Operationstechnik und klinische Ergebnisse des DUROM™-Hip-Resurfacing-Systems mit dem lateralen Zugang

Early failure of the Durom prosthesis in metal-on-metal hip resurfacing in Chinese patients

Hip resurfacing (HR) is being used increasingly as an alterative to total hip arthroplasty in osteonecrosis (ON) and ankylosing spondylitis (AS) of the hip. We performed 141 consecutive HR arthroplasties in 111 patients comprising 3 etiology groups: ON, AS, and osteoarthritis (OA). After retrospective study of retrieved components, we hypothesized that the main reason for revision was femoral loosening in the ON group (4 of 46 hips; 8.7%) and femoral-neck fracture in the AS group (3 of 58 hips; 5.2%). Necrotic areas were seen on femoral heads retrieved from patients with femoral loosening, whereas femoral heads were fixed tightly to components in patients with femoral-neck fractures. Etiology may be an important risk factor for postoperative complications.

Hip resurfacing: a systematic review of literature

PURPOSE

We conducted a systematic review of the literature in order to take stock of hip resurfacing according to the principle of "evidence based medicine". Our main objective was to compare the rate of revision of resurfacing implants with survival limits set by the National Institute of Clinical Excellence (NICE).

METHODS

A systematic review was undertaken of all published (Medline, Cochrane, EMBASE) literature research databases up to July 2012 as recommended by the PRISMA statement. Data extraction focused on functional outcomes, complications and survival rates. The survival rates of implants were analysed according to the mean of the series in comparison to the NICE criteria.

RESULTS

Fifty-three studies were identified and included 26,456 cases with an average of 499.17 ± 856.7 (range, 38-5000) cases per study. The median survival was 95.57 % ± 3.7 % (range, 84-100). The percentage of studies which satisfied the criteria set by NICE was 69.8 %. In terms of cumulative revision rates pondered by the number of implants, BHR®, Conserve Plus® and Cormet® showed the best results. The mean postoperative score was 91.2 ± 7.72 (range, 68.3-98.6). There was no statistically significant difference between implants in terms of functional outcomes.

CONCLUSION

On the basis of the current evidence base, this review of the literature emphasises the importance of certain parameters that can improve the results of resurfacing. The type of implant seems to play an important role as does patient selection.

High revision rate at 5 years after hip resurfacing with the Durom implant

BACKGROUND/RATIONALE

There is growing evidence that different resurfacing implants are associated with variable survival and revision rates. A registry analysis indicated the Durom resurfacing implant had high revision rates at 5 years, whereas three original studies reported low revision rates at short-term followups. Thus, the revision rates appear controversial.

QUESTIONS/PURPOSES

We therefore assessed (1) the survivorship including differences between women and men at a mean of 5 years after resurfacing with the Durom implant, and (2) clinical scores and radiographic parameters.

PATIENTS AND METHODS

We prospectively followed all 100 Durom hip resurfacings implanted in 91 patients (25 women and 66 men; mean age, 52 years) between 2003 and 2004. Survivorship analysis was performed with pending revision or revision for any reason as the endpoint. The minimum followup was 47 months (mean, 60 months; range, 47-72 months).

RESULTS

At a mean of 5 years, 11 hips were revised for various reasons. Cumulative survival was 88.2% for all patients and 81.5% for women. The mean Oxford (OHS) and Harris hip (HHS) scores were 14.6 and 94.7, respectively. The mean UCLA activity level was 7.9. Sclerotic changes around the short femoral stem (pedestal sign) were detected in 40% of the hips. We observed considerable femoral neck thinning with component-to-neck ratios of 0.85 preoperatively and 0.82 at 5 years.

CONCLUSIONS

Our study highlights a high revision rate 5 years after hip resurfacing with the Durom implant. This observation underlines previous findings from registry data and suggests that revision rates increase with time.

LEVEL OF EVIDENCE

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Survival of metal-on-metal hip resurfacing arthroplasty: a systematic review of the literature

We systematically reviewed the peer-reviewed literature to relate the survival of hybrid metal-on-metal hip resurfacing arthroplasty devices to a National Institute of Clinical Excellence (NICE) benchmark for choosing a primary total hip replacement, which is a survival rate of 90% at a follow-up of ten years. A total of 29 articles (10 621 resurfaced hips) met the inclusion criteria. The mean follow-up ranged from 0.6 to 10.5 years and the survival of the implant ranged from 84% to 100%. Of the 10 621 hips, 370 were revised (3.5%), with aseptic loosening as the most frequent mode of failure. None of the hip resurfacing arthroplasty implants used to date met the full ten-year NICE benchmark of survival. A total of 13 studies showed satisfactory survival compared with the three-year NICE benchmark.