only 4 patients (5.6%) at two years follow up. None of these patients developed a femoral neck fracture (FNF).
CONCLUSION: Femoral neck narrowing after MOMHR occurred as early as 3 mo postoperatively, and stabilized thereafter. Excessive FNN was not common in patients within the first two years of surgery and was not correlated with risk of FNF.
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Nijman TH, Scholtes VA, de Meulemeester FRAJ, van der Hart CP, Poolman RW. Short-term functional outcome after hip resurfacing surgery. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 23:197-202. [PMID: 23412452 DOI: 10.1007/s00590-012-0946-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Accepted: 01/20/2012] [Indexed: 10/14/2022]
Abstract
Hip resurfacing arthroplasty is a popular method for treating late stage osteoarthritis, especially in young and active patients. Most studies presenting short-term follow-up after hip resurfacing present radiographic or dual clinician-patient-related outcome. These kinds of outcomes are influenced by interpretation of the clinician and do not tell us much about functional outcome from the patients perspective. Today, functional outcome is often measured using patient-reported outcome instruments. We used the patient-reported 'Hip Disability and osteoarthritis Outcome Score' questionnaire, which has good measurement properties, to assess short-term functional outcome in 160 patients (mean follow-up of 2.6 years) after hip resurfacing surgery. Furthermore, we focused on pain, range of motion, subjective improvement and complications. The majority (86.9%) of patients was free of pain after surgery and range of motion improved significantly. Subjective improvement was indicated in 95% of the patients. Mean HOOS in 149 patients was 87.5. In total, there were 11 complications (6%), and deep infections contributed the most (3.4%). In general, short-term follow-up after hip resurfacing in this cohort showed good clinical and patient-reported functional outcome. When assessing the results of medical interventions, a good PRO instrument can give reliable and valuable information from the patients perspective.
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Affiliation(s)
- Thomas H Nijman
- Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
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Caouette C, Bureau MN, Lavigne M, Vendittoli PA, Nuño N. A new interface element with progressive damage and osseointegration for modeling of interfaces in hip resurfacing. Proc Inst Mech Eng H 2013; 227:209-20. [DOI: 10.1177/0954411912471494] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Finite element models of orthopedic implants such as hip resurfacing femoral components usually rely on contact elements to model the load-bearing interfaces that connect bone, cement and implant. However, contact elements cannot simulate progressive degradation of bone–cement interfaces or osseointegration. A new interface element is developed to alleviate these shortcomings. This element is capable of simulating the nonlinear progression of bone–cement interface debonding or bone–implant interface osseointegration, based on mechanical stimuli in normal and tangential directions. The new element is applied to a hip resurfacing femoral component with a stem made of a novel biomimetic composite material. Three load cases are applied sequentially to simulate the 6-month period required for osseointegration of the stem. The effect of interdigitation depth of the bone–cement interface is found to be negligible, with only minor variations of micromotions. Numerical results show that the biomimetic stem progressively osseointegrates (α averages 0.7 on the stem surface, with spot-welds) and that bone–stem micromotions decrease below 10 µm. Osseointegration also changes the load path within the femoral bone: a decrease of 300 µε was observed in the femoral head, and the inferomedial part of the femoral neck showed a slight increase of 165 µε. There was also increased stress in the implant stem (from 7 to 11 MPa after osseointegration), indicating that part of the load is supported through the stem. The use of the new osseointegratable interface element has shown the osseointegration potential of the biomimetic stem. Its ability to model partially osseointegrated interfaces based on the mechanical conditions at the interface means that the new element could be used to study load transfer and osseointegration patterns on other models of uncemented hip resurfacing femoral components.
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Affiliation(s)
- Christiane Caouette
- Laboratoire de recherche en Imagerie et Orthopédie (LIO), Ecole de technologie supérieure, Montreal, QC, Canada
| | - Martin N Bureau
- Advanced Polymer Composites Group, National Research Council of Canada (NRC), Boucherville, QC, Canada
| | - Martin Lavigne
- Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, QC, Canada
| | | | - Natalia Nuño
- Laboratoire de recherche en Imagerie et Orthopédie (LIO), Ecole de technologie supérieure, Montreal, QC, Canada
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Illical E, Belanger H, Kim PR, Beaulé PE. Groin pain after metal on metal hip resurfacing: mid-term follow-up of a prospective cohort of patients. HSS J 2012; 8:257-61. [PMID: 24082869 PMCID: PMC3470668 DOI: 10.1007/s11420-012-9299-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 07/05/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE Groin pain after metal on metal hip resurfacing has been previously reported. The purpose of this study was to determine the natural history of a cohort of patients with groin pain after hip resurfacing previously reported on and incidence of revision surgery. METHODS Our group previously reported an 18% incidence of groin pain at a mean of 18 months post hip resurfacing. This cohort of groin pain patients was prospectively followed. Patients were evaluated using a visual analog pain rating score, the University of California at Los Angeles (UCLA) Physical Activity Index, and the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index. Functional outcome scores were compared from initial to latest follow up using the paired Student's t test. Further diagnostic evaluation and/or intervention or other complication was also recorded. RESULTS The latest mean follow up from surgery was 63 ± 15 months. The mean pain rating, UCLA, and WOMAC scores all improved at latest follow up, although WOMAC score improvement was not statistically significant. Mean pain rating score improved from 5.2 ± 2.0 to 2.5 ± 1.4 (p = 0.0001). UCLA activity score improved from 6.4 ± 2.0 to 6.9 ± 1.6 (p = 0.03). Total WOMAC score improved from 75.6 ± 20.5 to 84.5 ± 14.8 (p = 0.15). Only one patient was revised for an adverse local tissue reaction. CONCLUSION Groin pain post hip resurfacing has a multifactorial etiology, and in the vast majority of cases improves over time with no significant functional limitations. However, the surgeon should be aware of the many potential causes, and help minimize the possibility with proper patient selection and surgical technique.
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Affiliation(s)
- Emmanuel Illical
- Division of Orthopaedic Surgery, 501 Smyth Road, Room W1650, Ottawa, ON K1H 8L6 Canada
| | - Heather Belanger
- Division of Orthopaedic Surgery, 501 Smyth Road, Room W1650, Ottawa, ON K1H 8L6 Canada
| | - Paul R. Kim
- Division of Orthopaedic Surgery, 501 Smyth Road, Room W1650, Ottawa, ON K1H 8L6 Canada
| | - Paul E. Beaulé
- Division of Orthopaedic Surgery, 501 Smyth Road, Room W1650, Ottawa, ON K1H 8L6 Canada
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Abstract
BACKGROUND Metal-on-metal bearing with cemented femoral component and cementless acetabular fixation is the current standard in surface replacement arthroplasty (RSA) of the hip. Because of concerns about the long-term survivorship of cemented stems in conventional hip arthroplasty, it seems logical to achieve cementless fixation on the femoral side with RSA. QUESTIONS/PURPOSES The goals of this review were to evaluate clinical and radiological data reported from previously published cementless RSA series. In addition, we intend to review author's preliminary experience with Conserve Plus cementless devices specifically assessing the clinical outcomes, the complications rate, the survivorship, and the metallic ions levels measured in follow-up. METHODS A references search was done with PubMed using the key words "cementless hip resurfacing", "cementless hip resurfacing prosthesis", and "femoral cementless hip resurfacing". Additionally, the clinical outcomes, the complications rate, the survivorship, and the metallic ions levels were measured in 94 cementless Conserve Plus(©) devices in 90 patients (68 males and 22 females) with a mean age of 41.1 years (18-59). Mean follow-up was 13.1 months (8-16). RESULTS No revision was performed during the observed follow-up. Neither radiological signs of loosening nor neck narrowing >10% were evident. Chromium and cobalt levels in whole blood samples rose respectively from 0.53 μg/l (0.1-1.7) to 1.7 μg/l (0.6-2.9) and from 0.54 μg/l (0.1-1.4) to 1.98 μg/l (0.1-2.8). CONCLUSIONS Cementless "fit and fill" femoral-side fixation, which seems to be potentially evolved and design-related, should be considered for future hip-resurfacing device generations.
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Affiliation(s)
- Julien Girard
- Department of Orthopaedic Surgery, Roger Salengro Hospital, University of Lille, 2 avenue Oscar Lambret, Lille, France
- Department of Sports Medicine, University of Lille 2, Lille cedex, 59037 France
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13
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Gross TP, Liu F. Hip resurfacing with the Biomet Hybrid ReCap-Magnum system: 7-year results. J Arthroplasty 2012; 27:1683-1689.e2. [PMID: 22595183 DOI: 10.1016/j.arth.2012.03.049] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 03/28/2012] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to report our clinical outcome of a large series of metal-on-metal hip resurfacing arthroplasty (HRA) using the hybrid Biomet ReCap-Magnum system. This is a single-designer surgeon series with an average of 5 ± 1 years. Seven hundred forty consecutive hybrid HRAs were performed in 653 patients. Kaplan-Meier survivorship with any revision as an end point was 96.4% at 7 years. Twenty-five (3.4%) cases were revised: 8 due to acetabular component loosening, 6 due to femoral neck facture, 4 due to failure of femoral component fixation, 2 due to deep infection, 2 due to adverse wear, 1 due to psoas tendonitis, 1 due to recurrent dislocation, and 1 due to unexplained pain. Biomet ReCap and Magnum HRA components with hybrid fixation methods showed excellent survivorship for a minimally selected young patient cohort at 7 years.
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Caouette C, Bureau M, Vendittoli PA, Lavigne M, Nuño N. Anisotropic bone remodeling of a biomimetic metal-on-metal hip resurfacing implant. Med Eng Phys 2012; 34:559-65. [DOI: 10.1016/j.medengphy.2011.08.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 06/22/2011] [Accepted: 08/27/2011] [Indexed: 10/17/2022]
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Coulter G, Young DA, Dalziel RE, Shimmin AJ. Birmingham hip resurfacing at a mean of ten years: results from an independent centre. ACTA ACUST UNITED AC 2012; 94:315-21. [PMID: 22371536 DOI: 10.1302/0301-620x.94b3.28185] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report the findings of an independent review of 230 consecutive Birmingham hip resurfacings (BHRs) in 213 patients (230 hips) at a mean follow-up of 10.4 years (9.6 to 11.7). A total of 11 hips underwent revision; six patients (six hips) died from unrelated causes; and 13 patients (16 hips) were lost to follow-up. The survival rate for the whole cohort was 94.5% (95% confidence interval (CI) 90.1 to 96.9). The survival rate in women was 89.1% (95% CI 79.2 to 94.4) and in men was 97.5% (95% CI 92.4 to 99.2). Women were 1.4 times more likely to suffer failure than men. For each millimetre increase in component size there was a 19% lower chance of a failure. The mean Oxford hip score was 45.0 (median 47.0, 28 to 48); mean University of California, Los Angeles activity score was 7.4 (median 8.0, 3 to 9); mean patient satisfaction score was 1.4 (median 1.0, 0 to 9). A total of eight hips had lysis in the femoral neck and two hips had acetabular lysis. One hip had progressive radiological changes around the peg of the femoral component. There was no evidence of progressive neck narrowing between five and ten years. Our results confirm that BHR provides good functional outcome and durability for men, at a mean follow-up of ten years. We are now reluctant to undertake hip resurfacing in women with this implant.
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Affiliation(s)
- G Coulter
- Melbourne Orthopaedic Group, 33 The Avenue Windsor, Melbourne 3181, Australia
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16
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Gross TP, Liu F. Risk factor analysis for early femoral failure in metal-on-metal hip resurfacing arthroplasty: the effect of bone density and body mass index. J Orthop Surg Res 2012; 7:1. [PMID: 22233783 PMCID: PMC3284462 DOI: 10.1186/1749-799x-7-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 01/10/2012] [Indexed: 11/16/2022] Open
Abstract
Background The importance of appropriately selecting patients based on factors such as bone mineral density, body mass index, age, gender, and femoral component size has been demonstrated in many studies as an aid in decreasing the rate of revisions and improving the outcomes for patients after hip resurfacing arthroplasty (HRA); however, there are few published studies quantitatively specifying the potential risk factors that affect early femoral component failures. Therefore, the purpose of this study was to investigate the specific causes of early femoral component failures in hip resurfacing separately and more carefully in order to develop strategies to prevent these failures, rather than excluding groups of patients from this surgical procedure. Methods This retrospective study included 373 metal-on-metal HRAs performed by a single surgeon using the vascular sparing posterior minimally invasive surgical approach. The average length of follow-up was 30 ± 6 months. In order to understand the causes of early femoral failure rate, a multivariable logistic regression model was generated in order to analyze the effects of bone mineral density (T-score), gender, diagnosis, body mass index, femoral implant fixation type, age, and femoral component size. Results The average post-operative Harris hip score was 92 ± 11 points and the average post-operative UCLA score was 7 ± 2 points. There were three revisions due to femoral neck fracture and two for femoral component loosening. These occurred in two female and three male patients. In the multi-variable regression model, only T-score and body mass index showed significant effects on the failure rate of femoral components. Patients with a lower T-score and a higher body mass index had a significantly increased risk of early femoral component failure. Conclusion We recommend that dual energy x-ray absorptiometry scan T-score tests should be routinely performed on all hip resurfacing patients pre-operatively. If a patient has a low T-score (≤ -1.5), consideration should be given to additional precautions or treatments to alleviate his or her risk, especially when the patient has a higher body mass index (≥ 29 kg/m2).
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17
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Metal-on-metal hip resurfacing with uncemented fixation of the femoral component. A minimum 2 year follow up. Hip Int 2011; 21:475-8. [PMID: 21786263 DOI: 10.5301/hip.2011.8513] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2011] [Indexed: 02/04/2023]
Abstract
The current generation of metal-on-metal hip resurfacing designs has largely been characterized by cemented femoral fixation using a cementless cup. We present the clinical results of 135 entirely uncemented metal-on-metal hip resurfacing procedures. The primary outcome measures were revision for any cause and the Oxford hip score at the latest follow up. The average length of followup was 2.9 years. The mean Oxford hip score was 18.4 and no patient required revision of either component during the study period. Uncemented femoral fixation may be comparable to fixation with cement in metal-on-metal hip resurfacing.
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18
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Zywiel MG, Sayeed SA, Johnson AJ, Schmalzried TP, Mont MA. State of the art in hard-on-hard bearings: how did we get here and what have we achieved? Expert Rev Med Devices 2011; 8:187-207. [PMID: 21627555 DOI: 10.1586/erd.10.75] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Total hip arthroplasty has shown excellent results in decreasing pain and improving function in patients with degenerative disease of the hip. Improvements in prosthetic materials, designs and implant fixation have now resulted in wear of the bearing surface being the limitation of this technology, and a number of hard-on-hard couples have been introduced to address this concern. The purpose of this article is to review the origins, development, survival rates and potential advantages and disadvantages of the following hard-on-hard bearings for total hip arthroplasty: metal-on-metal standard total hip arthroplasty; metal-on-metal hip resurfacing arthroplasty, ceramic-on-ceramic total hip arthroplasty; and ceramic-on-metal bearings. Improvements in the manufacturing of metal-on-metal bearings over the past 50 years have resulted in implants that provide low wear rates and allow for the use of large femoral heads. However, concerns remain regarding elevated serum metal ion levels, potential teratogenic effects and potentially devastating adverse local tissue reactions, whose incidence and pathogenesis remains unclear. Modern total hip resurfacing has shown excellent outcomes over 10 years in the hands of experienced surgeons. Current ceramic-on-ceramic bearings have demonstrated excellent survival with exceptionally low wear rates and virtually no local adverse effects. Concerns remain for insertional chipping, in vivo fracture and the variable incidence of squeaking. Contemporary ceramic-on-metal interfaces are in the early stages of clinical use, with little data reported to date. Hard-on-hard bearings for total hip arthroplasty have improved dramatically over the past 50 years. As bearing designs continue to improve with new and modified materials and improved manufacturing techniques, it is likely that the use of hard-on-hard bearings will continue to increase, especially in young and active patients.
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Affiliation(s)
- Michael G Zywiel
- Division of Orthopaedic Surgery, University of Toronto, 100 College Street Room 302, Toronto, Ontario M5G 1L5, Canada
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Pal B, Gupta S. The effect of primary stability on load transfer and bone remodelling within the uncemented resurfaced femur. Proc Inst Mech Eng H 2011; 225:549-61. [PMID: 22034739 DOI: 10.1177/0954411910397102] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
One of the major causes of aseptic loosening in an uncemented implant is the lack of any attachment between the implant and the bone. The implant’s stability depends on a combination of primary stability (mechanical stability) and secondary stability (biological stability). The primary stability may affect the implant–bone interface condition and thus influence the load transfer and mechanical stimuli for bone remodelling in the resurfaced femur. This paper reports the results of a study into the affect of primary stability on load transfer and bone adaptation for an uncemented resurfaced femur. Three-dimensional finite element models were used to simulate the intact and resurfaced femurs and the bone remodelling. As a first step towards assessing the immediate post-operative condition, a debonded interfacial contact condition with varying levels of the friction coefficient (0.4, 0.5, and 0.6) was simulated at the implant–bone interface. Then, using a threshold value of micromotion of 50 µm, the implant–bone interfacial condition was varied along the implant–bone boundary to mechanically represent non-osseointegrated or osseointegrated regions of the interface. The considered applied loading conditions included normal walking and stair climbing. Resurfacing leads to strain shielding in the femoral head (20–75 per cent strain reductions). In immediate post-operative conditions, there was no occurrence of elevated strains in the cancellous bone around the proximal femoral neck–component junction resulting in a lower risk of neck fracture. Predominantly, the micromotions were observed to remain below 50 µm at the implant–bone interface, which represents 97–99 per cent of the interfacial surface area. The predicted micromotions at the implant–bone interface strongly suggest the likelihood of bone ingrowth onto the coated surface of the implant, thereby enhancing implant fixation. For the osseointegrated implant–bone interface, the effect of strain shielding was observed in a considerably greater bone volume in the femoral head as compared to the initial debonded interfacial condition. A 50–80 per cent periprosthetic bone density reduction was predicted as compared to the value of the intact femur, indicating bone resorption within the superior resurfaced head. Although primary fixation of the resurfacing component may be achieved, the presence of high strain shielding and peri-prosthetic bone resorption are a major concern.
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Affiliation(s)
- Bidyut Pal
- Department of Mechanical Engineering, Indian Institute of Technology, Kharagpur, West Bengal, India
| | - Sanjay Gupta
- Department of Mechanical Engineering, Indian Institute of Technology, Kharagpur, West Bengal, India
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20
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Zywiel MG, Sayeed SA, Johnson AJ, Schmalzried TP, Mont MA. Survival of hard-on-hard bearings in total hip arthroplasty: a systematic review. Clin Orthop Relat Res 2011; 469:1536-46. [PMID: 21057988 PMCID: PMC3094609 DOI: 10.1007/s11999-010-1658-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Improvements in prosthetic materials, designs, and implant fixation for THA have led to bearing surface wear being the limitation of this technology. Hard-on-hard bearings promise decreased wear rates and increased survival. However, there may be different survival rates based on bearing materials, manufacturing technologies, and femoral component designs. Additionally, survival rate variability may be based on study design. QUESTIONS/PURPOSES We determined survival rates and study levels of evidence and quality for the following bearings: stemmed metal-on-metal THA, metal-on-metal hip resurfacing, ceramic-on-ceramic THA, and ceramic-on-metal THA. METHODS We performed a systematic review of the peer-reviewed literature addressing THA hard-on-hard bearings. Quality for Level I and II studies was assessed. RESULTS The four Level I or II second-generation stemmed metal-on-metal THA studies reported between 96% and 100% mean survival at 38 to 60 months. The two Level I hip resurfacing studies reported 94% and 98% mean survival at 56 and 33 months. The four Level I studies of ceramic-on-ceramic THA reported survival from 100% at mean 51 months to 96% at 8 years. CONCLUSIONS While hard-on-hard bearing survival rates have generally been variable with earlier designs, contemporary implants have demonstrated survival of 95% or greater at followup of between 3 and 10 years. Some variability in survival may be due to differences in surgical technique, component positioning, and implant designs. As bearing designs continue to improve with modified materials and manufacturing techniques, use will increase, especially in young and active patients, though concerns remain about the increased reports of adverse events after metal-on-metal bearings.
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Affiliation(s)
- Michael G. Zywiel
- Center for Joint Preservation and Replacement, The Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215 USA
| | - Siraj A. Sayeed
- Center for Joint Preservation and Replacement, The Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215 USA
| | - Aaron J. Johnson
- Center for Joint Preservation and Replacement, The Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215 USA
| | | | - Michael A. Mont
- Center for Joint Preservation and Replacement, The Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215 USA
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21
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Spencer RF. Evolution in hip resurfacing design and contemporary experience with an uncemented device. J Bone Joint Surg Am 2011; 93 Suppl 2:84-8. [PMID: 21543695 DOI: 10.2106/jbjs.j.01716] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The concepts of surface replacement of the hip and metal-on-metal articulation date back to the 1930s, and recent hip resurfacing designs have been more successful than their predecessors. Experience with the Cormet device followed initial collaboration with Mr. Derek McMinn. Both hybrid implants (a cementless cup and a cemented head) and entirely cementless implants, inserted with use of a variety of surgical approaches, yielded good results, with the cementless option increasing in popularity. The indications for hip resurfacing have become better understood, with the procedure considered most suitable for young and middle-aged males with a high activity profile. In addition, revision surgery, if necessary, has been associated in most cases with bone and soft-tissue conservation. Caution should be exercised when treating small individuals (especially females) and individuals with accompanying diagnoses other than osteoarthritis (such as hip dysplasia), for whom other bone-conserving options may be more appropriate to avoid an adverse reaction to metal debris. Correct implant placement during hip resurfacing is of critical importance.
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Affiliation(s)
- Robert F Spencer
- Department of Orthopaedics, Weston General Hospital, Grange Road, Uphill, Weston-super-Mare BS23 4TQ, United Kingdom.
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22
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Radiographic changes of the femoral neck after total hip resurfacing. Orthop Traumatol Surg Res 2011; 97:229-40. [PMID: 21458396 DOI: 10.1016/j.otsr.2011.01.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2010] [Revised: 12/13/2010] [Accepted: 01/04/2011] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Significant femoral neck narrowing following hip resurfacing arthroplasty has been observed. Several factors contributing to the physiopathology of femoral neck narrowing have been suggested. The aim of this study was to evaluate the femoral neck radiographic changes observed after hip resurfacing at a minimum follow-up period of 5 years and to determine their causes. PATIENTS AND METHODS We conducted a prospective study of 57 hip resurfacing arthroplasties performed in 53 patients (30 men, 23 women) of mean age 49.2 years (32-65) at surgery. These patients were clinically reviewed (inguinal pain during walking, WOMAC and UCLA scores) at 2 years and radiographically examined at 1, 2 and 5 postoperative years. The accuracy of our computer-aided measurement method was 1mm. Measurement of femoral neck to implant ratio was performed to assess the amount of neck thinning at the femoral neck-implant junction (N/H) and midway between the implant and the inter-trochanteric line (N(1/2)H) on an AP radiograph. Neck-thinning greater than 10% was considered as significant. Any other radiographic morphologic change in the femoral neck was investigated. Metallic ion concentration in blood was measured. A uni- and multivariate analysis was performed to determine the correlation with radiographic changes. RESULTS In one third of the patients, femoral neck narrowing was greater than 1mm at 2 and 5 postoperative years. Such result corresponds to a mean decrease in neck to implant ratio (N/H) of 5.9% (range, 2.3 to 9.4) at 2 years and 8.3% (range, 2.5 to 23.8) at 5 years. At 5 postoperative years, an overall neck thinning greater than 10% was reported in 3 patients (with a 10- to 17-% increase in femoral neck narrowing between the 2nd and the 5th postoperative year). In one case, neck thinning was associated with fracture of the femoral stem managed with revision surgery during which femoral neck necrosis was confirmed. Neck thinning was, in these cases, circumferential to the neck-implant junction. There was no significant negative impact on clinical scores and no relationship could be established between neck thinning and factors such as BMI or patient activity. Moreover, neck thinning greater than 10% was reported in two cases after 2 postoperative years through the appearance of a localized femoral neck notching which was absent in the postoperative period, secondary to a femoroacetabular impingement. DISCUSSION-CONCLUSION Femoral neck narrowing used to be a common phenomenon after HR when polyethylene acetabular bearings were implanted thus inducing osteolysis secondary to PE wear debris. The incidence of such phenomenon has decreased but still occurs after HR when using a metal-on-metal bearing surface. It has an early occurence but stabilizes after 2 postoperative years. Changes in mechanical stress distribution in the neck region after hip resurfacing have been hypothesized to be a cause of neck thinning. Other aetiologies may be suggested. An overall evolutive femoral neck narrowing after 2 postoperative years should raise the suspicion of necrosis leading to a risk of loosening, fracture or implant failure. Therefore, radiographic monitoring should be conducted. The presence of femoral neck notching secondary to femoroacetabular impingement represents a differential diagnosis which conservative treatment is advocated in the absence of any associated symptoms.
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Ho KKW, Beazley J, Parsons N, Costa ML, Foguet P. Narrowing of the femoral neck after resurfacing arthroplasty of the hip: a comparison of cemented and uncemented femoral components. Hip Int 2011; 20:542-6. [PMID: 21157762 DOI: 10.1177/112070001002000420] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/04/2010] [Indexed: 02/04/2023]
Abstract
We performed a radiographic review of a consecutive series of 87 resurfacing arthroplasties of the hip, performed between 2004 and 2006. There were 54 cemented femoral components and 33 uncemented femoral components. All of the procedures were performed by the same surgeon using the same approach. There was no difference between the groups with regards to gender, age, pre-operative diagnosis and the average diameter of the components. The primary outcome measured was the neck-prosthesis ratio on standard anterior-posterior pelvis radiographs taken post-operatively and at a minimum follow up of two years. The difference between the immediate post-operative ratio and the most recent radiograph was statistically significant in patients with cemented femoral components (p=0.006), but not in the group with uncemented components (p=0.173). We have demonstrated a difference in narrowing of the femoral neck between cemented and uncemented femoral components in the first two years following surgery.
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Affiliation(s)
- Kevin K W Ho
- Department of Orthopaedic Surgery, University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK.
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24
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Takamura KM, Yoon J, Ebramzadeh E, Campbell PA, Amstutz HC. Incidence and significance of femoral neck narrowing in the first 500 Conserve® Plus series of hip resurfacing cases: a clinical and histologic study. Orthop Clin North Am 2011; 42:181-93, viii. [PMID: 21435494 DOI: 10.1016/j.ocl.2011.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Narrowing of the femoral neck after metal-on-metal hip resurfacing arthoplasty has been reported as a common radiologic feature, although its significance is still unknown. This study reports the presence and significance of neck narrowing in the first 500 consecutive Conserve® Plus metal-on-metal hip resurfacings in 431 patients.
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Affiliation(s)
- Karren M Takamura
- Joint Replacement Institute, St Vincent Medical Center, Los Angeles, CA 90057, USA
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25
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Gross TP, Liu F. Comparison of fully porous-coated and hybrid hip resurfacing: a minimum 2-year follow-up study. Orthop Clin North Am 2011; 42:231-9, viii-ix. [PMID: 21435497 DOI: 10.1016/j.ocl.2010.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The purpose of this study was to compare clinical and radiological outcomes of the first 191 fully porous-coated hip resurfacing arthroplasties with 96 hybrid hip resurfacing arthroplasties performed during the same period at a minimum 2-year follow-up to evaluate the initial fixation of uncemented femoral resurfacing components. The results of this study indicate that fully porous-coated femoral resurfacing components can routinely achieve reliable fixation and provide similar initial results as have been achieved with cemented fixation. Long-term results are needed to determine which type of fixation is superior for the femoral hip resurfacing component.
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26
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Amstutz HC, Le Duff MJ, Campbell PA, Wisk LE, Takamura KM. Complications after metal-on-metal hip resurfacing arthroplasty. Orthop Clin North Am 2011; 42:207-30, viii. [PMID: 21435496 DOI: 10.1016/j.ocl.2010.12.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This article determines the incidence and cause of the complications commonly associated with metal-on-metal hip resurfacing implants and the proposed methods to prevent these complications. The literature available in PubMed was reviewed. Complication rates after hip resurfacing are low, and the procedure has shown both safety and efficacy in the hands of surgeons trained in specialized centers. Proper surgical technique can further reduce the incidence of femoral neck fracture, component loosening, and abnormal wear of the prosthesis. A more systematic detection of adverse local tissue reactions is needed to provide accurate assessments of their prevalence.
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Affiliation(s)
- Harlan C Amstutz
- Joint Replacement Institute at Saint Vincent Medical Center, Los Angeles, CA 90057, USA.
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27
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Grammatopoulos G, Pandit H, Murray DW, Gill HS. The relationship between head-neck ratio and pseudotumour formation in metal-on-metal resurfacing arthroplasty of the hip. ACTA ACUST UNITED AC 2010; 92:1527-34. [PMID: 21037347 DOI: 10.1302/0301-620x.92b11.24640] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Pseudotumour is a rare but important complication of metal-on-metal hip resurfacing that occurs much more commonly in women than in men. We examined the relationship between head-neck ratio (HNR) and pseudotumour formation in 18 resurfaced hips (18 patients) revised for pseudotumour and 42 asymptomatic control resurfaced hips (42 patients). Patients in whom pseudotumour formation had occurred had higher pre-operative HNR than the control patients (mean 1.37 (sd 0.10) vs mean 1.30 (sd 0.08) p = 0.001). At operation the patients with pseudotumours had a greater reduction in the size of their femoral heads (p = 0.035) and subsequently had greater neck narrowing (mean 10.1% (sd 7.2) vs mean 3.8% (sd 3.2) p < 0.001). No female patient with a pre-operative HNR ≤ 1.3 developed a pseudotumour. We suggest that reducing the size of the femoral head, made possible by a high pre-operative HNR, increases the risk of impingement and edge loading, and may contribute to high wear and pseudotumour formation. As the incidence of pseudotumour is low in men, it appears safe to perform resurfacing in men. However, this study suggests that it is also reasonable to resurface in women with a pre-operative HNR ≤ 1.3.
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Affiliation(s)
- G Grammatopoulos
- Botnar Research Centre, Nuffield Orthopaedic Centre, 150 Windmill Road, Oxford OX3 7LD, UK
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Rahman L, Muirhead-Allwood SK, Alkinj M. What is the midterm survivorship and function after hip resurfacing? Clin Orthop Relat Res 2010; 468:3221-7. [PMID: 20574804 PMCID: PMC2974897 DOI: 10.1007/s11999-010-1438-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hip resurfacing arthroplasty is a common procedure that improves functional scores and has a reported survivorship between 95% and 98% at 5 years. However, most studies are reported from the pioneering rather than independent centers or have relatively small patient numbers or less than five years followup. Various factors have been implicated in early failure. QUESTIONS/PURPOSES Our purposes were to determine: (1) the midterm survival of the BHR; (2) the function in patients treated with hip resurfacing; and (3) whether age, gender, BMI, or size of components related to failure. METHODS We reviewed the first 302 patients (329 hips) on whom we performed resurfacing arthroplasty. We assessed the survivorship, change in functional hip scores (HHS, OHS, WOMAC, UCLA), and analyzed potential risk factors (age, gender, BMI, component size) for failure. The mean age at the time of surgery was 56.0 years (range, 28.2-75.5 years). The minimum followup was 5 years (mean, 6.6 years; range, 5-9.2 years). RESULTS Kaplan-Meier analysis showed survival of 96.5% (95% CI, 94.7-98.4) at 9 years taking revision for any cause as the endpoint. All functional hip scores (HHS, OHS, WOMAC, UCLA) improved. Survivorship was higher in men compared with women. The component sizes and body mass index were smaller in the revised group compared with the nonrevised group. CONCLUSIONS Medium-term survivorship and functional scores of hip resurfacing are comparable to those from the pioneering center. Hip resurfacing remains a good alternative to THA, particularly in the younger male population with relatively large femoral head sizes.
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Affiliation(s)
- Luthfur Rahman
- The London Hip Unit, 30 Devonshire Street, London, W1G 6PU UK
| | | | - Muhannad Alkinj
- The London Hip Unit, 30 Devonshire Street, London, W1G 6PU UK
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Femoral neck resorption following hybrid metal-on-metal hip resurfacing arthroplasty: a radiological and biomechanical analysis. Arch Orthop Trauma Surg 2010; 130:1433-8. [PMID: 20213452 DOI: 10.1007/s00402-010-1070-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Indexed: 12/13/2022]
Abstract
INTRODUCTION With the resurgence of resurfacing hip arthroplasty complications such as femoral neck fracture and thinning have been identified. We therefore conducted a radiological and biomechanical evaluation of factors affecting femoral neck resorption following resurfacing hip arthroplasty (RHA). METHODS We retrospectively reviewed 61 resurfacing hip arthroplasties in 53 patients with a minimum of a 2-year follow-up. Data regarding age, gender, body mass index, indication for surgery, and component size was obtained from case records. Radiographic measurements were made from standardised digital AP pelvic radiographs. The neck shaft angle, stem shaft angle, and the varus-valgus femoral stem alignment were calculated. Changes in abductor/body moment arm, hip ratio, and cup-to-neck ratio were calculated from the pre-op, immediate post-op and 2 year post-operative radiographs. RESULTS Femoral neck thinning was identified in 98% of cases (60/61) and was greater than 10% in 59% (39/61). The mean change in component-to-neck ratio was 0.12 (0-0.44). No significant relationship was found between the amount of femoral neck resorption and patient age, BMI, gender, diagnosis, component size or orientation. A significant positive correlation was found between a change in abductor moment arm and femoral neck resorption (R = 0.575; p < 0.01). We also calculated that approximately one-third of the change in CNR could be explained by a change in abductor moment arm. From this we formulated the Pillai-Joseph equation to calculate projected thinning at 2 years from the initial post-operative radiograph (CNR difference = 0.094 × AMA difference + 0.129). CONCLUSIONS RHA significantly alters hip biomechanics and this may result in altered loading patterns with adaptive remodelling causing neck thinning. In order to minimise neck thinning care must be taken not to increase the abductor moment arm.
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30
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Amstutz HC, Esposito C, Campbell P. Long term preservation of femoral bone following hemiresurfacing. Hip Int 2010; 20:236-41. [PMID: 20544659 DOI: 10.1177/112070001002000215] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2010] [Indexed: 02/04/2023]
Abstract
Long term femoral fixation, bone remodeling and neck preservation are demonstrated histologically in three hips treated with hemiresurfacing. They were performed in young patients for Ficat stage III or early IV osteonecrosis as a "time buying procedure". The cases were revised after 13, 16 and 22 years because of cartilage wear which was anticipated. One head was resurfaced using titanium and two with custom alumina ceramic components. Fixation was achieved using early bone cleansing and cementing techniques. Retrieval analysis found remarkable preservation of bone stock and viability without neck narrowing.
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Affiliation(s)
- Harlan C Amstutz
- Joint Replacement Institute, St. Vincent Medical Center, Los Angeles, CA, USA.
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31
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Stulberg BN, Fitts SM, Bowen AR, Zadzilka JD. Early return to function after hip resurfacing: is it better than contemporary total hip arthroplasty? J Arthroplasty 2010; 25:748-53. [PMID: 19643563 DOI: 10.1016/j.arth.2009.05.034] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Accepted: 05/24/2009] [Indexed: 02/01/2023] Open
Abstract
Our hypothesis was that return of function for young patients undergoing resurfacing total hip arthroplasty (THA) with metal-on-metal bearings or contemporary THA with ceramic bearings would be comparable. Results from 337 unilateral hip resurfacing patients were compared with results from 266 unilateral ceramic-on-ceramic THA patients. Early differences in Harris Hip Scores were observed, but all differences faded by 24 months. Hip resurfacing seems to be a viable alternative to THA for well-selected patients. However, the public perception of improved functional capabilities was not demonstrated in this patient population. Resurfacing patients may be more impaired (slightly higher pain scores/lower function scores) than their THA counterparts in the early postoperative period, but these differences disappear by 24 months when both groups report Harris Hip Scores in the excellent range.
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Affiliation(s)
- Bernard N Stulberg
- Cleveland Clinic Orthopaedic and Rheumatologic Institute, Cleveland, Ohio 44113, USA
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32
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Berstock J, Barakat MJ, Annamalais S, Ahmad R, Gillespie G, Spencer RF. An early comparison of clinical and mechanical aspects of hybrid and uncemented hip resurfacing. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2010. [DOI: 10.1007/s00590-010-0633-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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The Effects of Interfacial Conditions and Stem Length on Potential Failure Mechanisms in the Uncemented Resurfaced Femur. Ann Biomed Eng 2010; 38:2107-20. [DOI: 10.1007/s10439-010-0007-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2010] [Accepted: 03/09/2010] [Indexed: 10/19/2022]
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34
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Nunley RM, Zhu J, Brooks PJ, Engh CA, Raterman SJ, Rogerson JS, Barrack RL. The learning curve for adopting hip resurfacing among hip specialists. Clin Orthop Relat Res 2010; 468:382-91. [PMID: 19779950 PMCID: PMC2807001 DOI: 10.1007/s11999-009-1106-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
UNLABELLED Patient demand and surgeon interest in hip resurfacing has recently increased, but surgeons in the United States are relatively inexperienced with this procedure. We determined the learning curve associated with hip resurfacing and compared the rate of early complications of the first 650 hip resurfacings between five experienced hip surgeons and a national safety survey database study we previously published, which included 89 surgeons and 537 hip resurfacings. Patient demographics and adverse events were recorded. Specific features on pre- and postoperative radiographs were measured in a blinded fashion by a single observer. There were 13 major complications (2.0%), which is 3.7 times lower than our national safety survey complication rate of 7.4%. All fractures occurred in the first 25 cases performed. The complication rate was higher for the first 25 procedures (5.6%) compared with the second 25 procedures (1.6%). For experienced hip surgeons, the learning curve for avoiding early complications was short, 25 cases or less. The learning curve for achieving the desired component positioning radiographically was much longer, 75 to 100 cases or more. If achieving some ideal component position proves important for long-term function and implant survival, improved instrumentation and surgical techniques would be necessary to shorten the learning curve. LEVEL OF EVIDENCE Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/education
- Arthroplasty, Replacement, Hip/methods
- Attitude of Health Personnel
- Clinical Competence
- Education, Medical, Graduate
- Female
- Health Knowledge, Attitudes, Practice
- Hip Joint/diagnostic imaging
- Hip Joint/physiopathology
- Hip Joint/surgery
- Humans
- Learning
- Male
- Middle Aged
- Radiography
- Retrospective Studies
- Time Factors
- Treatment Outcome
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Affiliation(s)
- Ryan M Nunley
- Department of Orthopaedic Surgery, Washington University, St Louis, MO 63130, USA.
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35
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Role of surgical position on interface stress and initial bone remodeling stimulus around hip resurfacing arthroplasty. J Arthroplasty 2009; 24:1137-42. [PMID: 18823747 DOI: 10.1016/j.arth.2008.08.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Accepted: 08/23/2008] [Indexed: 02/01/2023] Open
Abstract
Valgus alignment of femoral resurfacing components has been advocated to reduce proximal femur loading and thus minimize the risk for femoral neck fractures. However, such reduction in loading may exacerbate undesirable stress shielding. This study examined the effect of extreme implant orientations (+/-15 degrees ) and stem canal overreaming on initial bone remodeling stimulus using finite element models. The changes in implant-cement interface stresses due to implant alignment were also evaluated. The valgus model showed increased initial bone resorption stimulus, which extended distally and peripherally around the femoral neck. The peak implant-cement interface shear stress for the varus model was 10.9 MPa, exceeding the interface shear strength. Overreaming of the stem canal eliminated distal tip loading, but proximal stress shielding was still unavoidable. These data show bone loading and interface fixation trends emanating from valgus and varus implant positions that will be of interest to practicing physicians.
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Springer BD, Connelly SE, Odum SM, Fehring TK, Griffin WL, Mason JB, Masonis JL. Cementless femoral components in young patients: review and meta-analysis of total hip arthroplasty and hip resurfacing. J Arthroplasty 2009; 24:2-8. [PMID: 19556097 DOI: 10.1016/j.arth.2009.04.032] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Accepted: 04/22/2009] [Indexed: 02/01/2023] Open
Abstract
The study purpose was to analyze current results of modern cementless femoral components in young patients having total hip arthroplasty (THA) or hip resurfacing. Twenty-two studies (n = 5907; hips = 6408) evaluating modern cementless THA in young patients and 15 studies evaluating hip resurfacing (n = 3002; hips = 3269) were included. Meta-analysis techniques were used to pool failure rates. The pooled failure rate for THA using femoral revision for mechanical failure as an end point was 1.3% (95% confidence interval [CI], 1.0%-1.7%) at a mean 8.4 years of follow-up. At a mean of 3.9 years of follow-up, the pooled mechanical failure rate of the femoral component for hip resurfacing was 2.6% (95% CI, 2.0-3.4). In conclusion, the enthusiasm for hip resurfacing should be tempered by these data. Longer follow-up and direct comparison trials are required to confirm these findings.
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Affiliation(s)
- Bryan D Springer
- OrthoCarolina Hip and Knee Center, Charlotte, North Carolina 28207, USA
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37
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Gebert A, Peters J, Bishop N, Westphal F, Morlock M. Influence of press-fit parameters on the primary stability of uncemented femoral resurfacing implants. Med Eng Phys 2009; 31:160-4. [DOI: 10.1016/j.medengphy.2008.04.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2007] [Revised: 04/15/2008] [Accepted: 04/16/2008] [Indexed: 10/22/2022]
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Amstutz HC, Le Duff MJ. Cementing the metaphyseal stem in metal-on-metal resurfacing: when and why. Clin Orthop Relat Res 2009; 467:79-83. [PMID: 18972179 PMCID: PMC2600982 DOI: 10.1007/s11999-008-0570-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2008] [Accepted: 09/29/2008] [Indexed: 01/31/2023]
Abstract
UNLABELLED Initial fixation of the femoral component in hip resurfacing is key to the enduring survival of the prosthesis. Cementing the metaphyseal stem increases the interface area between bone and cement. We compared the clinical and survivorship results of two groups in a cohort of 1000 hips (838 patients) implanted with Conserve((R)) Plus hip resurfacing; one group was resurfaced with a cemented metaphyseal stem (400 hips; Group 1) and the other with a press-fit stem (600 hips; Group 2). We carried out a time-dependent analysis to determine the indications for cementing the stem. The 5-year Kaplan-Meier survival estimate was 98.2% for Group 1 and 94.4% for Group 2, using any revision as an endpoint. Femoral aseptic failure was reduced in Group 1 compared to Group 2. Cementing the metaphyseal stem is particularly effective for hips with a small femoral component size (< 48 mm) and hips with large femoral defects (> 1 cm). There was no difference between groups in incidence of femoral neck narrowing or femoral neck fractures. Longer followup is needed to determine if cementing the stem can be detrimental to the long-term durability of the femoral implant. LEVEL OF EVIDENCE Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Harlan C Amstutz
- Joint Replacement Institute at St Vincent Medical Center, The S Mark Taper Building, Los Angeles, CA 90057, USA.
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39
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Mabilleau G, Kwon YM, Pandit H, Murray DW, Sabokbar A. Metal-on-metal hip resurfacing arthroplasty: a review of periprosthetic biological reactions. Acta Orthop 2008; 79:734-47. [PMID: 19085489 DOI: 10.1080/17453670810016795] [Citation(s) in RCA: 112] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Metal-on-metal hip resurfacing arthroplasty has undergone a recent resurgence as an alternative treatment option for young and active patients with significant osteoarthritis. The claimed advantages of metal-on-metal hip resurfacing arthroplasty include lower wear rate, preservation of bone stock for subsequent revision procedures, restoration of anatomic hip mechanics, and enhanced stability due to the larger diameter of articulation. A disadvantage, however, is that the metal-on-metal resurfacing releases large amounts of very small wear particles and metal ions. The long-term biological consequences of the exposure to these Co-Cr particles and ions remain largely unknown. The purpose of this review is to provide an overview of the current literature on the adverse periprosthetic biological reactions associated with metal-on-metal hip resurfacing arthroplasty.
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Affiliation(s)
- Guillaume Mabilleau
- Nuffield Department of Orthopaedic Surgery, Institute of Musculoskeletal Science, Botnar Research Centre, University of Oxford, Oxford, UK.
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40
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Spencer S, Carter R, Murray H, Meek RMD. Femoral neck narrowing after metal-on-metal hip resurfacing. J Arthroplasty 2008; 23:1105-9. [PMID: 18534469 DOI: 10.1016/j.arth.2007.10.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2007] [Revised: 08/18/2007] [Accepted: 10/14/2007] [Indexed: 02/01/2023] Open
Abstract
We reviewed 40 Corin Cormet 2000 (Corin, Cirencester, UK) metal-on-metal resurfacing hips, in 36 patients, for the presence of femoral neck narrowing. A neck-to-prosthesis ratio was calculated by dividing the diameter of the femoral neck with that of the implant. This ratio was measured on plain anteroposterior pelvis radiographs taken immediately and 2 years postoperation. Subsequent radiographs were measured up to a maximum 7 years (mean, 5.3 years) postoperation. Femoral neck narrowing was observed in 90% of hips at 2 years, with the average neck narrowing ranging from a ratio of 0.865 to 0.811. Importantly, no further narrowing occurred beyond this point up to 7 years postoperation. We described a simple reproducible method of measuring neck narrowing on plain radiographs and discuss possible causal factors for neck narrowing after hip resurfacing.
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Affiliation(s)
- Simon Spencer
- Department of Orthopaedic Surgery, Southern General Hospital, Glasgow, United Kingdom
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Kluess D, Zietz C, Lindner T, Mittelmeier W, Schmitz KP, Bader R. Limited range of motion of hip resurfacing arthroplasty due to unfavorable ratio of prosthetic head size and femoral neck diameter. Acta Orthop 2008; 79:748-54. [PMID: 19085490 DOI: 10.1080/17453670810016803] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND AND PURPOSE Hip resurfacing arthroplasty is being used more and more frequently. The small ratio in size between the resurfaced femoral head and the relatively thick femoral neck raises the question of whether the range of motion is sufficient, particularly with regard to the high mobility required by younger patients. We analyzed motion in a CAD model. METHODS Three-dimensional CAD models of the natural hip were created from CT scans and 8 designs of hip resurfacing prostheses (head diameter between 42 mm and 54 mm combined with a hemispherical cup) were implanted in a virtual sense. We simulated 3 different leg positions and the range of motion was evaluated, considering five different implant positions. RESULTS The range of motion of the hip resurfacing designs analyzed was far below the range of motion of stemmed total hip prostheses. None of the resurfacing prostheses provided flexion movements of 90 degrees without impingement. The average range of motion of hip resurfacing arthroplasty was 31-48 degrees below the range of motion of a stemmed total hip replacement with 32-mm head diameter. INTERPRETATION The range of motion of the hip resurfacing designs examined was substantially less than that of a conventional total hip prosthesis. Since impingement of the femoral neck on the acetabular component increases the risk of neck fractures, of dislocation and of subsequent implant loosening, the design and position of the implant should be considered before using hip resurfacing arthroplasty as a standard treatment for younger patients.
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Affiliation(s)
- Daniel Kluess
- Department of Orthopedics, Institute for Biomedical Engineering, University of Rostock, Germany.
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42
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Amstutz HC, Le Duff MJ. Eleven years of experience with metal-on-metal hybrid hip resurfacing: a review of 1000 conserve plus. J Arthroplasty 2008; 23:36-43. [PMID: 18639431 DOI: 10.1016/j.arth.2008.04.017] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Accepted: 04/06/2008] [Indexed: 02/01/2023] Open
Abstract
Hip resurfacing is currently the fastest growing hip procedure worldwide. We reviewed 1000 hips in 838 patients who received a Conserve Plus (Wright Medical Technology, Inc., Arlington, Tenn) resurfacing at a single institution. The mean age of the patients was 50.0 years with 74.7% male. The hips were resurfaced irrespective of femoral defect size or etiology. The mean follow-up was 5.6 years (range, 1.1-11.0 years). All clinical scores improved significantly (P < .05). There was no acetabular component loosening. Ten were converted to total hip arthroplasty for femoral neck fracture, 20 for femoral loosening, 2 for sepsis, and 1 for recurrent subluxations. The 5-year survivorship was 95.2% with no failures in hips implanted since 2002. Short-term failures can be prevented. First-generation surgical technique and a low body mass index were the most important risk factors for the procedure. Improvements in bone preparation significantly increased prosthetic survival in hips with risk factors for failure.
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Affiliation(s)
- Harlan C Amstutz
- Joint Replacement Institute at St Vincent Medical Center, Los Angeles, California 90057, USA
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43
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Gross TP, Liu F. Metal-on-metal hip resurfacing with an uncemented femoral component. A seven-year follow-up study. J Bone Joint Surg Am 2008; 90 Suppl 3:32-7. [PMID: 18676934 DOI: 10.2106/jbjs.h.00614] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Metal-on-metal hip resurfacing with hybrid fixation has been introduced as an alternative to standard total hip arthroplasty, especially for young and active patients. There are few studies in the literature on the midterm results of cementless femoral side resurfacing. The purpose of this study was to present our seven-year clinical results of a series of twenty cementless metal-on-metal hip resurfacing procedures. METHODS Between 1999 and 2000, eighteen patients (twenty hips) underwent primary metal-on-metal hip resurfacing with uncemented femoral and acetabular components. One patient was lost to follow-up. This left eleven men and six women, who had a mean age of forty-five years at the time of surgery. Clinical and radiographic examinations were performed prospectively, and the results were analyzed. RESULTS The mean duration of follow-up was 7.4 years. There were four revisions, none of which was due to aseptic failure of the femoral component. Two were due to loosening of the acetabular component, one was due to a late hematogenous infection, and one was due to persistent pain despite normal radiographic findings. The mean preoperative Harris hip score was 54 points, and it increased to 94 points at the time of the last follow-up. Radiographic examination of the hips for which the procedure was successful revealed no femoral or acetabular radiolucencies, no migration of any implant, and no osteolysis. The radiographs of one patient (two hips) showed substantial narrowing of the femoral necks (a mean of 12%), which stabilized at three years postoperatively. This patient had a Harris hip score of 100 points for both hips at six years. CONCLUSIONS This study suggests that cementless femoral fixation may be a viable alternative to fixation with cement in metal-on-metal hip resurfacing. Further study of this concept in larger numbers of patients is warranted.
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Affiliation(s)
- Thomas P Gross
- Midlands Orthopaedics, 1910 Blanding Street, Columbia, SC 29201, USA.
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44
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Mont MA, Schmalzried TP. Modern metal-on-metal hip resurfacing: important observations from the first ten years. J Bone Joint Surg Am 2008; 90 Suppl 3:3-11. [PMID: 18676930 DOI: 10.2106/jbjs.h.00750] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Michael A Mont
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopaedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA.
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45
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Ong KL, Manley MT, Kurtz SM. Have contemporary hip resurfacing designs reached maturity? A review. J Bone Joint Surg Am 2008; 90 Suppl 3:81-8. [PMID: 18676941 DOI: 10.2106/jbjs.h.00574] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The increasing prevalence of hip replacements in young patients is expected to fuel the demand for hip resurfacing arthroplasty. Patient selection, surgical technique, and implant design can influence the clinical outcomes for these patients. In this review, we discuss whether contemporary hip resurfacing designs have reached maturity and suggest design considerations for future-generation implants. These design-related factors include the amount and extent of cement fixation, adoption of cementless femoral fixation, optimization of implant position, minimization of stress-shielding, improvement in modularity or sizing and geometry options, metallurgy, development of alternative bearing options, and examination of in vivo cup deformation. In addition, this review is based on an understanding of the causes of failure of revision hip resurfacing arthroplasty, which is essential to help guide research, implant design, and clinical decision-making.
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Affiliation(s)
- Kevin L Ong
- Exponent Incorporated, 3401 Market Street, Suite 300, Philadelphia, PA 19104, USA.
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46
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Bader R, Klüß D, Gerdesmeyer L, Steinhauser E. Biomechanische Aspekte zur Implantatverankerung und Kinematik von Oberflächenersatzhüftendoprothesen. DER ORTHOPADE 2008; 37:634-43. [DOI: 10.1007/s00132-008-1285-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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47
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Uncemented hydroxyapatite-coated stems for primary total hip arthroplasty. CURRENT ORTHOPAEDIC PRACTICE 2008. [DOI: 10.1097/bco.0b013e3282f53e22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
The main advantage of hip resurfacing is bone conservation for patients likely to outlive a primary conventional hip replacement. Previous attempts at hip resurfacing failed predominantly because of the consequences of a high amount of wear of thin polyethylene acetabular components and poor femoral component fixation. With correct patient selection, surgeon education, and operative technique, survivorship at five years is comparable with that of traditional hip replacements. Hip resurfacing has its own unique set of complications, including a fractured neck of the femur. It is necessary to understand the risk factors prior to performing the procedure.
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Affiliation(s)
- Andrew Shimmin
- Melbourne Orthopaedic Group, 33 The Avenue, Windsor, Victoria 3181, Australia.
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Gulotta LV, Baldini A, Foote K, Lyman S, Nestor BJ. Femoral revision with an extensively hydroxyapatite-coated femoral component. HSS J 2008; 4:55-61. [PMID: 18751863 PMCID: PMC2504273 DOI: 10.1007/s11420-007-9068-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2007] [Accepted: 11/12/2007] [Indexed: 02/07/2023]
Abstract
Between December 1996 and April 2003, 26 consecutive femoral component revisions in 24 patients were performed with an extensively hydroxyapatite-coated femoral stem. Two patients were lost to follow-up, and two patients died of unrelated causes. Of the 22 femoral revisions in 20 patients, there was a 0% incidence of mechanical loosening at average follow-up of 3.2 years (2-6.3 years). The Harris Hip Score improved from 59 (36 to 83) to 95 (84 to 100) postoperatively (p < 0.001). Rate of revision was 18.2% (4.5% for sepsis, 9.1% for instability, and 4.5% for polyethelene wear). All 22 femoral components had evidence of bone ingrowth. The extensively coated hydroxyapatite stem in this series produced excellent clinical results with a low incidence of thigh pain (4.5%) and severe stress shielding (4.5%).
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Affiliation(s)
- Lawrence V. Gulotta
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021 USA ,Hospital for Special Surgery, 310 E 71st Street, #7D, New York, NY 10021 USA
| | - Andreas Baldini
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021 USA
| | - Kristin Foote
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021 USA
| | - Stephen Lyman
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021 USA
| | - Bryan J. Nestor
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021 USA
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50
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Mont MA, Seyler TM, Ulrich SD, Beaule PE, Boyd HS, Grecula MJ, Goldberg VM, Kennedy WR, Marker DR, Schmalzried TP, Sparling EA, Vail TP, Amstutz HC. Effect of changing indications and techniques on total hip resurfacing. Clin Orthop Relat Res 2007; 465:63-70. [PMID: 17891034 DOI: 10.1097/blo.0b013e318159dd60] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Recently, improved metal-on-metal bearing technology has led to the reemergence of resurfacing as a reasonable option for total hip arthroplasty. During the course of a prospective multicenter FDA-IDE evaluation of metal-on-metal total hip resurfacings, we modified our indications and emphasized surgical technique where the femoral surface area was small due to femoral cysts and small component size. We assessed the influence of these changes on complication rates in the first cohort of 292 patients and the second of 724, and then compared these outcomes in the second cohort with historical reports of resurfacing. We had a minimum followup of 24 months (mean, 33 months; range, 24-60 months). After changes were made in the indications and technique, the overall complication rate decreased from 13.4% to 2.1% with the femoral neck fracture rate reduced from 7.2% to 0.8%. The outcomes of the second cohort compare with modern-day resurfacing devices and appear superior to historical results. The data suggest patients should be carefully selected and technique optimized to reduce complications. Long-term followup is required to see if these promising results will be maintained.
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Affiliation(s)
- Michael A Mont
- The Center for Joint Preservation and Reconstruction, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD 21215, USA.
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