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Uklejewski R, Winiecki M, Dąbrowski M, Rogala P. Towards the First Generation of Biomimetic Fixation for Resurfacing Arthroplasty Endoprostheses. Biomimetics (Basel) 2024; 9:99. [PMID: 38392145 PMCID: PMC10887084 DOI: 10.3390/biomimetics9020099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/21/2024] [Accepted: 02/06/2024] [Indexed: 02/24/2024] Open
Abstract
This paper presents advances in designs of resurfacing arthroplasty endoprostheses that occurred through their historical generations. The critical characteristics of contemporary generation hip resurfacing arthroplasty endoprostheses are given and the failures resulting from the specific generation cemented and short stem fixation of the femoral component are reviewed. On the background of these failures, the critical need arises for an alternative approach to the fixation of components of resurfacing arthroplasty leading towards the first generation of biomimetic fixation for resurfacing arthroplasty endoprostheses. The state of the art of the completed bioengineering research on the first biomimetic fixation for resurfacing arthroplasty endoprostheses is presented. This new design type of completely cementless and stemless resurfacing arthroplasty endoprostheses of the hip joint (and other joints), where endoprosthesis components are embedded in the surrounding bone via the prototype biomimetic multi-spiked connecting scaffold (MSC-Scaffold), initiates the first at all generations of biomimetic endoprostheses of diarthrodial joints.
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Affiliation(s)
- Ryszard Uklejewski
- Department of Constructional Materials and Biomaterials, Faculty of Materials Engineering, Kazimierz Wielki University, Jan Karol Chodkiewicz Street 30, 85-064 Bydgoszcz, Poland
| | - Mariusz Winiecki
- Department of Constructional Materials and Biomaterials, Faculty of Materials Engineering, Kazimierz Wielki University, Jan Karol Chodkiewicz Street 30, 85-064 Bydgoszcz, Poland
| | - Mikołaj Dąbrowski
- Adult Spine Orthopaedics Department, Wiktor Dega Orthopaedic and Rehabilitation Clinical Hospital, Poznan University of Medical Sciences, 28 Czerwca 1956 Street 135/147, 61-545 Poznan, Poland
| | - Piotr Rogala
- Institute of Health Sciences, Hipolit Cegielski State College of Higher Education, Card. Stefan Wyszyński Street 38, 62-200 Gniezno, Poland
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Regis D, Lugani G, Valentini A, Sandri A, Ambrosini C, Bagnis F, Dorigotti A, Negri S, Magnan B. Mid-term clinical and radiographic outcome of metal-on-metal hip resurfacing through an anterolateral approach. Musculoskelet Surg 2023; 107:439-446. [PMID: 37285004 DOI: 10.1007/s12306-023-00789-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 05/17/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE The aim of this retrospective study was to evaluate the medium-term clinical and radiographic results of current generation metal-on-metal resurfacing prostheses performed through anterolateral approach. MATERIALS AND METHODS Fifty-seven hips in 52 patients underwent resurfacing arthroplasty. Two patients died from unrelated causes, leaving 55 hips in 35 males (3 bilateral) and 15 females (2 bilateral), with a mean age at surgery of 56.2 years (range, 27-70 years). Clinical and radiographic assessment was carried out preoperatively and at follow-up in all the survived cases. The cumulative survival rate was determined according to the method of Kaplan-Meier. RESULTS At a mean follow-up of 5.2 years (range, 1.8-9.1 years), 2 HRs of the same female patient were revised because of early loosening of the acetabular component. Deep venous thrombosis and transient femoral nerve palsy occurred both in 1 case. No specific complications of HR were observed. Average Harris hip score improved significantly from 59.8 points (range, 30.4-90.6) preoperatively to 93.7 points (range, 53-100) at the latest examination. Neck narrowing showed an average of 3.27%, but it never exceeded 10%. Nonprogressive acetabular radiolucencies and osteolysis were detected both in 2 hips. A high rate of patients (32, 60.4%) developed heterotopic ossifications, although low-grade in most cases (27, 84.4%). The cumulative survival rate at 9.1 years with revision for any reason as the end point was 93.0%. CONCLUSIONS The early clinical and radiographic results of modern metal-on-metal hip resurfacing performed through an anterolateral approach are promising, but longer-term follow-up studies are necessary.
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Affiliation(s)
- D Regis
- Department of Orthopaedic and Trauma Surgery, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale A Stefani 1, 37126, Verona, Italy.
| | - G Lugani
- Department of Orthopaedic and Trauma Surgery, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale A Stefani 1, 37126, Verona, Italy
| | - A Valentini
- Department of Orthopaedics and Traumatology, Ospedale Valli del Noce, Viale de Gasperi 31, 38023, Cles, Italy
| | - A Sandri
- Department of Orthopaedic and Trauma Surgery, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale A Stefani 1, 37126, Verona, Italy
| | - C Ambrosini
- Department of Orthopaedic and Trauma Surgery, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale A Stefani 1, 37126, Verona, Italy
| | - F Bagnis
- Department of Orthopaedic and Trauma Surgery, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale A Stefani 1, 37126, Verona, Italy
| | - A Dorigotti
- Department of Orthopaedic and Trauma Surgery, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale A Stefani 1, 37126, Verona, Italy
| | - S Negri
- Department of Orthopaedic and Trauma Surgery, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale A Stefani 1, 37126, Verona, Italy
| | - B Magnan
- Department of Orthopaedic and Trauma Surgery, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale A Stefani 1, 37126, Verona, Italy
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Cherian NJ, Eberlin CT, Kucharik MP, Abraham PF, Nazal MR, Dean MC, Martin SD. Labral Reconstruction via Capsular Augmentation Maintains Perfusion to the Acetabular Labrum and Locally Transferred Autograft: An in Vivo Laser Doppler Flowmetry Analysis. JB JS Open Access 2023; 8:e23.00026. [PMID: 37753110 PMCID: PMC10516391 DOI: 10.2106/jbjs.oa.23.00026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/28/2023] Open
Abstract
Background The purpose of the present study was to examine the effects of arthroscopic labral repair with capsular augmentation on blood flow in vivo with use of laser Doppler flowmetry (LDF) to measure microvascular perfusion of the labrum and autograft tissue. Methods The present prospective case series included patients ≥18 years old who underwent arthroscopic acetabular labral repair with capsular augmentation; all procedures were performed by a single surgeon between 2018 and 2022. The LDF probe measured microvascular blood flow flux within 1 mm3 of the surrounding labral and capsular tissue of interest. Mean baseline measurements of flux were compared with readings immediately following capsular elevation and after completing labral augmentation. Blood flux changes were expressed as the percent change from the baseline measurements. Results The present study included 41 patients (24 men [58.5%] and 17 women [41.5%]) with a mean age (and standard deviation) of 31.3 ± 8.4 years, a mean BMI of 24.6 ± 3.4 kg/m2, a mean lateral center-edge of angle 35.3° ± 4.9°, a mean Tönnis angle of 5.8° ± 5.8°, and a mean arterial pressure of 93.7 ± 10.9 mm Hg. Following capsular elevation, the mean percent change in capsular blood flow flux was significantly different from baseline (-9.24% [95% confidence interval (CI), -18.1% to -0.04%]; p < 0.001). Following labral augmentation, the mean percent change in labral blood flow flux was significantly different from baseline both medially (-22.3% [95% CI, -32.7% to -11.9%]; p < 0.001) and laterally (-32.5% [95% CI, -41.5% to -23.6%]; p = 0.041). There was no significant difference between the changes in medial and lateral perfusion following repair (p = 0.136). Conclusions Labral repair with capsular augmentation sustains a reduced blood flow to the native labrum and capsular tissue at the time of fixation. The biological importance of this reduction is unknown, but these findings may serve as a benchmark for other labral preservation techniques and support future correlations with clinical outcomes. Level of Evidence Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Nathan J. Cherian
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
- Department of Orthopaedic Surgery, University of Nebraska, Omaha, Nebraska
| | - Christopher T. Eberlin
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
- Department of Orthopaedic Surgery, University of Iowa, Iowa City, Iowa
| | - Michael P. Kucharik
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
- Department of Orthopaedic Surgery, University of South Florida, Tampa, Florida
| | - Paul F. Abraham
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, California
| | - Mark R. Nazal
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, Kentucky
| | - Michael C. Dean
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Scott D. Martin
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
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[Translated article] Improvement of survival after 10 years with the Durom-type hip resurfacing prosthesis in selected patients: Experience of a public university hospital. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022. [DOI: 10.1016/j.recot.2021.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Marqués López F, Cuenca Llavall M, Mestre Cortadellas C, Tey Pons M, León García A. Mejoría de la supervivencia a los 10 años con la prótesis de recubrimiento de cadera tipo Durom en pacientes seleccionados. Experiencia de un hospital público universitario. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022; 66:182-188. [DOI: 10.1016/j.recot.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/30/2021] [Accepted: 09/07/2021] [Indexed: 10/19/2022] Open
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Meertens R, Casanova F, Knapp KM, Thorn C, Strain WD. Use of near-infrared systems for investigations of hemodynamics in human in vivo bone tissue: A systematic review. J Orthop Res 2018; 36:2595-2603. [PMID: 29727022 DOI: 10.1002/jor.24035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 04/27/2018] [Indexed: 02/04/2023]
Abstract
A range of technologies using near infrared (NIR) light have shown promise at providing real time measurements of hemodynamic markers in bone tissue in vivo, an exciting prospect given existing difficulties in measuring hemodynamics in bone tissue. This systematic review aimed to evaluate the evidence for this potential use of NIR systems, establishing their potential as a research tool in this field. Major electronic databases including MEDLINE and EMBASE were searched using pre-planned search strategies with broad scope for any in vivo use of NIR technologies in human bone tissue. Following identification of studies by title and abstract screening, full text inclusion was determined by double blind assessment using predefined criteria. Full text studies for inclusion were data extracted using a predesigned proforma and quality assessed. Narrative synthesis was appropriate given the wide heterogeneity of included studies. Eighty-eight full text studies fulfilled the inclusion criteria, 57 addressing laser Doppler flowmetry (56 intra-operatively), 21 near infrared spectroscopy, and 10 photoplethysmography. The heterogeneity of the methodologies included differing hemodynamic markers, measurement protocols, anatomical locations, and research applications, making meaningful direct comparisons impossible. Further, studies were often limited by small sample sizes with potential selection biases, detection biases, and wide variability in results between participants. Despite promising potential in the use of NIR light to interrogate bone circulation, the application of NIR systems in bone requires rigorous assessment of the reproducibility of potential hemodynamic markers and further validation of these markers against alternative physiologically relevant reference standards. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2595-2603, 2018.
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Affiliation(s)
- Robert Meertens
- Medical Imaging, University of Exeter Medical School, South Cloisters, St Luke's Campus, Heavitree Road, Exeter EX2 1LU, United Kingdom
| | - Francesco Casanova
- Diabetes and Vascular Research Centre, University of Exeter Medical School and National Institute of Health Research Exeter Clinical Research Facility, Barrack Rd, Exeter EX2 5DW, United Kingdom
| | - Karen M Knapp
- Medical Imaging, University of Exeter Medical School, South Cloisters, St Luke's Campus, Heavitree Road, Exeter EX2 1LU, United Kingdom
| | - Clare Thorn
- Diabetes and Vascular Research Centre, University of Exeter Medical School and National Institute of Health Research Exeter Clinical Research Facility, Barrack Rd, Exeter EX2 5DW, United Kingdom
| | - William David Strain
- Diabetes and Vascular Research Centre, University of Exeter Medical School and National Institute of Health Research Exeter Clinical Research Facility, Barrack Rd, Exeter EX2 5DW, United Kingdom
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Budzik JF, Lefebvre G, Behal H, Verclytte S, Hardouin P, Teixeira P, Cotten A. Assessment of the zonal variation of perfusion parameters in the femoral head: a 3-T dynamic contrast-enhanced MRI pilot study. Skeletal Radiol 2018; 47:261-270. [PMID: 29143112 DOI: 10.1007/s00256-017-2802-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 10/11/2017] [Accepted: 10/16/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective was to describe MR perfusion characteristics of the femoral head, with a focus on the subchondral bone. MATERIALS AND METHODS This prospective monocentric study was approved by our local Ethics Committee. Written informed consent was obtained from all subjects. Dynamic contrast-enhanced MRI of the right hip was performed in 59 adults with suspected spondyloarthritis (32 women, 28 men). Mean age was 37.5 (±12.5) years. Regions of interest were drawn in the femoral head epiphysis, in the subchondral areas the most exposed to mechanical load (superolateral, anterosuperior, and posterior zones) and in areas less exposed to mechanical load (inferior subchondral zone and center of the femoral head). Semi-quantitative and pharmacokinetic parameters were calculated using the Tofts model. Statistical analysis was performed with a linear mixed model to compare the perfusion parameters in the different femoral head zones. RESULTS Extravascular extracellular volume and area under the curve were lower in the superolateral zone than in the inferior zone (p = 0.0135 and p < 0.0001 respectively) and the central zone (p = 0.007 and p = 0.0134 respectively). Extravascular extracellular volume and rate constant were lower in the anterosuperior zone than in the inferior zones (p = 0.011 and p = 0.029). In the anterosuperior zone, extravascular extracellular volume was lower, and time to peak was higher than in the central zones (p = 0.0056 and p = 0.0013 respectively). No significant differences were found for any values between other paired zones. CONCLUSION The perfusion of femoral head subchondral bone assessed with dynamic contrast-enhanced magnetic resonance imaging is not homogeneous: the areas exposed to more mechanical loading are less perfused.
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Affiliation(s)
- Jean-François Budzik
- Imaging Department, Lille Catholic Hospitals, Lille Catholic University, F-59000, Lille, France.
- Lille University, Littoral Côte d'Opale University, EA 4490, PMOI, Physiopathologie des Maladies Osseuses Inflammatoires, F-59000, Lille, France.
| | - Guillaume Lefebvre
- Musculoskeletal Imaging Department, Centre de Consultation et d'Imagerie de l'Appareil Locomoteur, CHU Lille, University of Lille Nord de France, F-59000, Lille, France
| | - Hélène Behal
- Biostatistics Department, Lille Regional University Hospital, University of Lille Nord de France, F-59000, Lille, France
| | - Sébastien Verclytte
- Imaging Department, Lille Catholic Hospitals, Lille Catholic University, F-59000, Lille, France
| | - Pierre Hardouin
- Littoral Côte d'Opale University, Lille University, EA 4490, PMOI, Physiopathologie des Maladies Osseuses Inflammatoires, F-59000, Lille, France
| | - Pedro Teixeira
- Service d'Imagerie Guilloz, Hôpital Central, Centre Hospitalier Universitaire de Nancy, 29 Ave du Maréchal de Lattre de Tassigny, F-54035, Nancy, France
| | - Anne Cotten
- Lille University, Littoral Côte d'Opale University, EA 4490, PMOI, Physiopathologie des Maladies Osseuses Inflammatoires, F-59000, Lille, France
- Musculoskeletal Imaging Department, Centre de Consultation et d'Imagerie de l'Appareil Locomoteur, CHU Lille, University of Lille Nord de France, F-59000, Lille, France
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Waewsawangwong W, Ruchiwit P, Huddleston JI, Goodman SB. Hip arthroplasty for treatment of advanced osteonecrosis: comprehensive review of implant options, outcomes and complications. Orthop Res Rev 2016; 8:13-29. [PMID: 30774467 PMCID: PMC6209358 DOI: 10.2147/orr.s35547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Surgical treatment for late stage (post-collapse) osteonecrosis of the femoral head is controversial. In these situations, the outcome of joint preservation procedures is poor. There are several arthroplasty options for late-stage disease. The clinical outcomes of hemiarthroplasty and hemiresurfacing are unpredictable because of progressive acetabular cartilage degeneration. Total hip resurfacing may be associated with further vascular insult to the femoral head and early failure of the implant. Total hip replacement with metal-on-conventional polyethylene bearing surfaces has been the gold standard, but implant survivorship is limited in young active patients due to wear and osteolysis. Newer alternative bearing surfaces may have improved wear characteristics, but their durability must be confirmed in longer-term studies.
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Affiliation(s)
| | - Pirapat Ruchiwit
- Department of Orthopedic Surgery, Stanford University, Stanford, CA, USA,
| | - James I Huddleston
- Department of Orthopedic Surgery, Stanford University, Stanford, CA, USA,
| | - Stuart B Goodman
- Department of Orthopedic Surgery, Stanford University, Stanford, CA, USA,
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Abstract
Hip resurfacing arthroplasty (HRA) presents several advantages over conventional total hip arthroplasty (THA), including conservation and preservation of bone, reduced risk of dislocation, easy replication of hip biomechanics and easy revision if needed. It is a particularly appealing procedure for young patients. HRA has been performed for over 40 years following the same technological advances as THA. The bearing material used by most designs is metal-on-metal (MoM), which has the best compromise between strength and wear properties. However, MoM HRA has a specific set of possible complications. Aseptic femoral failures were initially the most prevalent cause for revision but progress in patient selection and surgical technique seem to have resolved this problem. Wear-related failures (high metal ion levels and adverse local tissue reactions) are now the main concern, and are essentially associated with poor acetabular component design and orientation, to which MoM is more sensitive than other bearing materials. The concept of functional coverage is key to understanding how MoM bearings are affected by edge wear. Only a 3-D assessment of cup position (e.g., the contact patch to rim distance) provides the necessary information to determine the role of cup positioning in relationship with abnormal bearing wear.The concept of hip resurfacing is more valid today than ever as the age of the patients in need of hip arthroplasty keeps getting lower. The recent publication of several excellent long-term survivorship results suggests that selection of a well-designed resurfacing system and accuracy in the placement of the cup can achieve long-term durability.
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Zylberberg AD, Nishiwaki T, Kim PR, Beaulé PE. Clinical results of the conserve plus metal on metal hip resurfacing: an independent series. J Arthroplasty 2015; 30:68-73. [PMID: 25212284 DOI: 10.1016/j.arth.2014.08.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 08/05/2014] [Accepted: 08/07/2014] [Indexed: 02/01/2023] Open
Abstract
The purpose of the present study was to report the clinical and radiographic results of an independent series of the Conserve Plus hip resurfacing. Five hundred forty-eight consecutive hip resurfacings were performed using the Conserve Plus prosthesis in 458 patients (350 males) with a mean age of 48.3 years (range 19 to 66). No patients were lost to follow-up. At a mean follow-up of 6.6 years (3.9 to 11.9) thirty (5.4%) hips required conversion to a total hip arthroplasty (THA) (20 males, 10 females, mean age=48.3±7.3 years). Five-year survival with as revision endpoint was 94.5% (95% CI: 93.5% to 95.5%). This study confirms the good clinical results previously reported with the Conserve Plus hip resurfacing device.
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M Takamura K, Maher P, Nath T, Su EP. Survivorship of standard versus modified posterior surgical approaches in metal-on-metal hip resurfacing. Bone Joint Res 2014; 3:150-4. [PMID: 24842931 PMCID: PMC4037883 DOI: 10.1302/2046-3758.35.2000282] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives Metal-on-metal hip resurfacing (MOMHR) is available as an alternative
option for younger, more active patients. There are failure modes
that are unique to MOMHR, which include loosening of the femoral
head and fractures of the femoral neck. Previous studies have speculated
that changes in the vascularity of the femoral head may contribute
to these failure modes. This study compares the survivorship between
the standard posterior approach (SPA) and modified posterior approach
(MPA) in MOMHR. Methods A retrospective clinical outcomes study was performed examining
351 hips (279 male, 72 female) replaced with Birmingham Hip Resurfacing
(BHR, Smith and Nephew, Memphis, Tennessee) in 313 patients with
a pre-operative diagnosis of osteoarthritis. The mean follow-up
period for the SPA group was 2.8 years (0.1 to 6.1) and for the
MPA, 2.2 years (0.03 to 5.2); this difference in follow-up period
was statistically significant (p < 0.01). Survival analysis was
completed using the Kaplan–Meier method. Results At four years, the Kaplan–Meier survival curve for the SPA was
97.2% and 99.4% for the MPA; this was statistically significant
(log-rank; p = 0.036). There were eight failures in the SPA and
two in the MPA. There was a 3.5% incidence of femoral head collapse
or loosening in the SPA and 0.4% in the MPA, which represented a
significant difference (p = 0.041). There was a 1.7% incidence of
fractures of the femoral neck in the SPA and none in the MPA (p
= 0.108). Conclusion This study found a significant difference in survivorship at
four years between the SPA and the MPA (p = 0.036). The clinical
outcomes of this study suggest that preserving the vascularity of
the femoral neck by using the MPA results in fewer vascular-related
failures in MOMHRs. Cite this article: Bone Joint Res 2014;3:150–4
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Affiliation(s)
- K M Takamura
- UCLA David Geffen School of Medicine, 10833 Le Conte Avenue, Los Angeles, California 90095, USA
| | - P Maher
- Weill Cornell Medical College, 1300 York Ave, New York, New York 10021, USA
| | - T Nath
- Center for Hip Preservation, 535 East 70th Street, New York, New York 10021, USA
| | - E P Su
- Hospital for Special Surgery, 535 East 70th street, New York, New York 10021, USA
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Haider IT, Speirs AD, Beaulé PE, Frei H. Influence of ingrowth regions on bone remodelling around a cementless hip resurfacing femoral implant. Comput Methods Biomech Biomed Engin 2014; 18:1349-57. [DOI: 10.1080/10255842.2014.903931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Patel NK, Wright J, Sabharwal S, Afsharpad A, Bajekal R. Hip resurfacing arthroplasty at a non-specialist centre. Ann R Coll Surg Engl 2014; 96:67-72. [PMID: 24417834 PMCID: PMC5137647 DOI: 10.1308/003588414x13824511649850] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Few studies have reported the outcome of hip resurfacing arthroplasty (HRA) with respect to implant characteristics from non-specialist centres. We report the survival, clinical and radiological outcomes of a single surgeon series of HRA with an average follow-up duration of five years. METHODS All consecutive HRAs performed by a single surgeon between 2003 and 2011 at a district general hospital were retrospectively examined clinically and radiologically. RESULTS A total of 85 patients underwent 109 HRAs (58 male [53.2%] and 51 female patients [46.8%]) with a mean follow-up period of 62 months (range: 12-102 months). The median age was 57 years (range: 25-75 years). The mean acetabular and femoral head component sizes were 54 mm (range: 48-64 mm) and 48 mm (range: 42-58 mm) respectively with a mean acetabular inclination angle of 42.9° (range: 20-75°). The survival rate was 95% with five revisions due to aseptic loosening (n=3) and fracture (n=2): these were predominantly for female patients (n=4), with significantly smaller mean acetabular (51 mm, p=0.04) and femoral (44 mm, p=0.02) implant sizes. Furthermore, they had a higher mean acetabular inclination angle of 48.1° (p=0.74). The mean Oxford hip score was 43.8 (range: 25-48) and the mean University of California Los Angeles (UCLA) activity score was 6.8 (range: 3-10). Radiological findings included heterotopic ossification in 13 (11.9%), radiolucent lines in 6 (5.5%), femoral neck thinning in 2 (1.8%) and femoral neck notching in 5 patients (4.6%). CONCLUSIONS We have shown that HRA at a non-specialist centre has short to medium-term outcomes comparable with those at specialist centres. HRA therefore remains a viable option although vigilance is required in case selection and follow-up according to national guidance.
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Affiliation(s)
- N K Patel
- Department of Trauma and Orthopaedic Surgery, Barnet and Chase Farm NHS Trust, Barnet, Hertfordshire, UK.
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Increased post-operative ischemia in the femoral head found by microdialysis by the posterior surgical approach: a randomized clinical trial comparing surgical approaches in hip resurfacing arthroplasty. Arch Orthop Trauma Surg 2013; 133:1735-45. [PMID: 24100766 DOI: 10.1007/s00402-013-1851-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Hip resurfacing arthroplasty (HRA) is associated with osteonecrosis of the femoral head and femoral neck fracture, which may be caused by a decrease in the perfusion of the bone initiated at surgery. Several studies have demonstrated a decreased blood flow during surgery depending on the choice of surgical approach. We investigated the effect of the surgical approach on the blood flow and metabolism in the femoral head and neck in HRA by Laser Doppler flowmetry (LDF) and microdialysis. MATERIALS AND METHODS We conducted a randomized clinical trial on 38 patients, allocated to HRA by either the posterior (Post) or the antero-lateral (AntLat) surgical approach. LDF was performed during surgery and microdialysis after surgery to assess the concentration of the following metabolic markers: glucose, lactate, pyruvate and glycerol. RESULTS At 44-50 h after surgery, the mean lactate/pyruvate (L/P) and lactate/glucose (L/G) ratio was higher in the Post group compared to the AntLat group; L/P 195.3 (SEM 123) in Post and 128.5 (108.0) in AntLat; L/G 16.9 (6.5) in Post and 8.9 (3.7) in AntLat (p L/P = 0.02 and p L/G = 0.03). There was no difference in the LDF measurements (p = 0.74). INTERPRETATION HRA in the posterior approach results in increased post-operative ischemia in the femoral head and neck although during surgery, no difference in the blood flow was found. Still, the antero-lateral approach also causes considerable ischemia and other possible explanations, such as damage to the retinacular vessels during surgery or altered microcirculation because of heating from the cementation process, needs to be investigated.
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Amarasekera HW, Roberts P, Costa ML, Parsons N, Achten J, Griffin DR, Williams NR. Scintigraphic assessment of bone status at one year following hip resurfacing: Comparison of two surgical approaches using SPECT-CT scan. Bone Joint Res 2012; 1:86-92. [PMID: 23610676 PMCID: PMC3626242 DOI: 10.1302/2046-3758.15.2000046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 05/09/2012] [Indexed: 12/02/2022] Open
Abstract
Objectives To study the vascularity and bone metabolism of the femoral head/neck
following hip resurfacing arthroplasty, and to use these results
to compare the posterior and the trochanteric-flip approaches. Methods In our previous work, we reported changes to intra-operative
blood flow during hip resurfacing arthroplasty comparing two surgical
approaches. In this study, we report the vascularity and the metabolic
bone function in the proximal femur in these same patients at one
year after the surgery. Vascularity and bone function was assessed
using scintigraphic techniques. Of the 13 patients who agreed to
take part, eight had their arthroplasty through a posterior approach
and five through a trochanteric-flip approach. Results One year after surgery, we found no difference in the vascularity
(vascular phase) and metabolic bone function (delayed phase) at
the junction of the femoral head/neck between the two groups of
patients. Higher radiopharmaceutical uptake was found in the region
of the greater trochanter in the trochanteric-flip group, related
to the healing osteotomy. Conclusions Our findings using scintigraphic techniques suggest that the
greater intra-operative reduction in blood flow to the junction
of the femoral head/neck, which is seen with the posterior approach
compared with trochanteric flip, does not result in any difference
in vascularity or metabolic bone function one year after surgery.
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Affiliation(s)
- H W Amarasekera
- Warwick Orthopaedics, University of Warwick, Clinical Sciences Research Institute, Clinical Sciences Building, Clifford Bridge Road, Coventry CV2 2DX, UK
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16
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Gross TP, Liu F. Is there added risk in resurfacing a femoral head with cysts? J Orthop Surg Res 2011; 6:55. [PMID: 22004681 PMCID: PMC3216843 DOI: 10.1186/1749-799x-6-55] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 10/17/2011] [Indexed: 11/19/2022] Open
Abstract
Background Femoral head cysts have been identified as a risk factor for early femoral failures after metal-on-metal hip resurfacing arthroplasty (HRA) based on limited scientific data. However, we routinely performed HRA if less than 1/3 of the femoral head appeared destroyed by cysts on the preoperative radiograph. This study was undertaken to analyze whether there was an added risk of early femoral failures in HRA when femoral head cysts were present. Methods This retrospective case-control study included 939 MOM HRAs operated by a single surgeon with use of the posterior minimally invasive surgical (MIS) approach between November 2005 and January 2009. Patients with all diagnoses except osteonecrosis were included. Among them, 117 HRAs had femoral head cysts ≥ 1 cm identified in surgery. All cysts were treated with bone grafting using acetabular reamings packed into the cavitary defect (instead of filling the cysts with cement). The control group, which had no cyst observed at the time of surgery, was randomly selected from our database using computer algorithms to match those cases in the study group for the parameters of surgical date, age, gender, body mass index, diagnosis, femoral fixation method, and the size of the femoral component. Results The minimum follow-up was 24 months for both groups. The early femoral failure rate in the study group was 3/117 (2.6%) and 0/117 in the control group; there was no statistical difference between these two groups (P = 0.08). In the study group, there were two femoral neck fractures (revised): both occurred in patients having a cyst size of 1 cm3; and there was one femoral component loosening at 3-year follow up in a patient having a cyst size of 2 cm3. Conclusion Although the risk of early femoral failures among the group with cysts appeared higher than the group without cysts, we could not demonstrate a significant statistical difference between the two groups. It is possible that bone grafting cysts rather than cementing them may account for the low failure rate, and that this technique may minimize the risk of resurfacing a femoral head with cysts.
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Affiliation(s)
- Thomas P Gross
- Midlands Orthopaedics, P.A. Columbia, South Carolina, USA
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17
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High revision rate at 5 years after hip resurfacing with the Durom implant. Clin Orthop Relat Res 2011; 469:2598-604. [PMID: 21279484 PMCID: PMC3148364 DOI: 10.1007/s11999-011-1792-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Accepted: 01/18/2011] [Indexed: 01/31/2023]
Abstract
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.
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18
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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: 1.3] [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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Jiang Y, Zhang K, Die J, Shi Z, Zhao H, Wang K. A systematic review of modern metal-on-metal total hip resurfacing vs standard total hip arthroplasty in active young patients. J Arthroplasty 2011; 26:419-26. [PMID: 20851564 DOI: 10.1016/j.arth.2010.07.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Accepted: 07/15/2010] [Indexed: 02/01/2023] Open
Abstract
This systematic review compared 2 treatments for hip disease in active young patients: modern metal-on-metal total hip resurfacing and standard total hip arthroplasty. We conducted a literature search to identify relevant randomized and clinical controlled trials and included 968 patients from 4 trials in our analysis. Our results indicated increased rates of revision, femoral neck fractures, and component loosening among patients who received modern metal-on-metal hip resurfacing. No significant differences in the rates of mortality, dislocation, or deep hip joint infection were found between treatment groups. Hip function scores were similar between the 2 groups, but the resurfacing group showed higher activity levels. These results have provided insufficient evidence to determine whether modern metal-on-metal total hip resurfacing offers clinical advantages over standard total hip arthroplasty.
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Affiliation(s)
- Yong Jiang
- Department of Orthopedic Surgery, Xi'an Red Cross Hospital, Xi'an, Shaanxi, People's Republic of China
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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: 3.1] [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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21
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Schlegel UJ, Rothstock S, Siewe J, Schiwy-Bochat KH, Eysel P, Morlock MM. Does impaction matter in hip resurfacing? A cadaveric study. J Arthroplasty 2011; 26:296-302. [PMID: 20570106 DOI: 10.1016/j.arth.2010.01.108] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Revised: 11/24/2009] [Accepted: 01/29/2010] [Indexed: 02/01/2023] Open
Abstract
Eight pairs of fresh frozen human femora were prepared for hip resurfacing. One side of each pair was impacted gently, the other side vigorously. After implantation procedure, specimens were loaded in a material testing machine to the ultimate fracture load. Median impaction loads on the vigorously implanted side were 11,298N compared to 1374N on the gently implanted side. Failure loads in the high-impact group (median, 8873N) were significantly (P = .0078) reduced when compared with the low-impact group (median, 9237N). The study stresses that meticulous reaming of the femoral head and the pinhole is of tremendous importance. Remaining obstacles can lead to excessive loads, while attempting to enforce the correct seating of the implant. Only careful, slight tapping should be applied to ensure final seating.
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Affiliation(s)
- Ulf J Schlegel
- Department of Orthopedic and Trauma Surgery, University of Cologne, Cologne, Germany
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22
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Olsen M, Davis ET, Whyne CM, Zdero R, Schemitsch EH. The biomechanical consequence of insufficient femoral component lateralization and exposed cancellous bone in hip resurfacing arthroplasty. J Biomech Eng 2010; 132:081011. [PMID: 20670060 DOI: 10.1115/1.4001159] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Insufficient lateralization of the femoral component coupled with exposed reamed cancellous bone has been speculated to predispose to femoral neck fracture. The current study examined the effect of mediolateral implant position and exposed cancellous bone on the strength of the resurfaced proximal femur. Composite femurs were prepared in three configurations: (1) partial, with the implant placed at the native femoral head offset of the femur, partially exposing reamed cancellous bone; (2) proud, with a medialized implant exposing a circumferential ring of cancellous bone; and (3) complete, with a lateralized implant covering all reamed cancellous bone. Specimens were loaded to failure in axial compression. A finite element model was used to further explore the effect of exposed cancellous bone, cement mantle thickness, and relative valgus orientation on the strain distributions in the resurfaced femur. The proud group (2063 N) was significantly weaker than both the partial (2974 N, p=0.004) and complete groups (5899 N, p=0.001) when tested to failure. The partial group was also significantly weaker than the complete group when tested to failure (p=0.001). The finite element model demonstrated increasing levels of strain in the superior reamed cortical-cancellous bone interface with increasing degree of exposed cancellous bone. The condition of the femoral component medialized as the result of a thick cement mantle had the greatest detrimental impact on strain level in the superior reamed cancellous bone while a valgus oriented implant provided a protective effect. This study provides biomechanical evidence that exposed reamed cancellous bone significantly reduces the load-to-failure and increases maximum strains in the resurfaced proximal femur. The perceived benefit of reconstructing the femur to its native geometry may inherently weaken the proximal femur and increase femoral neck fracture risk if the femoral component is not sufficiently lateralized to cover all unsupported reamed cancellous bone. Relative valgus orientation of the implant may help to minimize the risk of neck fracture if reamed cancellous bone remains exposed following implant impaction.
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Affiliation(s)
- Michael Olsen
- Martin Orthopaedic Biomechanics Laboratory, St. Michael's Hospital, 5-066 Shuter Wing, 30 Bond Street, Toronto, ON, M5B1W8, Canada.
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Abstract
We review the history and literature of hip resurfacing arthroplasty. Resurfacing and the science behind it continues to evolve. Recent results, particularly from the national arthroplasty registers, have spread disquiet among both surgeons and patients. A hip resurfacing arthroplasty is not a total hip replacement, but should perhaps be seen as a means of delaying it. The time when hip resurfacing is offered to a patient may be different from that for a total hip replacement. The same logic can apply to the timing of revision surgery. Consequently, the comparison of resurfacing with total hip replacement may be a false one. Nevertheless, the need for innovative solutions for young arthroplasty patients is clear. Total hip replacement can be usefully delayed in many of these patients by the use of hip resurfacing arthroplasty.
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Affiliation(s)
- J M Simpson
- The Richard Villar Practice, Spire Cambridge Lea Hospital, 30 New Road, Cambridge CB24 9EL, UK.
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Kannan A, Bal CS, Kumar V, Mittal R, Damle N, Malhotra R. Femoral-head vascularity after hip surface arthroplasty. J Orthop Traumatol 2010; 11:221-7. [PMID: 20957405 PMCID: PMC3014470 DOI: 10.1007/s10195-010-0107-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Accepted: 08/31/2010] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND iatrogenic devascularization of the femoral head is as an area of concern following hip resurfacing arthroplasty, with probable implications on short-term failure and long-term survival of the implant. MATERIALS AND METHODS we assessed the vascularity of 25 resurfaced femoral heads in 20 patients by comparison with preoperative and postoperative Tc-99m methylene diphosphonate (MDP) bone scintigraphy images, the postoperative scans being done 9 months after the surgery. RESULTS eight out of 25 hips (32%) showed <55% of their preoperative uptake at a mean of 9 months after surgery and were categorized as showing reduced vascularity. CONCLUSION our study reveals reduction in vascularity of the femoral-head remnant as a frequent occurrence after hip resurfacing. Our study also highlights the role of bone scintigraphy as tool in assessing the vascularity of resurfaced femoral heads.
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Affiliation(s)
- Arun Kannan
- Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
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25
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Bitsch RG, Jäger S, Lürssen M, Loidolt T, Schmalzried TP, Clarius M. Influence of bone density on the cement fixation of femoral hip resurfacing components. J Orthop Res 2010; 28:986-91. [PMID: 20162694 DOI: 10.1002/jor.21094] [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: 02/04/2023]
Abstract
In clinical outcome studies, small component sizes, female gender, femoral shape, focal bone defects, bad bone quality, and biomechanics have been associated with failures of resurfacing arthroplasties. We used a well-established experimental setup and human bone specimens to analyze the effects of bone density on cement fixation of femoral hip resurfacing components. Thirty-one fresh frozen femora were prepared for resurfacing using the original instruments. ASR resurfacing prostheses were implanted after dual-energy X-ray densitometer scans. Real-time measurements of pressure and temperature during implantation, analyses of cement penetration, and measurements of micro motions under torque application were performed. The associations of bone density and measurement data were examined calculating regression lines and multiple correlation coefficients; acceptability was tested with ANOVA. We found significant relations between bone density and micro motion, cement penetration, cement mantle thickness, cement pressure, and interface temperature. Mean bone density of the femora was 0.82 +/- 0.13 g/cm(2), t-score was -0.7 +/- 1.0, and mean micro motion between bone and femoral resurfacing component was 17.5 +/- 9.1 microm/Nm. The regression line between bone density and micro motion was equal to -56.7 x bone density + 63.8, R = 0.815 (p < 0.001). Bone density scans are most helpful for patient selection in hip resurfacing, and a better bone quality leads to higher initial component stability. A sophisticated cementing technique is recommended to avoid vigorous impaction and incomplete seating, since increasing bone density also results in higher cement pressures, lower cement penetration, lower interface temperatures, and thicker cement mantles.
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Affiliation(s)
- Rudi G Bitsch
- Stiftung Orthopädische Universitätsklinik, Schlierbacher Landstrasse 200A, 69118 Heidelberg, Germany.
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Shimmin AJ, Walter WL, Esposito C. The influence of the size of the component on the outcome of resurfacing arthroplasty of the hip. ACTA ACUST UNITED AC 2010; 92:469-76. [DOI: 10.1302/0301-620x.92b4.22967] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The survivorship of contemporary resurfacing arthroplasty of the hip using metal-on-metal bearings is better than that of first generation designs, but short-term failures still occur. The most common reasons for failure are fracture of the femoral neck, loosening of the component, osteonecrosis of the femoral head, reaction to metal debris and malpositioning of the component. In 2008 the Australian National Joint Registry reported an inverse relationship between the size of the head component and the risk of revision in resurfacing hip arthroplasty. Hips with a femoral component size of ≤ 44 mm have a fivefold increased risk of revision than those with femoral components of ≥ 55 mm irrespective of gender. We have reviewed the literature to explore this observation and to identify possible reasons including the design of the implant, loading of the femoral neck, the orientation of the component, the production of wear debris and the effects of metal ions, penetration of cement and vascularity of the femoral head. Our conclusion is that although multifactorial, the most important contributors to failure in resurfacing arthroplasty of the hip are likely to be the design and geometry of the component and the orientation of the acetabular component.
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Affiliation(s)
- A. J. Shimmin
- Melbourne Orthopaedic Group Research Foundation, 33 The Avenue, Windsor, 3181 Victoria, Australia
| | - W. L. Walter
- Specialist Orthopaedic Group Mater Clinic, Suite 1.08, 3-9 Gillies Street, North Sydney, New South Wales 2060, Australia
| | - C. Esposito
- Specialist Orthopaedic Group Mater Clinic, Suite 1.08, 3-9 Gillies Street, North Sydney, New South Wales 2060, Australia
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Amanatullah DF, Cheung Y, Di Cesare PE. Hip resurfacing arthroplasty: a review of the evidence for surgical technique, outcome, and complications. Orthop Clin North Am 2010; 41:263-72. [PMID: 20399365 DOI: 10.1016/j.ocl.2010.01.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Hip resurfacing arthroplasty has reemerged as a valid reconstruction option for the osteoarthritic hip. Patient selection is critical for excellent surgical outcomes, especially when compared with total hip arthroplasty. However, concerns regarding surgical technique and postsurgical complications persist. The authors review the evidence for surgical technique, outcomes, and complications related to modern metal-on-metal hip resurfacing arthroplasty.
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Affiliation(s)
- Derek F Amanatullah
- Department of Orthopaedic Surgery, University of California Davis Medical Center, 4860 Y Street, Suite 3800, Sacramento, CA 95817, USA
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28
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Letter to the editor: Association of osteonecrosis and failure of hip resurfacing arthroplasty. Clin Orthop Relat Res 2010; 468:902-3; author reply 904-5. [PMID: 20012718 PMCID: PMC2816786 DOI: 10.1007/s11999-009-1194-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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29
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30
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White CA, Beaulé PE. Femoral Head Vascularity. Impact and Implications for Hip Resurfacing Arthroplasty. Tech Orthop 2010. [DOI: 10.1097/bto.0b013e3181d1e4ae] [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: 11/25/2022]
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Scheerlinck T, Delport H, Kiewitt T. Influence of the cementing technique on the cement mantle in hip resurfacing: an in vitro computed tomography scan-based analysis. J Bone Joint Surg Am 2010; 92:375-87. [PMID: 20124065 DOI: 10.2106/jbjs.i.00322] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The cement mantle within a hip resurfacing head is important for implant survival. Too much cement leads to thermal bone necrosis, whereas not enough cement might cause mechanical failure and particle-induced osteolysis. We evaluated the impact of different cementing techniques on the quality of the cement mantle in hip resurfacing. METHODS Sixty bovine condyles were prepared to fit a size-46 ReCap (Biomet) implant and divided into five groups of twelve specimens each. In two of the groups, a polymeric replica was filled halfway with low-viscosity cement; suction was employed in one of those groups and not used in the other. Medium-viscosity cement was used in the remaining three groups: it was spread out within the implant in one group, it was packed on the bone in another, and a combination of those techniques was used in the third. Half of the sixty specimens had six anchoring holes. The specimens underwent computed tomography and were analyzed with custom-made segmentation software. RESULTS The cementing technique and anchoring holes influenced the cement quantity within the implant and the thickness of the cement mantle; suction and bone density did not. Both filling techniques involving the use of low-viscosity cement resulted in excessive cement within the implant (filling index, 47.30% to 60.66%) and large cement defects at the base. The combined technique also resulted in large cement quantities (filling index, 46.62% to 54.12%) but fewer cement defects at the base. The filling technique involving the use of medium-viscosity cement decreased the cement quantity (filling index, 43.31% to 45.68%), but cement packing was the best technique (filling index, 29.20% to 31.05%), resulting in the thinnest, most homogeneous cement mantle. However, distal cement defects remained, and the prevalence of proximal cement-implant interfacial gaps was about 10%. CONCLUSIONS The results of this experimental study cannot be extrapolated directly to the in vivo situation, and they apply only to implants with an inner geometry similar to that of the size-46 ReCap resurfacing head and to the cement brands that we used. None of the cementing techniques was "perfect." Both of the filling techniques involving use of low-viscosity cement and the combined technique resulted in excessive cement proximally. The filling technique involving use of medium-viscosity cement was promising, but the cement-packing technique offered the best opportunity to control the quality of the cement mantle. However, the presence of interfacial gaps raised new questions. We suggest that the use of anchoring holes in cancellous bone should be considered with caution in order to avoid overfilling with cement.
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Affiliation(s)
- Thierry Scheerlinck
- Department of Orthopaedic Surgery and Traumatology, Universitair Ziekenhuis Brussel,1090 Brussels, Belgium.
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32
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The vascular network in the femoral head and neck after hip resurfacing. J Arthroplasty 2010; 25:146-51. [PMID: 19056230 DOI: 10.1016/j.arth.2008.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2008] [Accepted: 09/19/2008] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to determine whether femoral neck fracture after cemented resurfacing hip arthroplasty (RHA) arises from intraosseous vascularity around the femoral head-neck junction. We implanted a replica of the femoral head component into osteoarthritic femoral heads and compared the intraosseous vascularity network between the femoral heads with and without the RHA procedure using microangiography through a retinacular artery with micro-computed tomography. Our results showed no significant difference in the vascularity around the femoral head-neck junction between the groups with and without the RHA procedure. These results suggest that deterioration of the intraosseous vascular network around the head-neck junction after RHA was not severe enough to induce complete avascularity.
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Delgado Martínez A. Abordajes quirúrgicos en la artroplastia de superficie de la cadera. Rev Esp Cir Ortop Traumatol (Engl Ed) 2009. [DOI: 10.1016/j.recot.2009.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Delgado Martínez A. Surgical approaches to hip resurfacing surgery. Rev Esp Cir Ortop Traumatol (Engl Ed) 2009. [DOI: 10.1016/s1988-8856(09)70201-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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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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Beaulé PE, Shim P, Banga K. Clinical experience of Ganz surgical dislocation approach for metal-on-metal hip resurfacing. J Arthroplasty 2009; 24:127-31. [PMID: 19553070 DOI: 10.1016/j.arth.2009.04.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Accepted: 04/03/2009] [Indexed: 02/01/2023] Open
Abstract
Although the posterior approach is the most commonly used for hip resurfacing, concerns remain in terms of risk of femoral neck fracture secondary to an osteonecrotic event. The purpose of this study was to look at the short-term results of metal-on-metal hip resurfacing done by the vascular-preserving surgical approach as developed by Ganz in 116 hip resurfacing arthroplasties performed in 106 patients (86 men, 20 women; mean age, 46.5 years; range, 19-62). At a mean follow-up of 38.3 months (range, 12-84), Harris Hip Scores improved significantly from 53.1 to 90.16 (P < .001). There were 10 nonunions (8.7%) and 21 hips (18.3%) requiring screw removal for painful bursitis. Two hips underwent conversion to total hip arthroplasty: one at 18 months for femoral loosening and one at 7 years for acetabular loosening. Although the trochanteric slide approach as developed by Ganz provides excellent exposure to the hip joint and preserves femoral head vascularity, it does carry some inherent morbidity in regard to the greater trochanter.
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Affiliation(s)
- Paul E Beaulé
- The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
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Schoeniger R, Espinosa N, Sierra RJ, Leunig M, Ganz R. Role of the extraosseus blood supply in osteoarthritic femoral heads? Clin Orthop Relat Res 2009; 467:2235-40. [PMID: 19384562 PMCID: PMC2866934 DOI: 10.1007/s11999-009-0839-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2008] [Accepted: 04/02/2009] [Indexed: 02/06/2023]
Abstract
Blood perfusion to the femoral head might be endangered during the surgical approach or the preparation of the femoral head or both in hip resurfacing arthroplasty. The contribution of the intramedullary blood supply to the femoral head in osteoarthritis is questionable. Therefore, the contribution of the extraosseous blood supply to osteoarthritic femoral heads was measured intraoperatively to question if there is measurable blood flow between the epiphysis and metaphysis in osteoarthritic hips in case of extraosseus vessel damage. At defined points during surgery we acquired the epiphyseal and metaphyseal femoral head perfusion by high-energy laser Doppler flowmetry. Complete femoral neck osteotomy sparing the retinacular vessels to simulate intraosseous blood disruption showed unchanged epiphyseal blood flow compared to initial measurement after capsulotomy. The pulsatile signal disappeared after transection of the retinacular vessels. Based on these acute measurements, we conclude intramedullary blood vessels to the femoral head do not provide measurable blood supply to the epiphysis once the medial femoral circumflex artery or the retinacular vessels have been damaged. We recommend the use of a safe surgical approach for hip resurfacing and careful implantation of the femoral component to respect blood supply to the femoral head and neck region in hip resurfacing arthroplasty.
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Affiliation(s)
- Ralf Schoeniger
- Department of Orthopaedic Surgery, Spital Bern-Ziegler, Morillonstrasse 75-91, 3001 Berne, Switzerland
| | - Norman Espinosa
- Department of Orthopaedic Surgery, University of Zurich, Balgrist, Zurich, Switzerland
| | - Rafael J. Sierra
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN USA
| | - Michael Leunig
- Hip Service, Clinic Schulthess, Zurich, Switzerland ,University of Berne, Berne, Switzerland
| | - Reinhold Ganz
- Department of Orthopaedic Surgery, University of Berne, Berne, Switzerland
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Verdonck HWD, Meijer GJ, Kessler P, Nieman FH, de Baat C, Stoelinga PJW. Assessment of bone vascularity in the anterior mandible using laser Doppler flowmetry. Clin Oral Implants Res 2009; 20:140-4. [DOI: 10.1111/j.1600-0501.2008.01631.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Current status of hip resurfacing arthroplasty. CURRENT ORTHOPAEDIC PRACTICE 2009. [DOI: 10.1097/bco.0b013e31819675d3] [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
After disastrous outcomes due to wear-induced osteolysis in the 1980s, hip resurfacing arthroplasty has undergone a renaissance, mainly because of the introduction of metal-on-metal bearings. However, there are still problems associated with this technique, such as femoral neck fractures, neck thinning, and aseptic loosening, and their causes are still being investigated. During the last years, increasing evidence has shown that both the frequently used posterior approach to the hip as well as preparation of the femoral epiphysis can impair blood supply to the femoral head. In the presence of mechanical stresses (impaction, heat development during cement polymerization) during the implantation, the epiphysis might not be able to compensate for this. This paper summarizes the current understanding of the blood supply to the femoral head and proposes a way to preserve the viability after hip resurfacing.
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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: 1.9] [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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42
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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: 3.1] [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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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: 1.1] [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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Rubin LE, Galante NJ, Smith BG, DeLuca PA. Direct intraosseous pressure monitoring of the femoral head during surgery for slipped capital femoral epiphysis. Orthopedics 2008; 31:663-6. [PMID: 18705558 DOI: 10.3928/01477447-20110505-11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Preventing avascular necrosis following surgical management of pediatric slipped capital femoral epiphysis is a critical goal. The direct intraosseous pressure monitor is a readily available and affordable technique that can easily be used by surgeons around the world.
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Affiliation(s)
- Lee E Rubin
- Department of Orthopaedics and Rehabilitation, Yale-New Haven Hospital, New Haven, Connecticut 06520, USA
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45
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[Metal-on-metal hybrid hip resurfacing. Development and current state]. DER ORTHOPADE 2008; 37:679-84. [PMID: 18560804 DOI: 10.1007/s00132-008-1286-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Worldwide the employment of surface replacements using metal-on-metal components as an option, particularly for the young and active patient, has gained broad acceptance. Part of the attraction for hip resurfacing is its conservative nature as a prosthetic solution for hip arthritis. It is anatomical, replicating the normal hip and limb length, preserving proximal femoral bone, and is a truly minimally bone invasive approach with excellent outcome of joint function. The purpose of this article is to show the data of 1,000 Conserve(c) Plus hybrid metal-on-metal prostheses in a consecutive study of 1,140 patients with a follow-up of 5.6 years. The current Kaplan and Meier survival estimates of the prosthesis, using any conversion to total hip replacement as the end point, were 98.1% at 3 years [95% confidence interval (CI): 96.8-98.9%], 96.7% at 4 years (95% CI: 94.8-97.8%), and 95.2% at 5 years (95% CI: 93.0-96.8%). The mean postoperative Harris hip score was 93.3. The current state of metal-on-metal surface replacement is positive. The new generation of hip resurfacing has a lot of improvements. The purpose of this review of the procedure is to point out the definite improvements from earlier designs using polyethylene as well as to highlight the overall results and durability achieved by one surgeon's extensive experience and to assess the results from other series and centers. We also want to point out the areas where further investigation is needed.
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Abstract
SUMMARY The tribologic quality of metal-on-metal bearings has enabled a second generation of hip resurfacing techniques. Compared with a conventional hip prosthesis, this type of arthroplasty has many advantages: sparing femoral (and acetabular) bone stock, preservation of hip joint biomechanics (femoral offset, leg length), better recovery for high-level sports activities, easier revision, less risk of dislocation, less risk of extension to the shaft in the event of osteolysis. Hip resurfacing can thus be considered as true "minimally invasive bone surgery". There are however specific complications of resurfacing, including femoral neck fracture and collapse of the femoral head. All of the conventional approaches can be used for hip resurfacing procedures, but a precise operative technique is mandatory. The key to success is a proper position of the femoral piece. Certain biomechanical rules for implantation are required in order to limit the cam effect, spare femoral bone, and maintain harmonious loading. Hip resurfacing can be indicated for young and/or active subjects for whom restoration of hip biomechanics offers a real advantage over conventional hip arthroplasty. The mid-term results have been encouraging, both clinically and radiographically.
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48
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The influence of surgical approach on outcome in Birmingham hip resurfacing. Clin Orthop Relat Res 2008; 466:920-6. [PMID: 18224379 PMCID: PMC2504647 DOI: 10.1007/s11999-008-0121-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2007] [Accepted: 01/07/2008] [Indexed: 01/31/2023]
Abstract
UNLABELLED Various approaches have been described for metal-on-metal hip resurfacing. We compared the posterolateral and direct lateral approaches for complications, pain, function, and implant survival in the short and medium term for two surgeons in a consecutive series of 790 patients (909 hips; July 1997 to July 2004) followed until July 2007. The direct lateral approach group included 135 resurfacing procedures and the posterolateral group included 774 procedures. There was no difference between the two groups for age or gender. The minimum followup for the anterolateral group was 2 years (mean, 5.1 years; range, 2.0-9.4 years) and for the posterolateral group 2 years (mean, 5.5 years; range, 2.0-9.6 years). There were no differences between the two approaches for complications, additional surgery, implant survival, or Oxford hip scores. The 8-year survival rate was 97.9% (95% confidence interval, 89.9-100) for the direct lateral approach and 97.2% (95% confidence interval, 93.9-99.3) for the posterolateral approach. This study indicates both approaches offer excellent pain reduction and return to function after Birmingham hip resurfacing with no difference in survival or in the incidence of complications. An 8-year survival rate of 97% can be achieved using either the posterolateral approach or the direct lateral approach. LEVEL OF EVIDENCE Level III, therapeutic study. See the Guidelines for authors for a complete description of levels of evidence.
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Amarasekera HW, Costa ML, Foguet P, Krikler SJ, Prakash U, Griffin DR. The blood flow to the femoral head/neck junction during resurfacing arthroplasty. ACTA ACUST UNITED AC 2008; 90:442-5. [PMID: 18378916 DOI: 10.1302/0301-620x.90b4.20050] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We used Laser Doppler flowmetry to measure the effect on the blood flow to the femoral head/neck junction of two surgical approaches during resurfacing arthroplasty. We studied 24 hips undergoing resurfacing arthroplasty for osteoarthritis. Of these, 12 had a posterior approach and 12 a trochanteric flip approach. A Laser probe was placed under radiological control in the superolateral part of the femoral head/neck junction. The Doppler flux was measured at stages of the operation and compared with the initial flux. In both groups the main fall in blood flow occurred during the initial exposure and capsulotomy of the hip joint. There was a greater reduction in blood flow with the posterior (40%) than with the trochanteric flip approach (11%).
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Affiliation(s)
- H. W. Amarasekera
- Clinical Sciences Institute University of Warwick Medical School, Clinical Sciences Building, University Hospital, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - M. L. Costa
- Clinical Sciences Institute University of Warwick Medical School, Clinical Sciences Building, University Hospital, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - P. Foguet
- University Hospitals of Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - S. J. Krikler
- University Hospitals of Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - U. Prakash
- University Hospitals of Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - D. R. Griffin
- Clinical Sciences Institute University of Warwick Medical School, Clinical Sciences Building, University Hospital, Clifford Bridge Road, Coventry CV2 2DX, UK
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50
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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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