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Za P, Casciaro C, Papalia GF, Parisi FR, Longo UG, Falez F, Papalia R. Hip resurfacing versus total hip arthroplasty: a systematic review and meta-analysis of randomized clinical trials. INTERNATIONAL ORTHOPAEDICS 2024; 48:2589-2601. [PMID: 39107628 DOI: 10.1007/s00264-024-06269-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 07/29/2024] [Indexed: 09/25/2024]
Abstract
PURPOSE Total hip arthroplasty (THA) is the gold standard in the treatment of advanced hip osteoarthritis. However, hip resurfacing (HR) arthroplasty may present a viable alternative. The aim of this study was to compare complications, implant survivorship, and functional outcomes between HR and THA, to assess HR as a valid and safe alternative to THA. METHODS Inclusion criteria were randomized clinical trials (RCTs) published in English, comparing clinical outcomes and complications between HR and THA. A systematic review of the literature was performed on PubMed, Scopus and Cochrane Library, following the PRISMA 2020 statement, from January 1, 2015 to November 30, 2023. A meta-analysis was performed by Review Manager (RevMan) software version 5.4 to compare the rates of revisions, dislocations, infection, aseptic loosening and pseudotumor, and the clinical outcomes between the two groups. We used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to assess the risk of bias. RESULTS A total of 8 RCT were included, involving 844 patients (387 hips for HR group and 469 hips for THA group). The mean follow-up was 7.72 years. There were no statistically significant differences between the two groups for UCLA and WOMAC score, revision rate, infection, aseptic loosening and pseudotumor (all p > 0.05), while the dislocation rate was significantly lower in the HR group (p = 0.04). CONCLUSIONS HR is a safe and effective alternative to THA. However, several factors are involved to reduce the complication rate and achieve high implant survival.
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Affiliation(s)
- Pierangelo Za
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Roma, Italy
| | - Carlo Casciaro
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Roma, Italy
| | - Giuseppe Francesco Papalia
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128, Roma, Italy.
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Roma, Italy.
| | - Francesco Rosario Parisi
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Roma, Italy
| | - Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Roma, Italy
| | - Francesco Falez
- Department of Orthopaedics and Traumatology, S. Filippo Neri Hospital, ASL Roma 1, Rome, Italy
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Roma, Italy
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Synnott PA, Kiss MO, Shahin M, Morcos MW, Binette B, Vendittoli PA. Total hip arthroplasty with monobloc press-fit acetabular components and large-diameter bearings for atypical acetabula is safe: a consecutive case series of 125 hips with mean follow-up of 9 years. Can J Surg 2024; 67:E40-E48. [PMID: 38320777 PMCID: PMC10852195 DOI: 10.1503/cjs.014022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Large-diameter head (LDH) total hip arthroplasty (THA) with a monobloc acetabular component improves hip stability. However, obtaining initial press-fit stability is quite challenging in atypical acetabula. The purpose of this study was to assess primary and secondary fixation of monobloc cups in atypical acetabula. METHODS In this consecutive case series, the local arthroplasty database was used to retrospectively identify patients with secondary osteoarthritis who underwent primary hip replacement with press-fit only LDH monobloc acetabular components between 2005 and 2018 and who had a minimum of 2 years of follow-up. Radiographic evaluation was performed at last follow-up, and patient-reported outcome measures (PROMs) were assessed with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Forgotten Joint Score (FJS), and the Patient's Joint Perception (PJP) question. RESULTS One hundred and six LDH THAs and 19 hip resurfacings were included in the study. Preoperative diagnoses included hip dysplasia (36.8%), Legg-Calve-Perthes disease (32.0%), osteoarthritis with acetabular deficiency (17.6%), periacetabular osteotomy (8.0%), arthrodesis (4.0%), and osteopetrosis (1.6%). After a mean follow-up of 9.2 years, no aseptic loosening of the acetabular component was recorded nor observed on radiologic review. There were 13 (10.4%) revisions unrelated to the acetabular component fixation. The mean WOMAC and FJS scores were 9.2 and 80.9, respectively. In response to the PJP question, 49.4% of the patients perceived their hip as natural, 19.1% as an artificial joint with no restriction, 31.5% as an artificial joint with restriction, and none as a non-functional joint. CONCLUSION Primary press-fit fixation of monobloc acetabular components with LDH implanted in atypical acetabula led to secondary fixation in all cases with low revision and complication rates and great functional outcomes. With careful surgical technique and experience, systematic use of supplemental screw fixation is not essential in THA with atypical acetabula.
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Affiliation(s)
- Paul-André Synnott
- From the Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Que. (Synnott, Kiss, Shahin, Morcos, Binette, Vendittoli); the Department of Surgery, Université de Montréal, Montréal, Que. (Kiss, Morcos, Binette, Vendittoli); Clinique orthopédique Duval, Laval, Que. (Kiss, Vendittoli); and the Personalized Arthroplasty Society, Atlanta, Georgia (Vendittoli)
| | - Marc-Olivier Kiss
- From the Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Que. (Synnott, Kiss, Shahin, Morcos, Binette, Vendittoli); the Department of Surgery, Université de Montréal, Montréal, Que. (Kiss, Morcos, Binette, Vendittoli); Clinique orthopédique Duval, Laval, Que. (Kiss, Vendittoli); and the Personalized Arthroplasty Society, Atlanta, Georgia (Vendittoli)
| | - Maged Shahin
- From the Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Que. (Synnott, Kiss, Shahin, Morcos, Binette, Vendittoli); the Department of Surgery, Université de Montréal, Montréal, Que. (Kiss, Morcos, Binette, Vendittoli); Clinique orthopédique Duval, Laval, Que. (Kiss, Vendittoli); and the Personalized Arthroplasty Society, Atlanta, Georgia (Vendittoli)
| | - Mina W Morcos
- From the Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Que. (Synnott, Kiss, Shahin, Morcos, Binette, Vendittoli); the Department of Surgery, Université de Montréal, Montréal, Que. (Kiss, Morcos, Binette, Vendittoli); Clinique orthopédique Duval, Laval, Que. (Kiss, Vendittoli); and the Personalized Arthroplasty Society, Atlanta, Georgia (Vendittoli)
| | - Benoit Binette
- From the Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Que. (Synnott, Kiss, Shahin, Morcos, Binette, Vendittoli); the Department of Surgery, Université de Montréal, Montréal, Que. (Kiss, Morcos, Binette, Vendittoli); Clinique orthopédique Duval, Laval, Que. (Kiss, Vendittoli); and the Personalized Arthroplasty Society, Atlanta, Georgia (Vendittoli)
| | - Pascal-André Vendittoli
- From the Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Que. (Synnott, Kiss, Shahin, Morcos, Binette, Vendittoli); the Department of Surgery, Université de Montréal, Montréal, Que. (Kiss, Morcos, Binette, Vendittoli); Clinique orthopédique Duval, Laval, Que. (Kiss, Vendittoli); and the Personalized Arthroplasty Society, Atlanta, Georgia (Vendittoli)
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Palazzuolo M, Bensa A, Bauer S, Blakeney WG, Filardo G, Riegger M. Resurfacing Hip Arthroplasty Is a Safe and Effective Alternative to Total Hip Arthroplasty in Young Patients: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12062093. [PMID: 36983096 PMCID: PMC10052473 DOI: 10.3390/jcm12062093] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/02/2023] [Accepted: 03/04/2023] [Indexed: 03/30/2023] Open
Abstract
This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed at comparing resurfacing hip arthroplasty (RHA) and total hip arthroplasty (THA) in terms of rate of complications, revisions, functional outcomes, blood loss, operative time and metal ions levels. The search was conducted on three databases (PubMed, Cochrane and Web of Science) updated until 13 October 2022. The inclusion criteria were RCTs) written in the English language, with no time limitation, comparing RHA and THA. Among the retrieved 4748 articles, 18 RCTs were eligible for a total of 776 patients (mean age 53.1 ± 5.0). A meta-analysis was performed. RHA reported significantly lower blood loss compared to THA (p < 0.001) but with longer operative time (p < 0.001). No statistically significant difference was found between RHA and THA in terms of complications (12.08% and 16.24%, respectively) and revisions (6.32% and 6.14%, respectively). Both RHA and THA provide excellent clinical results in a population of young and active patients. Functional outcomes were not significantly different between the groups. Moreover, no significant difference in metal ion levels was found. These findings provide evidence concerning the safety and clinical effectiveness of RHA. Because of its bone-preserving properties, the lack of drawbacks and good outcomes, RHA appears to be a valid alternative to THA in young and active patients.
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Affiliation(s)
- Michele Palazzuolo
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, 6600 Locarno, Switzerland
| | - Alessandro Bensa
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, 6900 Lugano, Switzerland
| | - Stefan Bauer
- Service d'Orthopédie et de Traumatologie, Chirurgie de l'Épaule, Ensemble Hospitalier de la Côte, 1110 Morges, Switzerland
- Department of Orthopedic Surgery, Royal Perth Hospital, Perth, WA 6000, Australia
| | - William G Blakeney
- Department of Orthopedic Surgery, Royal Perth Hospital, Perth, WA 6000, Australia
| | - Giuseppe Filardo
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, 6900 Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Martin Riegger
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, 6900 Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
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Metal-on-Metal Hips: Ten-Year Clinical and Radiographic Outcomes of the ADEPT Metal-on-Metal Hip Resurfacing and Modular Total Hip Arthroplasty. J Clin Med 2023; 12:jcm12030889. [PMID: 36769537 PMCID: PMC9917924 DOI: 10.3390/jcm12030889] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/28/2022] [Accepted: 01/17/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The aim of this study is to update the 10-year follow-up survivorship and metal ions levels of a cohort of metal-on-metal (MoM) hip resurfacing (HR) and large-diameter-head (LDH) total hip arthroplasty (THA). METHODS The study is a retrospective analysis of prospectively collected data that compared the outcomes of 24 MoM HR (21 patients) and 15 (11 patients) modular LHD MoM THA at >10 years follow-up. Baseline characteristics as well as intraoperative and postoperative information were collected, including complications, revisions, clinical and radiographic outcomes, and serum metal ions level (Cobalt, Chromium). Metal ion levels were compared using a two-tailed unpaired t-test and Wilcoxon signed-rank test (jamovi v2.3.3.0, Sydney, NSW, AU). RESULTS No significant differences were detected in gender, BMI, and ASA score between the two groups. Patients in the modular THA group were significantly older (57 years vs. 46 years; p < 0.05). The HR overall survivorship was 91.7% (22 of 24 hips) with survivorship from implant failure and/or aseptic loosening and/or metal debris related 100% of problems. The modular THA overall survivorship was 86.7% (13 of 15 hips) with survivorship from implant aseptic loosening and metal ions complications of 93.4% (14 of 15 hips). No significant difference was noted when comparing clinical outcomes. Metal ions were significantly lower in the HR group (Co 25.8 nmol/L vs. 89 nmol/L; p < 0.001-Cr 33.5 nmol/L vs. 55.2 nmol/L; p = 0.026). CONCLUSION Both implants reported excellent and comparable clinical outcomes at >10 years follow-up. The Adept HR reported remarkable survivorship, in line with the registry data, proving once again its reliability in young active males. The modular LDH THA, despite being discontinued, presented higher reliability and a lower failure rate when compared with similar withdrawn MoM implants. Trunnionosis did not appear to be a significant problem in this particular modular design.
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Kumar P, Ksheersagar V, Aggarwal S, Jindal K, Dadra A, Kumar V, Patel S. Complications and mid to long term outcomes for hip resurfacing versus total hip replacement: a systematic review and meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03361-5. [PMID: 36006506 DOI: 10.1007/s00590-022-03361-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The long-term results of total hip replacement (THR) are excellent; however, it has higher failure rates in young and active patients. Hip resurfacing arthroplasty (HRA) is an alternative in such patients and gaining popularity. This review was done to compare complications and outcomes between HRA and THA by assessing the latest level 1 studies comparing the two from the past 10 years. METHOD A systematic review and meta-analysis was conducted using three databases (PubMed, EMBASE and SCOPUS) to compare the complications between THR and HRA in medium to long term follow up. The primary outcome of interest included the complication and revision rate between the two techniques. Functional outcomes and ionic levels at follow up were also compared as secondary outcomes. Risk of bias assessment was done using the Cochrane risk of bias tool. RESULT The present review included 6 level 1 studies. These included 308 THR and 304 HRA. On meta-analysis, overall complications rates were significantly lower in HRA compared to the THA group with an Odds ratio (OR) of 2.17 (95% CI 1.21, 3.88; p = 0.009). No difference was seen between the two groups in terms of revision rate (OR 1.06 95% CI 0.57, 1.99; p = 0.85). Functional outcomes in both the groups were satisfactory but the Harris Hip Score was found to be significantly better in the resurfacing group (MD 2.99 95% CI - 4.01, - 1.96, p < 0.00001). There were increased cobalt and chromium ions in the resurfacing group but no detrimental effect was seen in terms of reported poisoning. CONCLUSION Despite similar function and revision rates, HRA was seen to have lesser associated complications and ionic levels may not be a detrimental issue. Hip resurfacing provides relative ease during revisions, especially in younger patients and it may be an alternative to THR in the younger population.
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Affiliation(s)
- Prasoon Kumar
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivek Ksheersagar
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sameer Aggarwal
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Karan Jindal
- Dr B R Ambedkar State Institute of Medical Sciences, Mohali, India.
| | - Ankit Dadra
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Kumar
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Patel
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
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