ICLH double-cup arthroplasty, 1980-1987

Two-Year Results of Ceramic-on-Ceramic Hip Resurfacing in an International Multicenter Cohort

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.

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

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.

Ceramic-on-ceramic bearings in hip arthroplasty: state of the art and the future

This systematic review of the literature summarises the clinical experience with ceramic-on-ceramic hip bearings over the past 40 years and discusses the concerns that exist in relation to the bearing combination. Loosening, fracture, liner chipping on insertion, liner canting and dissociation, edge-loading and squeaking have all been reported, and the relationship between these issues and implant design and surgical technique is investigated. New design concepts are introduced and analysed with respect to previous clinical experience.

BONE-PRESERVING HIP ARTHROPLASTIES AS AN ALTERNATIVE TO CONVENTIONAL HIP REPLACEMENT FOR YOUNG PATIENTS — A REVIEW ARTICLE

Hip replacement is one of the most successful orthopedics' procedures in terms of restoring quality of life. In the past, indications for hip replacement were restricted to elderly people, but nowadays advances in bioengineering technology have driven development of hip implants with less wear and loosening and therefore with longer longevity. Early wear and loosening as well as stress shielding and bone preservation are considered as major issues especially when dealing with young patients. The main reason for this is the fact that younger patients might require one or more hip revision procedures during the course of their life due to their age and high activity level.

Especially in young patients it could be an advantage to use primary implants that are more bone preserving and allow more physiological load transfer which cause no or minimal stress shielding at the proximal femur. The two options which exist today are hip resurfacing which preserves the femoral head and various short stem prostheses which transfer the forces in the femur more proximally and more physiologically.

This review looks at the options which are available today in bone preserving hip arthroplasties.

Resurfacing hip prostheses revisited: failure analysis during a 16-year follow-up

We conducted a prospective study of the clinical and radiographic variables related to the survival of 114 cementless resurfacing double-cup hip replacements (RHR) with a mean follow-up of 9 (range: 1--16) years. Three patients died, and 22 were unavailable for the final review in 2003. Sixty-one RHRs had to be revised to a total hip replacement. Failure analysis of these revised RHRs showed femoral head and neck resorption under the prosthesis in 33, acetabular protrusion in seven, both femoral and acetabular resorption in 14 and a femoral-neck fracture in three. One hip had dislocated, and there were three hips with unexplained pain. The Kaplan-Meier 5-year mean survival was 92%, the 10-year survival was 47% (95% CI 37--57%) and the 15-year survival was 30% (95% CI 20--40%). Pre-operative joint destruction (grade 1), a high degree of radiological osteoporosis, a body mass index >25 and prosthesis mismatch were significantly related to failure of the RHR. We believe that in young, non-obese patients with pre-operative radiological central destruction but without severe proximal femoral osteoporosis, a resurfacing arthroplasty may have some value. Our failures were mainly due to femoral resorption under the prosthetic femoral component.

Metal-on-metal resurfacing versus total hip replacement-the value of a randomized clinical trial

This article describes a randomized clinical trial in young patients, comparing metal-on-metal cemented resurfacing hip replacement with cemented total hip replacement. The trial was stopped early, mainly because of a high incidence of failure of the cemented resurfacing acetabular component. The results reinforce the importance of clinical trials for evaluating the safety and efficacy of prosthesis designs before being used in a large cohort of patients. Although there may be advantages of resurfacing hip replacement, trials are also required to demonstrate it has a midterm success that reasonably approaches that of total hip replacement.

Acetabular morphology and resurfacing design

The bony surfaces of 18 archaeological hemipelves were scanned using a 3D laser surface scanner and CyDir software on a Silicon Graphics workstation. The acetabular area was selected and point data from the approximately spherical bone surface saved. These data were input to a MATLAB routine that calculated the radius and centre of the best-fit sphere. The goodness of fit was estimated using the mean and standard deviation of the distance of the bone surface points from the sphere surface. Eight points, at approximately equal distances around the acetabular rim, were selected with reference to bony landmarks. A plane containing three of these points served as an orientation reference plane. The vectors joining the eight rim points to the centre of the best-fit sphere were found. The angles between these vectors and the normal to the reference plane were calculated. Paired angles were summed to give the angle subtended by the acetabular rim in four directions. The overall mean angle was 158 degrees (range of mean angles 145 degrees -173 degrees ). The largest individual angles, some exceeding 180 degrees, were in the superior-inferior direction, while the mean angle in the anterior-posterior direction, i.e. that controlling flexion-extension, was 152 degrees. Males had larger subtended angles than females, although the difference was not statistically significant. Simulated reaming increased all angles by approximately 10 degrees. The subtended angles are important parameters in the design of the acetabular component of a hip replacement and particularly important in resurfacing hip replacement when the volume available is tightly constrained.

Alpine and cross-country skiing after total hip replacement: 2 cohorts of 50 patients each, one active, the other inactive in skiing, followed for 5-10 years

2 groups of 50 patients each, matched for age, weight, height, gender and type of implant, were clinically and radiographically examined after THR. Group A regularly carried out alpine skiing and/or cross-country skiing, while group B did no winter sports. At 5 years, no signs of loosening were found in group A, whereas 5/60 implants in group B had signs of loosening, mostly of the femoral component (p < 0.05). At 10 years, 30 patients remained in group A and 27 in group B. No new cases of loosening were found in group B, but 2/30 cases in group A. There was a higher (p < 0.05) average wear rate in group A (2.1 mm) than in group B (1.5 mm). The wear rate was particularly high (3-4 mm) in physically very active patients in group A with localized osteolysis at the interface. It seems likely that in an even longer follow-up, the number of cases of aseptic loosening would be greater in group A than group B. Our findings, combined with the results of previously-published biomechanical studies, do not provide any evidence that controlled alpine and/ or cross-country skiing has a negative effect on the acetabular or femoral component of hip replacements. The results of the biomechanical studies indicate, however, that it is advantageous to avoid short-radius turns on steep slopes or moguls.