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Pasqualini I, Huffman N, Emara AK, Klika AK, McLaughlin JP, Mesko N, Brooks PJ, Piuzzi NS. Establishing minimal clinically important differences and patient acceptable symptom state thresholds following birmingham hip resurfacing. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05443-x. [PMID: 38981870 DOI: 10.1007/s00402-024-05443-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 06/27/2024] [Indexed: 07/11/2024]
Abstract
INTRODUCTION Birmingham Hip Resurfacing (BHR) has emerged as a compelling and innovative alternative to total hip arthroplasty (THA), especially among young, active patients. However, the Minimal Clinically Important Difference (MCID) and the Patient Acceptable Symptom State (PASS) thresholds have not yet been determined for patients undergoing BHR. Therefore, the current study aimed to (1) determine the MCID and PASS thresholds for both the Hip disability and Osteoarthritis Outcome Score (HOOS)-Pain and HOOS physical function shortform (PS), for patients who underwent BHR; and (2) identify factors influencing the achievement of MCID and PASS for HOOS-Pain and HOOS-PS. METHODS Prospectively collected data from patients undergoing BHR was analyzed. Patients with osteoarthritis and completed preoperative and 1-year postoperative PROMs were included. Distribution-based and anchored-based approaches were used to estimate MCID and PASS, respectively. The optimal cut-off point for PASS thresholds was calculated using the Youden index. RESULTS MCID for HOOS-Pain and PS were calculated to be 9.2 and 9.3, respectively. The PASS threshold for HOOS-Pain and PS were ≥ 77.7 and ≥ 87.3, respectively. The current study identified several factors affecting postoperative achievement of thresholds. Baseline Mental Component Summary (MCS) scores were a predictor for achieving MCID for postoperative HOOS-Pain, achieving MCID for postoperative HOOS-PS, achieving PASS for postoperative HOOS-Pain, and achieving PASS for postoperative HOOS-PS. Furthermore, baseline HOOS-Pain was a significant predictor for achieving MCID for postoperative HOOS-PS, achieving PASS for postoperative HOOS-Pain, and achieving PASS for postoperative HOOS-PS. CONCLUSIONS MCID and PASS thresholds were established for HOOS-Pain and PS domains following BHR with most patients achieving these clinically meaningful benchmarks. Additionally, several factors affecting achievement of MCID and PASS were identified, including modifiable risk factors that may allow clinicians to implement optimization strategies and further improve outcomes.
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Affiliation(s)
- Ignacio Pasqualini
- Department of Orthopaedic Surgery, Orthopedic and Rheumatology Institute, Cleveland Clinic, 9500 Euclid Ave, A41, Cleveland, OH, 44195, USA
| | - Nickelas Huffman
- Department of Orthopaedic Surgery, Orthopedic and Rheumatology Institute, Cleveland Clinic, 9500 Euclid Ave, A41, Cleveland, OH, 44195, USA
| | - Ahmed K Emara
- Department of Orthopaedic Surgery, Orthopedic and Rheumatology Institute, Cleveland Clinic, 9500 Euclid Ave, A41, Cleveland, OH, 44195, USA
| | - Alison K Klika
- Department of Orthopaedic Surgery, Orthopedic and Rheumatology Institute, Cleveland Clinic, 9500 Euclid Ave, A41, Cleveland, OH, 44195, USA
| | - John P McLaughlin
- Department of Orthopaedic Surgery, Orthopedic and Rheumatology Institute, Cleveland Clinic, 9500 Euclid Ave, A41, Cleveland, OH, 44195, USA
| | - Nathan Mesko
- Department of Orthopaedic Surgery, Orthopedic and Rheumatology Institute, Cleveland Clinic, 9500 Euclid Ave, A41, Cleveland, OH, 44195, USA
| | - Peter J Brooks
- Department of Orthopaedic Surgery, Orthopedic and Rheumatology Institute, Cleveland Clinic, 9500 Euclid Ave, A41, Cleveland, OH, 44195, USA
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Orthopedic and Rheumatology Institute, Cleveland Clinic, 9500 Euclid Ave, A41, Cleveland, OH, 44195, USA.
- Department of Biomedical Engineering, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, USA.
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Lin D, Xu J, Weinrauch P, Young DA, De Smet K, Manktelow A, Beaulé PE, Walter WL. Two-Year Results of Ceramic-on-Ceramic Hip Resurfacing in an International Multicenter Cohort. J Arthroplasty 2024:S0883-5403(24)00514-X. [PMID: 38782243 DOI: 10.1016/j.arth.2024.05.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 05/13/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Hip resurfacing arthroplasty (HRA) is a bone-conserving alternative to total hip arthroplasty. We present the 2-year clinical and radiographic follow-up of a novel ceramic-on-ceramic HRA in an international multicenter cohort. METHODS Patients undergoing HRA between September 2018 and January 2021 were prospectively included. Patient-reported outcome measures (PROMs) in the form of the Forgotten Joint Score, Hip Disability and Osteoarthritis Outcome Score Jr., Western Ontario and McMaster Universities Arthritis Index, Oxford Hip Score, and University of California, Los Angeles, Activity Score were collected preoperatively, and at 1 and 2 years postoperation. Serial radiographs were assessed for migration, component alignment, evidence of osteolysis or loosening, and heterotopic ossification formation. RESULTS The study identified 200 patients who reached a minimum 2-year follow-up (mean 3.5 years). Of these, 185 completed PROMs follow-up at 2 years. There was a significant improvement in Hip Disability and Osteoarthritis Outcome Score (P < .001) and Oxford Hip Score (P < .001) between the preoperative, 1-year, and 2-year outcomes. Patients had improved activity scores on the University of California, Los Angeles, Active Score (P < .001), with 45% reporting a return to high-impact activity at 2 years. At 1 and 2 years, the Forgotten Joint Score was not significantly different (P = .38). There was no migration, osteolysis, or loosening of any of the implants. No fractures were reported over the 2-year follow-up, with only 1 patient reporting a sciatic nerve palsy. There were 2 revisions, 1 for unexplained pain at 3 months due to acetabular component malposition and 1 at 33.5 months for acetabular implant failure. CONCLUSIONS The ceramic-on-ceramic resurfacing at 2 years postoperation demonstrates promising results with satisfactory outcomes in all recorded PROMs. Further long-term data are needed to support the widespread adoption of this prosthesis as an alternative to other HRA bearings.
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Affiliation(s)
- David Lin
- Department of Orthopaedics and Trauma Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Joshua Xu
- Department of Orthopaedics and Trauma Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | | | - David A Young
- Melbourne Orthopaedic Group, Melbourne, Victoria, Australia
| | | | - Andrew Manktelow
- Department of Trauma and Orthopaedics, Queens Medical Centre, Nottingham, UK
| | - Paul E Beaulé
- Orthopaedic Department, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - William L Walter
- Department of Orthopaedics and Trauma Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
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Shah RV, Ly JA, Magnuson JA, Thompson M, Lorei MP. Hip resurfacing: case closed? A bibliometric analysis of the past 10 years. Arch Orthop Trauma Surg 2024; 144:909-916. [PMID: 37792058 DOI: 10.1007/s00402-023-05075-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 09/17/2023] [Indexed: 10/05/2023]
Abstract
INTRODUCTION Hip resurfacing (HR) was introduced as a potential alternative to total hip arthroplasty (THA), indicated predominantly for younger, high demand patients. The modern metal-on-metal implant was popularized in the 1990s and early 2000s and promised greater wear resistance. However, its popularity waned due to increased rates of complications related to metal toxicity including pseudo-tumors as well as the recall of many resurfacing implants. The purpose of this study was to conduct a bibliometric analysis and investigate the current trends in hip resurfacing literature. METHODS Using the keywords "hip resurfacing," publications between 2012 and 2022 were identified on Web of Science Core Collection of Clarivate Analytics. Results were screened for relevance by three independent reviewers using title, abstract, and full text. The retrieved data were evaluated by the bibliometric method. Included articles were imported into CiteSpace 5.7.R1, 64-bit (Drexel University, Philadelphia, PA, USA), VOSviewer 1.6.15 (Leiden University, Leiden, the Netherlands), and the Online Analysis Platform of Literature Metrology to identify trends in publication. RESULTS Search terms yielded 1200 results and 724 were included in final analysis. A steady decrease of publications was noted over the past decade with less than 40 articles published in 2020 and 2021. The Journal of Hip Arthroplasty (92), Hip International (74), and Clinical Orthopaedics and Related Research (54) published the most articles. Authors from the United States and the United Kingdom published the most studies. High-frequency keywords in co-occurrence and co-cited cluster analysis were metal-on-metal, metal ions, wear, pseudo-tumor, and revision, demonstrating that long-term concerns have been the focus of most recent studies. CONCLUSION In conclusion, our bibliometric analysis allowed novel exploration and identification of the current research trends, contributions, and the distribution of publications exploring HR. The understanding of HR and the poor long-term outcomes of some resurfacing implants has improved significantly over the past decade, with the most recent focus on failure rates and long-term complications from metal debris. However, the breadth of literature has steadily declined in the past decade, and ultimately demonstrates the decline of scientific interest and focus on novel areas in hip resurfacing and a potential reached consensus.
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Affiliation(s)
- Ronit V Shah
- Department of Orthopaedic Surgery and Sports Medicine, Temple University Hospital, Philadelphia, PA, 19140, USA.
| | - Justin A Ly
- Department of Orthopaedic Surgery and Sports Medicine, Temple University Hospital, Philadelphia, PA, 19140, USA
| | | | - Megan Thompson
- Lewis Katz School of Medicine at, Temple University, Philadelphia, PA, 19140, USA
| | - Matthew P Lorei
- Department of Orthopaedic Surgery and Sports Medicine, Temple University Hospital, Philadelphia, PA, 19140, USA
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McBryde CW, Prakash R, Haddad FS. Hip resurfacing. Bone Joint J 2023; 105-B:467-470. [PMID: 37121587 DOI: 10.1302/0301-620x.105b5.bjj-2023-0015.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- Callum W McBryde
- Young Adult Hip Unit, Royal Orthopaedic Hospital, Birmingham, UK
| | - Rohan Prakash
- Young Adult Hip Unit, Royal Orthopaedic Hospital, Birmingham, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
- The Bone & Joint Journal , London, UK
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Palazzuolo M, Bensa A, Bauer S, Blakeney WG, Filardo G, Riegger M. Resurfacing Hip Arthroplasty Is a Safe and Effective Alternative to Total Hip Arthroplasty in Young Patients: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12062093. [PMID: 36983096 PMCID: PMC10052473 DOI: 10.3390/jcm12062093] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/02/2023] [Accepted: 03/04/2023] [Indexed: 03/30/2023] Open
Abstract
This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed at comparing resurfacing hip arthroplasty (RHA) and total hip arthroplasty (THA) in terms of rate of complications, revisions, functional outcomes, blood loss, operative time and metal ions levels. The search was conducted on three databases (PubMed, Cochrane and Web of Science) updated until 13 October 2022. The inclusion criteria were RCTs) written in the English language, with no time limitation, comparing RHA and THA. Among the retrieved 4748 articles, 18 RCTs were eligible for a total of 776 patients (mean age 53.1 ± 5.0). A meta-analysis was performed. RHA reported significantly lower blood loss compared to THA (p < 0.001) but with longer operative time (p < 0.001). No statistically significant difference was found between RHA and THA in terms of complications (12.08% and 16.24%, respectively) and revisions (6.32% and 6.14%, respectively). Both RHA and THA provide excellent clinical results in a population of young and active patients. Functional outcomes were not significantly different between the groups. Moreover, no significant difference in metal ion levels was found. These findings provide evidence concerning the safety and clinical effectiveness of RHA. Because of its bone-preserving properties, the lack of drawbacks and good outcomes, RHA appears to be a valid alternative to THA in young and active patients.
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Affiliation(s)
- Michele Palazzuolo
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, 6600 Locarno, Switzerland
| | - Alessandro Bensa
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, 6900 Lugano, Switzerland
| | - Stefan Bauer
- Service d'Orthopédie et de Traumatologie, Chirurgie de l'Épaule, Ensemble Hospitalier de la Côte, 1110 Morges, Switzerland
- Department of Orthopedic Surgery, Royal Perth Hospital, Perth, WA 6000, Australia
| | - William G Blakeney
- Department of Orthopedic Surgery, Royal Perth Hospital, Perth, WA 6000, Australia
| | - Giuseppe Filardo
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, 6900 Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Martin Riegger
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, 6900 Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
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Metal-on-Metal Hips: Ten-Year Clinical and Radiographic Outcomes of the ADEPT Metal-on-Metal Hip Resurfacing and Modular Total Hip Arthroplasty. J Clin Med 2023; 12:jcm12030889. [PMID: 36769537 PMCID: PMC9917924 DOI: 10.3390/jcm12030889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/28/2022] [Accepted: 01/17/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The aim of this study is to update the 10-year follow-up survivorship and metal ions levels of a cohort of metal-on-metal (MoM) hip resurfacing (HR) and large-diameter-head (LDH) total hip arthroplasty (THA). METHODS The study is a retrospective analysis of prospectively collected data that compared the outcomes of 24 MoM HR (21 patients) and 15 (11 patients) modular LHD MoM THA at >10 years follow-up. Baseline characteristics as well as intraoperative and postoperative information were collected, including complications, revisions, clinical and radiographic outcomes, and serum metal ions level (Cobalt, Chromium). Metal ion levels were compared using a two-tailed unpaired t-test and Wilcoxon signed-rank test (jamovi v2.3.3.0, Sydney, NSW, AU). RESULTS No significant differences were detected in gender, BMI, and ASA score between the two groups. Patients in the modular THA group were significantly older (57 years vs. 46 years; p < 0.05). The HR overall survivorship was 91.7% (22 of 24 hips) with survivorship from implant failure and/or aseptic loosening and/or metal debris related 100% of problems. The modular THA overall survivorship was 86.7% (13 of 15 hips) with survivorship from implant aseptic loosening and metal ions complications of 93.4% (14 of 15 hips). No significant difference was noted when comparing clinical outcomes. Metal ions were significantly lower in the HR group (Co 25.8 nmol/L vs. 89 nmol/L; p < 0.001-Cr 33.5 nmol/L vs. 55.2 nmol/L; p = 0.026). CONCLUSION Both implants reported excellent and comparable clinical outcomes at >10 years follow-up. The Adept HR reported remarkable survivorship, in line with the registry data, proving once again its reliability in young active males. The modular LDH THA, despite being discontinued, presented higher reliability and a lower failure rate when compared with similar withdrawn MoM implants. Trunnionosis did not appear to be a significant problem in this particular modular design.
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Brown ML, Dunn JM, Early S, Challa S, Ezzet KA. The impact of failed novel technology and technical errors on the revision burden in total hip arthroplasty: what percentage of revision hip arthroplasty was potentially avoidable? Hip Int 2022; 32:771-778. [PMID: 33736475 DOI: 10.1177/1120700021996654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Despite the high success rate of total hip arthroplasty (THA), new implant technologies continue to be developed. Although potentially useful, such novel developments may result in unintended consequences, leading to revision surgery, often prematurely. In several instances, new technology that appeared promising was later found to be inferior to existing technology and resulting in early revision surgery. Additionally, technical surgical errors may also lead to early revisions. Some have argued that revisions related to such phenomena are potentially avoidable. The present analysis investigates to what extent the contribution of "failed new technology" and "technical errors" contributes to the revision burden and to the need for premature revision arthroplasty. METHODS We retrospectively analysed 432 revision THAs and categorised them as either "late revisions" based on survivorship of 10 years or "premature revisions". Among both cohorts, we determined what percentage of revisions were potentially avoidable and due to failed novel technologies and technical errors, and what percent were "unavoidable". RESULTS Of the 432 revisions, 267 (62%) were considered premature and 38% were considered late. Of the premature revisions, 108 were considered potentially avoidable (81 failed novel technologies, 27 technical errors). CONCLUSIONS Our data demonstrates that new technology and surgical techniques can result in premature failure of THA. Surgeons should take caution when incorporating new implant technology or surgical techniques into their practice.
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Affiliation(s)
- Matthew L Brown
- Department of Orthopaedic Surgery, St Luke's University Health Network, Fountain Hill, PA, USA
| | | | - Samuel Early
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA
| | - Sravya Challa
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA
| | - Kace A Ezzet
- Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA, USA
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The Surgical Treatment of Osteoarthritis. LIFE (BASEL, SWITZERLAND) 2022; 12:life12070982. [PMID: 35888072 PMCID: PMC9319328 DOI: 10.3390/life12070982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/20/2022] [Accepted: 06/28/2022] [Indexed: 11/17/2022]
Abstract
Osteoarthritis is a degenerative condition affecting the whole joint with the underlying bone, representing a major source of pain, disability, and socioeconomic cost worldwide. Age is considered the strongest risk factor, albeit abnormal biomechanics, morphology, congenital abnormality, deformity, malalignment, limb-length discrepancy, lifestyle, and injury may further increase the risk of the development and progression of osteoarthritis as well. Pain and loss of function are the main clinical features that lead to treatment. Although early manifestations of osteoarthritis are amenable to lifestyle modification, adequate pain management, and physical therapy, disease advancement frequently requires surgical treatment. The symptomatic progression of osteoarthritis with radiographical confirmation can be addressed either with arthroscopic interventions, (joint) preservation techniques, or bone fusion procedures, whereas (joint) replacement is preferentially reserved for severe and end-stage disease. The surgical treatment aims at alleviating pain and disability while restoring native biomechanics. Miscellaneous surgical techniques for addressing osteoarthritis exist. Advanced computer-integrated surgical concepts allow for patient personalization and optimization of surgical treatment. The scope of this article is to present an overview of the fundamentals of conventional surgical treatment options for osteoarthritis of the human skeleton, with emphasis on arthroscopy, preservation, arthrodesis, and replacement. Contemporary computer-assisted orthopaedic surgery concepts are further elucidated.
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Gani MH, Zahoor U, Hanna SA, Scott G. Metal-on-metal hip resurfacing arthroplasty provides excellent long-term survivorship and function in patients with a good-sized femoral head : results of a single, non-designer surgeon's cohort. Bone Jt Open 2022; 3:68-76. [PMID: 35045731 PMCID: PMC9047081 DOI: 10.1302/2633-1462.31.bjo-2021-0135.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Aims To establish the survivorship, function, and metal ion levels in an unselected series of metal-on-metal hip resurfacing arthroplasties (HRAs) performed by a non-designer surgeon. Methods We reviewed 105 consecutive HRAs in 83 patients, performed by a single surgeon, at a mean follow-up of 14.9 years (9.3 to 19.1). The cohort included 45 male and 38 female patients, with a mean age of 49.5 years (SD 12.5) Results At the time of review 13 patients with 15 hips had died from causes unrelated to the hip operation, and 14 hips had undergone revision surgery, giving an overall survival rate of rate of 86.7% (95% confidence interval (CI) 84.2 to 89.1). The survival rate in men was 97.7% (95% CI 96.3 to 98.9) and in women was 73.4% (95% CI 70.6 to 75.1). The median head size of the failed group was 42 mm (interquartile range (IQR) 42 to 44), and in the surviving group was 50 mm (IQR 46 to 50). In all, 13 of the 14 revised hips had a femoral component measuring ≤ 46 mm. The mean blood levels of cobalt and chromium ions were 26.6 nmol/l (SD 24.5) and 30.6 nmol/l (SD 15.3), respectively. No metal ion levels exceeded the safe limit. The mean Oxford Hip Score was 41.5 (SD 8.9) and Harris Hip Score was 89.9 (14.8). In the surviving group, four patients had radiolucent lines around the stem of the femoral component, and one had lysis around the acetabular component; eight hips demonstrated heterotopic ossification. Conclusion Our results confirm the existing understanding that HRA provides good long-term survival and function in patients with adequate-sized femoral heads. This is evidenced by a 97.7% survival rate among men (larger heads) in our series at a mean follow-up of 14.9 years. Failure is closely related to head sizes ≤ 46 cm. Cite this article: Bone Jt Open 2022;3(1):68–76.
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Affiliation(s)
- M Haseeb Gani
- Department of Orthopaedics, The Royal London Hospital, London, UK
| | - Ubaid Zahoor
- Department of Orthopaedics, The Royal London Hospital, London, UK
| | - Sammy A Hanna
- Department of Orthopaedics, The Royal London Hospital, London, UK
| | - Gareth Scott
- Department of Orthopaedics, The Royal London Hospital, London, UK.,Barts and the London School of Medicine and Dentistry, London, UK
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Comparison of the long-term cause of failure and survivorship of four hundred and twenty seven metal-on-metal hip arthroplasties: resurfacing versus large head total hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2021; 45:3075-3081. [PMID: 34155524 PMCID: PMC8626394 DOI: 10.1007/s00264-021-05044-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/12/2021] [Indexed: 12/20/2022]
Abstract
Introduction Comparison of mid- to long-term cause of failure and survivorship of metal-on-metal (MoM) resurfacing hip arthroplasty (RHA) and large head total hip arthroplasty (THA) remains sparse. This study aimed to identify and compare the cause of failure and survivorship of MoM RHA and THA at a minimum ten year follow-up. Methods Four hundred twenty-seven MoM hip arthroplasties (286 THA and 141 RHA) were retrospectively analyzed at a mean follow-up of 13 ± three years. Causes of failure were reported as MoM specific (i.e., adverse reaction to metal debris (ARMD) and painful hip with ion elevation) or MoM non-specific (i.e., fracture, infection, and dislocation). Chromium (Cr) and cobalt (Co) ion levels and Co/Cr ratio were compared. Survivorship was compared according to the cause of failure with revision as the endpoint. Results The rate of ARMD was significantly higher in THA (OR = 2.9 [95%-CI: 1–7]; p = 0.02). No significant difference was detected in failure rate due to other causes between the two groups (p = 0.2–0.9). Ion levels and Co/Cr ratio were both significantly higher in THA (p < 0.01). Survivorship was significantly lower in THA compared to RHA at ten years [89% (95%-CI: 85%–91%) vs 96% (95%-CI: 91%–98%); p = 0.01] and 15 years [73% (95%-CI: 67%–78%) vs 83% (95%-CI: 73%–90%); p = 0.01]. Conclusion RHA survivorship was significantly higher at any time point. Failure rate due to ARMD was significantly higher in THA while no significant difference in other causes of failure was observed between the two groups. This result emphasizes the role of fretting corrosion at the head-neck junction (i.e., trunnionosis) with significantly higher ion levels and Co/Cr ratio dissociation in THA.
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Bitar C, Krupic F, Felländer-Tsai L, Crnalic S, Wretenberg P. Living with a recalled implant: a qualitative study of patients' experiences with ASR hip resurfacing arthroplasty. Patient Saf Surg 2021; 15:2. [PMID: 33407687 PMCID: PMC7788783 DOI: 10.1186/s13037-020-00278-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/07/2020] [Indexed: 11/15/2022] Open
Abstract
Background Total hip arthroplasty is the traditional treatment for osteoarthritis in the hip joint. Hip resurfacing arthroplasty, with metal on metal bearing, is a modern concept initially developed mainly for young active people. The metal-on-metal hip arthroplasty implant, Articular Surface Replacement (ASR), was implanted in approximately 93,000 patients before it was recalled in 2010 due to a high complication rate. This study aimed to evaluate patients’ own experiences living with an implant that they knew had a high complication rate and had been recalled from the market. Methods A total of 14 patients, still living with the implant, of a cohort of 34 patients were available for follow-up. Qualitative semi-structured interviews were conducted with 14 patients where a majority actively sought for metal-on-metal hip resurfacing arthroplasty (HRA), and subsequently underwent HRA with an ASR prosthesis between 11/21/2006 and 09/28/2009. The responses were analyzed using content analysis described by Graneheim and Lundman to compress text and identify categories and subcategories. Results The results showed that most patients had already decided that they wanted a metal-on-metal HRA implant before meeting the surgeon. They expressed that the implant made it possible to live an active life. A majority did not think about the fact that they had a hip implant, because they lacked subjective pain. Most of the patients were positive about the annual exams at the hospital and wanted them to continue. None of them felt that their trust towards the healthcare system had changed after the implant recall. They expressed a belief that they would need new surgery sooner than they first thought. Conclusions Despite all the attention when the ASR prosthesis was recalled, patients with ASR-HRA did not report themselves negatively affected by the recall in this group of patients where a majority had actively sought for an HRA procedure. The healthcare system has an obligation to continue the annual exams, even if the implant provider does not continue reimbursement. Supplementary Information The online version contains supplementary material available at 10.1186/s13037-020-00278-y.
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Affiliation(s)
- Christian Bitar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. .,Department of Orthopedics, Karolinska University Hospital, Stockholm, Sweden.
| | - Ferid Krupic
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Li Felländer-Tsai
- Division of Orthopedics and Biothechnology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Orthopedics, Karolinska University Hospital, Stockholm, Sweden
| | - Sead Crnalic
- Department of Surgical and Perioperative Sciences (Orthopaedics), Umeå University, Umeå, Sweden
| | - Per Wretenberg
- Department of Orthopaedics, School of Medical Sciences, Örebro University and Örebro University Hospital, Örebro, Sweden
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Liang J, Zhao Y, Gao X, Fang X, Xu Y, Lu S. Design of custom-made navigational template of femoral head and pilot research in total hip resurfacing arthroplasty. BMC Surg 2020; 20:144. [PMID: 32605554 PMCID: PMC7325234 DOI: 10.1186/s12893-020-00807-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/23/2020] [Indexed: 11/26/2022] Open
Abstract
Background To develop a novel custom-made navigational template for accurate prosthesis implantation in total hip resurfacing arthroplasty (THRA) by computer-aided technology. Methods The template was produced based on data preoperatively acquired from computed tomography (CT) scan. The position of the drill guide was obtained according to the anatomical axis of the femoral neck which was defined by the point of the femoral head center and another point of the femoral neck center. The final direction of the drill guide was confirmed by a valgus angle. The surface of the template was constructed based on the inverse of the femoral neck surface. Then the template was made of acrylate resin by using rapid prototyping (RP) technique. Finally, all the templates were verified in 17 cadavers arranged for THRA and postoperative medical images were employed to evaluate the accuracy and validity of the template. Results The templates had achieved a high fitting with the femoral neck surface, and there were no guide failures. Postoperative evaluation revealed that the Kirschner-wires pass through the center of the femoral head and femoral neck, presenting a relative expected and acceptable valgus angle to the central axis of the femoral neck. The lateral offset showed the relative valgus angle achieved as expected, the horizontal offset showed that no obvious antero-posterior deviation occured. The comparison between the preoperative Neck-shaft angle (NSA) and the postoperative Stem-shaft angle (SSA) showed there is no significant difference(P > 0.05). Conclusion The novel custom-made navigational template of femoral head can effectively assist surgeons for accurately implanting the femoral head components to the desired position in THRA.
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Affiliation(s)
- Jinlong Liang
- Department of Orthopedics, 920 Hospital of Joint Logistic Support Force, Kunming, 650032, China
| | - Yonghui Zhao
- Department of Orthopedics, 920 Hospital of Joint Logistic Support Force, Kunming, 650032, China
| | - Xinjian Gao
- Xi'an Jiaotong University, Xian, 710049, China
| | - Xuewei Fang
- Xi'an Jiaotong University, Xian, 710049, China
| | - Yongqing Xu
- Department of Orthopedics, 920 Hospital of Joint Logistic Support Force, Kunming, 650032, China
| | - Sheng Lu
- Department of orthopedics, the first people's hospital of yunnan province; Yunnan Provincial Key laboratory of digital orthopedics, Kunming, 650032, China.
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Native Osseous CaP Biomineral Coating on a Biomimetic Multi-Spiked Connecting Scaffold Prototype for Cementless Resurfacing Arthroplasty Achieved by Combined Electrochemical Deposition. MATERIALS 2019; 12:ma12233994. [PMID: 31810185 PMCID: PMC6927003 DOI: 10.3390/ma12233994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/22/2019] [Accepted: 11/27/2019] [Indexed: 11/29/2022]
Abstract
The multi-spiked connecting scaffold (MSC-Scaffold) prototype with spikes mimicking the interdigitations of articular subchondral bone is an essential innovation in surgically initiated fixation of resurfacing arthroplasty (RA) endoprosthesis components. This paper aimed to present a determination of the suitable range of conditions for the calcium phosphate (CaP) potentiostatic electrochemical deposition (ECDV=const) on the MSC-Scaffold prototype spikes to achieve a biomineral coating with a native Ca/P ratio. The CaP ECDV=const process on the MSC-Scaffold Ti4Al6V pre-prototypes was investigated for potential VECDfrom −9 to −3 V, and followed by 48 h immersion in a simulated body fluid. An acid–alkaline pretreatment (AAT) was applied for a portion of the pre-prototypes. Scanning electron microscopy (SEM), energy dispersive X-ray spectroscopy (EDS) and X-ray diffraction (XRD) studies of deposited coatings together with coatings weight measurements were performed. Themost suitable VECD range, from −5.25 to −4.75 V, was determined as the native biomineral Ca/P ratio of coatings was achieved. AAT increases the weight of deposited coatings (44% for VECD = −5.25 V, 9% for VECD = −5.00 V and 15% for VECD = −4.75 V) and the coverage degree of the lateral spike surfaces (40% for VECD = −5.25 V, 14% for VECD = −5.00 V and 100% for VECD = −4.75 V). XRD confirmed that the multiphasic CaP coating containing crystalline octacalcium phosphate is produced on the lateral surface of the spikes of the MSC-Scaffold. ECDV=const preceded by AAT prevents micro-cracks on the bone-contacting surfaces of the MSC-Scaffold prototype, increases its spikes’ lateral surface coverage, and results in the best modification effect at VECD = −5.00 V. To conclude, the biomimetic MSC-Scaffold prototype with desired biomineral coating of native Ca/P ratio was obtained for cementless RA endoprostheses.
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14
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[Total hip arthroplasty in young patients : Bearings and custom-made prostheses]. DER ORTHOPADE 2019; 48:292-299. [PMID: 30737518 DOI: 10.1007/s00132-019-03692-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Carefully and correctly implanted components are the prerequisite for the lifespan of a prosthesis. Whether higher levels of activity lead to prior failure of total hip arthroplasty in young patients is controversially discussed. The right choice of bearings is still of great relevance. BEARINGS Ceramic-on-ceramic as well as polyethylene-on-ceramic bearings achieve comparable results, although ceramic-on-ceramic bearings should be avoided in patients with high demands on their range of motion. Polyethylene-on-metal bearings also show good clinical results, if corrosion between head and stem is absent. Metal-on-metal bearings lead to adverse systemic effects due to metal wear and should be implanted in individual cases only, e. g. as hip resurfacing. Alternative bearings have to give proof of effectivity first. Custom-made prostheses constitute an option for young patients with special conditions of hip anatomy. Planning and study results of these prostheses are elucidated in this review article.
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Bessa FS, Fuentes RD, Miyahara HDS, Croci AT, Ejnisman L, Vicente JRN. Clinical and radiographic outcomes of hip resurfacing arthroplasty after eight years – a retrospective study. REVISTA BRASILEIRA DE ORTOPEDIA (ENGLISH EDITION) 2018; 53:768-772. [PMID: 30377613 PMCID: PMC6204544 DOI: 10.1016/j.rboe.2017.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 09/19/2017] [Indexed: 11/30/2022]
Abstract
Objective To assess the clinical and radiographic outcomes of hip resurfacing arthroplasty for the treatment of hip osteoarthritis. Methods This study retrospectively assessed 30 patients with hip osteoarthritis who underwent hip resurfacing arthroplasty between 2005 and 2014. Patients of both genders suffering from advanced primary and secondary hip osteoarthritis were included in the study. Data were collected about postoperative complications and the need for revision of the arthroplasty. Antero-posterior pelvis and lateral hip x-rays were performed in order to classify osteolysis according to the Amstutz criteria; the Lequèsne index of severity for osteoarthritis of the hip and the UCLA activity level questionnaires were answered pre- and postoperatively. Results After a mean follow-up of eight years, a statistically significant improvement was observed between the mean of the outcomes of both scores, when compared pre- and postoperatively (p < 0.001). Nevertheless, there was a high incidence of arthroplasty revision (20%), related to the size of the femoral stem and errors in surgical technique. Conclusion Using the appropriate technique, hip resurfacing arthroplasty can present good results in well-selected patients.
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Affiliation(s)
- Felipe Spinelli Bessa
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Ortopedia Traumatologia, São Paulo, SP, Brazil
| | - Ronald Delgadillo Fuentes
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Ortopedia Traumatologia, São Paulo, SP, Brazil
| | - Helder de Souza Miyahara
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Ortopedia Traumatologia, São Paulo, SP, Brazil
| | - Alberto Tesconi Croci
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Ortopedia Traumatologia, São Paulo, SP, Brazil
| | - Leandro Ejnisman
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Ortopedia Traumatologia, São Paulo, SP, Brazil
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Avaliação do resultado clínico e radiográfico das próteses de recapeamento de quadril após oito anos – estudo retrospectivo. Rev Bras Ortop 2018. [DOI: 10.1016/j.rbo.2017.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Martin JW, Williams MA, Barker KL. Activity levels following hip resurfacing arthroplasty: A tool to help manage patient expectations. J Orthop 2018; 15:658-662. [PMID: 29881215 DOI: 10.1016/j.jor.2018.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 05/06/2018] [Indexed: 11/26/2022] Open
Abstract
Background When compared to total hip arthroplasty (THA), hip resurfacing arthroplasty (HRA) is usually undertaken in younger, more active patients with hip osteoarthritis. Previous research has noted that patients are able to return to pre-operative activity levels, with many even increasing their activity post HRA, but patterns in post-operative recovery have been less well investigated. Materials and Methodology A randomised controlled trial dataset was analysed to explore activity levels attained after HRA. Data was collected on 80 male patients. The primary outcome of focus was the University of California, Los Angeles (UCLA) Activity Index, with follow-up at 6 weeks, 16 weeks and 1 year. Results Mean UCLA at baseline was 5.4 (SD; 2.1) which, after an initial fall to 4.7 (SD; 1.6, p = 0.008) at 6 weeks, increased at both the 16 week and 1 year follow ups (p < 0.001), with a final mean activity index of 7.2 (SD; 1.7). Mode UCLA at 1 year was 7 or 8, representing patients who are regularly taking part in activities such as cycling and golf. Conclusion Following HRA, patients can achieve significant improvements in activity measured using the UCLA Activity Index. Activity levels have been shown to initially decrease following HRA, with improvement throughout the first postoperative year. The results of this study provide clinicians with a simple tool to help patients visualise their post-operative recovery. This may have implications when managing patient expectations of post-operative activity level in both HRA and large head THA populations.
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Affiliation(s)
- Jack W Martin
- Department of Sport and Health Sciences, Oxford Brookes University, Oxford, UK.,Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Mark A Williams
- Department of Sport and Health Sciences, Oxford Brookes University, Oxford, UK
| | - Karen L Barker
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
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