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Kebbach M, Schulze C, Meyenburg C, Kluess D, Sungu M, Hartmann A, Günther KP, Bader R. Do hip resurfacing and short hip stem arthroplasties differ from conventional hip stem replacement regarding impingement-free range of motion? J Orthop Res 2023; 41:2501-2515. [PMID: 37132090 DOI: 10.1002/jor.25584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/14/2023] [Accepted: 05/01/2023] [Indexed: 05/04/2023]
Abstract
Total hip joint replacement (THR) is clinically well-established. In this context, the resulting range of motion (ROM) is crucial for patient satisfaction when performing joint movements. However, the ROM for THR with different bone preserving strategies (short hip stem and hip resurfacing) raises the question of whether the ROM is comparable with conventional hip stems. Therefore, this computer-based study aimed to investigate the ROM and type of impingement for different implant systems. An established framework with computer-aided design 3D models based on magnetic resonance imaging data of 19 patients with hip osteoarthritis was used to analyse the ROM for three different implant systems (conventional hip stem vs. short hip stem vs. hip resurfacing) during typical joint movements. Our results revealed that all three designs led to mean maximum flexion higher than 110°. However, hip resurfacing showed less ROM (-5% against conventional and -6% against short hip stem). No significant differences were observed between the conventional and short hip stem during maximum flexion and internal rotation. Contrarily, a significant difference was detected between the conventional hip stem and hip resurfacing during internal rotation (p = 0.003). The ROM of the hip resurfacing was lower than the conventional and short hip stem during all three movements. Furthermore, hip resurfacing shifted the impingement type to implant-to-bone impingement compared with the other implant designs. The calculated ROMs of the implant systems achieved physiological levels during maximum flexion and internal rotation. However, bone impingement was more likely during internal rotation with increasing bone preservation. Despite the larger head diameter of hip resurfacing, the ROM examined was substantially lower than that of conventional and short hip stem.
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Affiliation(s)
- Maeruan Kebbach
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Christian Schulze
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Christian Meyenburg
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Daniel Kluess
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Mevluet Sungu
- Research and Development, Aesculap AG, Tuttlingen, Germany
| | - Albrecht Hartmann
- Department of Orthopedic Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Klaus-Peter Günther
- Department of Orthopedic Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Rainer Bader
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
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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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Resende RA, Kirkwood RN, Rudan JF, Deluzio KJ. How symmetric are metal-on-metal hip resurfacing patients during gait? Insights for the rehabilitation. J Biomech 2017; 58:37-44. [DOI: 10.1016/j.jbiomech.2017.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 02/10/2017] [Accepted: 04/09/2017] [Indexed: 10/19/2022]
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Wall PDH, Richards BL, Sprowson A, Buchbinder R, Singh JA. Do outcomes reported in randomised controlled trials of joint replacement surgery fulfil the OMERACT 2.0 Filter? A review of the 2008 and 2013 literature. Syst Rev 2017; 6:106. [PMID: 28558822 PMCID: PMC5450048 DOI: 10.1186/s13643-017-0498-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 05/10/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND It is not known, whether outcome reporting in trials of total joint arthroplasty in the recent years is adequate or not. Our objective was to assess whether outcomes reported in total joint replacement (TJR) trials fulfil the Outcome Measures in Rheumatology (OMERACT) Filter 2.0. METHODS We systematically reviewed all TJR trials in adults, published in English in 2008 or 2013. Searches were conducted in the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE. Two authors independently applied the inclusion criteria for the studies, and any disagreement was resolved with a third review author. All outcome measures were abstracted using a pre-piloted standardised data extraction form and assessed for whether they mapped to one of the three OMERACT Filter 2.0 core areas: pathophysiological, life impact, and death. RESULTS From 1635 trials identified, we included 70 trials (30 in 2008 and 40 in 2013) meeting the eligibility criteria. Twenty-two (31%) trials reported the three essential OMERACT core areas. Among the 27 hip replacement surgery trials and 39 knee replacement surgery trials included, 11 hip (41%) and nine knee (23%) trials reported all three essential OMERACT core areas. The most common outcome domains/measures were pain (20/27, 74%) and function (23/27, 85%) in hip trials and pain (26/39, 67%) and function (27/39, 69%) in knee trials. Results were similar for shoulder and hand joint replacement trials. CONCLUSIONS We identified significant gaps in the measurement of OMERACT core outcome areas in TJR trials, despite the majority reporting outcome domains of pain and function. An international consensus of key stakeholders is needed to develop a core domain set for reporting of TJR trials. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42014009216.
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Affiliation(s)
- Peter D H Wall
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Bethan L Richards
- Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Andrew Sprowson
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Frankston, VIC, Australia.,Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, VIC, Australia
| | - Jasvinder A Singh
- Birmingham Veterans Affairs Medical Center and University of Alabama at Birmingham, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL, 35294, USA. .,Mayo Clinic School of Medicine, Rochester, MN, USA.
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Richards BL, Wall PDH, Sprowson AP, Singh JA, Buchbinder R. Outcome Measures Used in Arthroplasty Trials: Systematic Review of the 2008 and 2013 Literature. J Rheumatol 2017; 44:1277-1287. [PMID: 28507180 DOI: 10.3899/jrheum.161477] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Previously published literature assessing the reporting of outcome measures used in joint replacement randomized controlled trials (RCT) has revealed disappointing results. It remains unknown whether international initiatives have led to any improvement in the quality of reporting and/or a reduction in the heterogeneity of outcome measures used. Our objective was to systematically assess and compare primary outcome measures and the risk of bias in joint replacement RCT published in 2008 and 2013. METHODS We searched MEDLINE, EMBASE, and CENTRAL for RCT investigating adult patients undergoing joint replacement surgery. Two authors independently identified eligible trials, extracted data, and assessed risk of bias using the Cochrane tool. RESULTS Seventy RCT (30 in 2008, 40 in 2013) met the eligibility criteria. There was no significant difference in the number of trials judged to be at low overall risk of bias (n = 6, 20%) in 2008 compared with 2013 [6 (15%); chi-square = 0.302, p = 0.75]. Significantly more trials published in 2008 did not specify a primary outcome measure (n = 25, 83%) compared with 18 trials (45%) in 2013 (chi-square = 10.6316, p = 0.001). When specified, there was significant heterogeneity in the measures used to assess primary outcomes. CONCLUSION While less than a quarter of trials published in both 2008 and 2013 were judged to be at low overall risk of bias, significantly more trials published in 2013 specified a primary outcome. Although this might represent a temporal trend toward improvement, the overall frequency of primary outcome reporting and the wide heterogeneity in primary outcomes reported remain suboptimal.
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Affiliation(s)
- Bethan L Richards
- From the Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; Sydney Medical School, University of Sydney, Sydney; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia; Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick, Coventry, UK; Medical Center and University of Alabama at Birmingham, Birmingham, Alabama; Mayo Clinic College of Medicine, Rochester, Minnesota, USA.,B.L. Richards, FRACP, MClinEpi, MSportsMed, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, and Sydney Medical School, University of Sydney; P.D. Wall, MBChB (Hons), MRCS (Edin), PhD, Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick; A.P. Sprowson, MD, FRCS, Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick; J.A. Singh, MD, MPH, Medical Center and University of Alabama at Birmingham, and Mayo Clinic College of Medicine; R. Buchbinder, MBBS (Hons), PhD, Dept. of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, and Monash Dept. of Clinical Epidemiology, Cabrini Hospital. Dr. Sprowson died on March 13, 2015
| | - Peter D H Wall
- From the Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; Sydney Medical School, University of Sydney, Sydney; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia; Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick, Coventry, UK; Medical Center and University of Alabama at Birmingham, Birmingham, Alabama; Mayo Clinic College of Medicine, Rochester, Minnesota, USA.,B.L. Richards, FRACP, MClinEpi, MSportsMed, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, and Sydney Medical School, University of Sydney; P.D. Wall, MBChB (Hons), MRCS (Edin), PhD, Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick; A.P. Sprowson, MD, FRCS, Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick; J.A. Singh, MD, MPH, Medical Center and University of Alabama at Birmingham, and Mayo Clinic College of Medicine; R. Buchbinder, MBBS (Hons), PhD, Dept. of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, and Monash Dept. of Clinical Epidemiology, Cabrini Hospital. Dr. Sprowson died on March 13, 2015
| | - Andrew P Sprowson
- From the Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; Sydney Medical School, University of Sydney, Sydney; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia; Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick, Coventry, UK; Medical Center and University of Alabama at Birmingham, Birmingham, Alabama; Mayo Clinic College of Medicine, Rochester, Minnesota, USA.,B.L. Richards, FRACP, MClinEpi, MSportsMed, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, and Sydney Medical School, University of Sydney; P.D. Wall, MBChB (Hons), MRCS (Edin), PhD, Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick; A.P. Sprowson, MD, FRCS, Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick; J.A. Singh, MD, MPH, Medical Center and University of Alabama at Birmingham, and Mayo Clinic College of Medicine; R. Buchbinder, MBBS (Hons), PhD, Dept. of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, and Monash Dept. of Clinical Epidemiology, Cabrini Hospital. Dr. Sprowson died on March 13, 2015
| | - Jasvinder A Singh
- From the Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; Sydney Medical School, University of Sydney, Sydney; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia; Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick, Coventry, UK; Medical Center and University of Alabama at Birmingham, Birmingham, Alabama; Mayo Clinic College of Medicine, Rochester, Minnesota, USA. .,B.L. Richards, FRACP, MClinEpi, MSportsMed, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, and Sydney Medical School, University of Sydney; P.D. Wall, MBChB (Hons), MRCS (Edin), PhD, Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick; A.P. Sprowson, MD, FRCS, Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick; J.A. Singh, MD, MPH, Medical Center and University of Alabama at Birmingham, and Mayo Clinic College of Medicine; R. Buchbinder, MBBS (Hons), PhD, Dept. of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, and Monash Dept. of Clinical Epidemiology, Cabrini Hospital. Dr. Sprowson died on March 13, 2015.
| | - Rachelle Buchbinder
- From the Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; Sydney Medical School, University of Sydney, Sydney; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia; Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick, Coventry, UK; Medical Center and University of Alabama at Birmingham, Birmingham, Alabama; Mayo Clinic College of Medicine, Rochester, Minnesota, USA.,B.L. Richards, FRACP, MClinEpi, MSportsMed, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, and Sydney Medical School, University of Sydney; P.D. Wall, MBChB (Hons), MRCS (Edin), PhD, Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick; A.P. Sprowson, MD, FRCS, Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick; J.A. Singh, MD, MPH, Medical Center and University of Alabama at Birmingham, and Mayo Clinic College of Medicine; R. Buchbinder, MBBS (Hons), PhD, Dept. of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, and Monash Dept. of Clinical Epidemiology, Cabrini Hospital. Dr. Sprowson died on March 13, 2015
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Hyodo K, Masuda T, Aizawa J, Jinno T, Morita S. Hip, knee, and ankle kinematics during activities of daily living: a cross-sectional study. Braz J Phys Ther 2017; 21:159-166. [PMID: 28473283 PMCID: PMC5537477 DOI: 10.1016/j.bjpt.2017.03.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 02/02/2016] [Accepted: 07/23/2016] [Indexed: 11/29/2022] Open
Abstract
Several ADLs in healthy individuals had larger joint angles than walking, climbing stairs, and standing up. Large joint angles in healthy individuals occurred at the hip and knee joints during trunk rotation, during crouching, and getting out of the bath. Adduction and internal rotation occurred simultaneously in few healthy individuals during maximum flexion of the hip in the measured tasks.
Background Joint angle data from healthy subjects are necessary as baseline information. Objective To analyze the problems of patients who struggle with activities of daily living (ADL) due to restricted range of motion and to provide ADL guidance based on objective data. Method An electromagnetic three-dimensional tracking system (FASTRAK) was used to quantify the hip, knee, and ankle angles of the dominant leg of 26 healthy adults as they performed 22 ADLs related to dressing, using the toilet, bathing, picking up objects, and crouching. For each ADL, the maximum angle was averaged across the 26 subjects. Mean angles of adduction/abduction and internal/external rotation during maximum hip flexion were also measured. Results The largest mean maximum angle was 101° for hip flexion (trunk rotation during crouching), 17° for hip adduction (putting on shoes), and 149° for knee flexion (trunk rotation during crouching). Analysis of adduction/abduction and internal/external rotation angles during maximum hip flexion showed the largest angle of adduction when putting on shoes, and the largest angle of internal rotation with trunk rotation during crouching. Conclusions ADLs such as crouching and putting on pants showed larger joint angles than walking, climbing stairs, and standing up. Results obtained from this study can provide important objective data for ADL guidance for total hip arthroplasty and femoroacetabular impingement patients.
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Affiliation(s)
- Kashitaro Hyodo
- Department of Physical Therapy, Mejiro University, Saitama, Japan; Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Tadashi Masuda
- Faculty of Symbiotic Systems Science, Fukushima University, Fukushima, Japan
| | - Junya Aizawa
- Athletic Rehabilitation Section, Sports Medicine Clinical Center, Medical Hospital of Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuya Jinno
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Sadao Morita
- Department of Rehabilitation Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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Outcomes of the Recalled Articular Surface Replacement Metal-on-Metal Hip Implant System: A Systematic Review. J Arthroplasty 2017; 32:341-346. [PMID: 27546469 DOI: 10.1016/j.arth.2016.06.060] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 06/05/2016] [Accepted: 06/27/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The aim of this review was to synthesize the main findings of clinical studies that have evaluated outcomes of the articular surface replacement (ASR) Hip System. METHODS We performed a systematic literature search to identify all articles published between January 2008 and June 2015 that included ASR hip resurfacing arthroplasty (ASR HRA) or ASR total hip arthroplasty (ASR XL THA) outcomes according to the PRISMA statement. RESULTS A total of 56 studies were assessed. The prevalence of adverse local tissue reactions (ALTRs) and revision rates were found to be high. ALTR prevalence varied from 12.5% to 69% (mean, 33.5%). Mean revision rate for any reason at 4-year to 7-year follow-up was 13.8% (range, 5.6%-31%) for ASR HRA and 14.5% (range, 0%-37%) for ASR XL THA. Femoral head size <53 mm was found to correlate with higher blood metal ion levels. Femoral head size >44 mm was not associated with higher ALTR prevalence or revision rates in ASR XL THA. High blood metal ion levels (>7 μg/L Co, >7 μg/L Cr) were associated with higher failure rates and bearing-related complications. The role of cup positioning was found to be controversial. CONCLUSION ALTR prevalence and failure rates were high. High blood metal ion levels were a risk factor for ALTR and failure. Surprisingly, the role of cup positioning and large femoral head size in ASR XL THA were controversial. These findings should be considered in the clinical follow-up and risk stratification of patients with the ASR Hip System.
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Pijls BG, Meessen JMTA, Schoones JW, Fiocco M, van der Heide HJL, Sedrakyan A, Nelissen RGHH. Increased Mortality in Metal-on-Metal versus Non-Metal-on-Metal Primary Total Hip Arthroplasty at 10 Years and Longer Follow-Up: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0156051. [PMID: 27295038 PMCID: PMC4905643 DOI: 10.1371/journal.pone.0156051] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 05/09/2016] [Indexed: 11/19/2022] Open
Abstract
IMPORTANCE There are concerns about increased mortality in patients with metal-on-metal bearings in total hip arthroplasty (THA). OBJECTIVE To determine the mortality and the morbidity in patients with metal-on-metal articulations (MOM THA) compared to patients with non-metal-on-metal articulations (non-MOM THA) after primary total hip arthroplasty. DATA SOURCES Search of PubMed, MEDLINE, EMBASE, Web of Science, Cochrane, CINAHL, AcademicSearchPremier, ScienceDirect, Wiley and clinical trial registers through March 2015, augmented by a hand search of references from the included articles. No language restrictions were applied. STUDY SELECTION Two reviewers screened and identified randomised controlled trials and observational studies of primary total hip arthroplasty comparing MOM THA with non-MOM THA. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted study data and assessed risk of bias. Risk differences (RD) were calculated with random effect models. Meta-regression was used to explore modifying factors. MAIN OUTCOMES AND MEASURES Difference in mortality and difference in morbidity expressed as revisions and medical complications between patients with MOM THA and non-MOM THA. RESULTS Forty-seven studies were included, comprising 4,000 THA in randomised trials and over 500,000 THA in observational studies. For mortality, random effects analysis revealed a higher pooled RD of 0.7%, 95%, confidence interval (CI) [0.0%, 2.3%], I-square 42%; the heterogeneity was explained by differences in follow-up. When restricted to studies with long term follow-up (i.e. 10 years or more), the RD for mortality was 8.5%, 95%, CI [5.8%, 11.2%]; number needed to treat was 12. Further subgroup analyses and meta-regression random effects models revealed no evidence for other moderator variables (study level covariates, e.g. resurfacing vs. non-resurfacing MOM) than follow-up duration. The quality of the evidence presented in this meta-analysis was characterized as moderate according to the CLEAR-NPT (for non-pharmacological trials) and Cochrane risk of bias Table. CONCLUSIONS AND RELEVANCE Meta-analysis suggests there may be an increased long-term risk of mortality and revision surgery for patients with MOM THA compared to patients with non-MOM THA. REGISTRATION PROSPERO 2014:CRD42014007417.
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Affiliation(s)
- B G Pijls
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - J M T A Meessen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - J W Schoones
- Walaeus Library, Leiden University Medical Centre, Leiden, The Netherlands
| | - M Fiocco
- Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
- Mathematical Institute, Leiden University, Leiden, The Netherlands
| | - H J L van der Heide
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - A Sedrakyan
- FDA Medical Device Epidemiology (MDEpiNet) Science and Infrastructure Center, U.S. Food and Drug Administration, Silver Spring, MD, United States of America
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, United States of America
| | - R G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
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9
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Abstract
BACKGROUND Metal-on-metal hip resurfacing (MOMHR) is an alternative to total hip replacement in young and active patients but little is known about the evolution of clinical outcome scores of hip resurfacing over time.The purpose of this study was 1) to assess the long-term evolution of UCLA hip scores and SF-12 Quality of life evaluations in a group of patients treated with hip resurfacing arthroplasty, 2) to determine whether the age of the patient at surgery influenced these outcome measurements, and 3) whether the changes in SF-12 scores are comparable with those of the general US population. PATIENT AND METHODS A total of 100 patients with unilateral, unrevised, Charnley class A MOMHR were retrospectively selected for the study. UCLA and SF-12 scores were calculated preoperatively, short-term postoperatively, and beyond 10 years. RESULTS There was a decrease in the UCLA function and activity scores, and in the SF-12 physical scores between the short-term and the last follow-up at a minimum of 10 years. However, pain, walking, and SF-12 mental scores were maintained through the last follow-up. Furthermore, the SF-12 physical scores at last follow-up were comparable with those of the general US population while the mental scores were greater. There were no significant differences between the two age groups at any of the follow-up intervals for any outcome measurement. CONCLUSIONS While there is a slight decline in physical function following hip resurfacing over time, pain relief, walking ability, and quality of life are maintained.
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Jensen C, Penny JØ, Nielsen DB, Overgaard S, Holsgaard-Larsen A. Quantifying Gait Quality in Patients with Large-Head and Conventional Total Hip Arthroplasty--A Prospective Cohort Study. J Arthroplasty 2015; 30:2343-8.e1. [PMID: 26278486 DOI: 10.1016/j.arth.2015.06.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 06/19/2015] [Accepted: 06/22/2015] [Indexed: 02/01/2023] Open
Abstract
We used the Gait Deviation Index (GDI) as method to compare preoperative to postoperative gait changes after uncemented 50 mm (median) large-head and 28/32 mm total hip arthroplasty (THA). We also identified predictors of improvements in GDI. Gait analysis and patient-reported (WOMAC) data were recorded in 35 patients before, 2 and 6-months after treatment. Twenty age-matched adults provided normative gait data. Contrary to our hypothesis, patients who received large-head THA had less improvement in GDI compared with patients who received 28/32 mm THA. The preoperative GDI score was identified as a predictor of postoperative GDI improvement, while WOMAC, age, gender and walking speed were not. This study provides useful information for clinicians and rehabilitation specialists about gait improvement that can be expected after THA.
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Affiliation(s)
- Carsten Jensen
- Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jeannette Ø Penny
- Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark; Department of Orthopedic Surgery, Naestved Hospital, Naestved, Denmark
| | - Dennis B Nielsen
- Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Søren Overgaard
- Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anders Holsgaard-Larsen
- Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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Impact of Total Hip Resurfacing Arthroplasty on Health-Related Quality of Life Measures: A Systematic Review and Meta-Analysis. J Arthroplasty 2015; 30:1938-52. [PMID: 26067708 DOI: 10.1016/j.arth.2015.05.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 05/07/2015] [Accepted: 05/08/2015] [Indexed: 02/01/2023] Open
Abstract
The aim of this study was to investigate the effect of total hip resurfacing arthroplasty (RA) on general health-related quality of life (HRQOL) and disease/hip-specific measures. Original studies published after 2000, enrolling at least ten skeletally mature patients with a minimum follow-up of 6 months were considered. The standardized mean difference (SMD) was obtained with a random effects model. The cumulative patient population encompassed 1898 patients (2123 RA). Mean follow-up duration was 4 years. The physical component score (P<0.001) and mental component score (P=0.05) of SF-12, and the EuroQol-5D (P<0.0001) improved significantly. WOMAC global score and the subscales (P<0.00001) were also improved. Harris Hip Score (P<0.00001), Oxford Hip Score (P<0.001) and UCLA (P<0.00001) were markedly improved and patient satisfaction was favorable.
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12
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Varnum C, Pedersen AB, Mäkelä K, Eskelinen A, Havelin LI, Furnes O, Kärrholm J, Garellick G, Overgaard S. Increased risk of revision of cementless stemmed total hip arthroplasty with metal-on-metal bearings. Acta Orthop 2015; 86:469-76. [PMID: 25715878 PMCID: PMC4513606 DOI: 10.3109/17453674.2015.1023132] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Data from the national joint registries in Australia and England and Wales have revealed inferior medium-term survivorship for metal-on-metal (MoM) total hip arthroplasty (THA) than for metal-on-polyethylene (MoP) THA. Based on data from the Nordic Arthroplasty Register Association (NARA), we compared the revision risk of cementless stemmed THA with MoM and MoP bearings and we also compared MoM THA to each other. PATIENTS AND METHODS We identified 32,678 patients who were operated from 2002 through 2010 with cementless stemmed THA with either MoM bearings (11,567 patients, 35%) or MoP bearings (21,111 patients, 65%). The patients were followed until revision, death, emigration, or the end of the study period (December 31, 2011), and median follow-up was 3.6 (interquartile range (IQR): 2.4-4.8) years for MoM bearings and 3.4 (IQR: 2.0-5.8) years for MoP bearings. Multivariable regression in the presence of competing risk of death was used to assess the relative risk (RR) of revision for any reason (with 95% confidence interval (CI)). RESULTS The cumulative incidence of revision at 8 years of follow-up was 7.0% (CI: 6.0-8.1) for MoM bearings and 5.1% (CI: 4.7-5.6) for MoP bearings. At 6 years of follow-up, the RR of revision for any reason was 1.5 (CI: 1.3-1.7) for MoM bearings compared to MoP bearings. The RR of revision for any reason was higher for the ASR (adjusted RR = 6.4, CI: 5.0-8.1), the Conserve Plus (adjusted RR = 1.7, CI: 1.1-2.5) and "other" acetabular components (adjusted RR = 2.4, CI: 1.5-3.9) than for MoP THA at 6 years of follow-up. INTERPRETATION At medium-term follow-up, the survivorship for cementless stemmed MoM THA was inferior to that for MoP THA, and metal-related problems may cause higher revision rates for MoM bearings with longer follow-up.
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Affiliation(s)
- Claus Varnum
- Department of Orthopaedic Surgery, Section for Hip and Knee Replacement, Vejle Hospital, Vejle,Clinical Institute, University of Southern Denmark, Odense,Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense
| | - Alma B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Keijo Mäkelä
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku
| | | | - Leif Ivar Havelin
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen,Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Ove Furnes
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen,Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Johan Kärrholm
- Swedish Hip Arthroplasty Register,Institute of Clinical Sciences, Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Göran Garellick
- Swedish Hip Arthroplasty Register,Institute of Clinical Sciences, Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Søren Overgaard
- Clinical Institute, University of Southern Denmark, Odense,Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense
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Busch V. The young osteoarthritic hip: Clinical outcome of total hip arthroplasty and a cost-effectiveness analysis. Acta Orthop 2015; 86:1-21. [PMID: 25898151 DOI: 10.3109/17453674.2015.1041354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Affiliation(s)
- Vincent Busch
- Sint Maartenskliniek Orthopaedic surgery P.O. Box 9011, 6500 GM Nijmegen The Netherlands
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Hjorth MH, Stilling M, Lorenzen ND, Jakobsen SS, Soballe K, Mechlenburg I. Block-step asymmetry 5 years after large-head metal-on-metal total hip arthroplasty is related to lower muscle mass and leg power on the implant side. Clin Biomech (Bristol, Avon) 2014; 29:684-90. [PMID: 24935131 DOI: 10.1016/j.clinbiomech.2014.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 03/19/2014] [Accepted: 03/20/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Metal-on-metal articulations mimic the human hip anatomy, presumably lower dislocation rates and increase the range-of-motion. This study aims to measure the muscle mass and power of both legs in patients with unilateral metal-on-metal total hip arthroplasty, and to investigate their effect on block-step test, spatio-temporal gait parameters and self-reported function. METHODS Twenty-eight patients (7 women), mean age 50 (28-68) years, participated in a 5-7 year follow-up. Patients had received one type unilateral large-head metal-on-metal total hip articulation, all of which were well-functioning at follow-up. Mean muscle mass was measured by the total-body Dual energy X-ray Absorption scans, and muscle power was measured in a leg extensor power rig. Block-step test and spatio-temporal gait parameters were measured with an inertial measurement unit. Self-reported function was assessed by the Hip Disability and Osteoarthritis Outcome Score. FINDINGS We found a significant difference between the mean muscle mass of the implant-side leg and the non-implant-side leg in hip, thigh and calf areas (P<0.008) and in mean muscle power (P=0.025). Correlations between mean muscle mass and mean muscle power were significant for both the implant-side leg (r=0.45, P=0.018) and the non-implant-side leg (r=0.51, P=0.007). The difference in mean muscle power between legs correlated with block-step test asymmetry during ascending (r=0.40, P=0.047) and descending (r=0.53, P=0.006). Correlations between self-reported function and power of the implant-side leg were not significant. INTERPRETATIONS Young patients have not fully regained muscle mass, muscle power and function 5-7 years after metal-on-metal total hip arthroplasty.
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Affiliation(s)
- M H Hjorth
- Department of Orthopaedics, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark.
| | - M Stilling
- Department of Orthopaedics, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark
| | - N D Lorenzen
- Department of Orthopaedics, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark
| | - S S Jakobsen
- Department of Orthopaedics, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark
| | - K Soballe
- Department of Orthopaedics, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark
| | - I Mechlenburg
- Department of Orthopaedics, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark
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15
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Prentice JR, Clark MJ, Hoggard N, Morton AC, Tooth C, Paley MN, Stockley I, Hadjivassiliou M, Wilkinson JM. Metal-on-metal hip prostheses and systemic health: a cross-sectional association study 8 years after implantation. PLoS One 2013; 8:e66186. [PMID: 23762480 PMCID: PMC3677913 DOI: 10.1371/journal.pone.0066186] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 05/02/2013] [Indexed: 12/19/2022] Open
Abstract
There is public concern over the long term systemic health effects of metal released from hip replacement prostheses that use large-diameter metal-on-metal bearings. However, to date there has been no systematic study to determine which organs may be at risk, or the magnitude of any effect. We undertook a detailed cross-sectional health screen at a mean of 8 years after surgery in 35 asymptomatic patients who had previously received a metal-on-metal hip resurfacing (MoMHR) versus 35 individually age and sex matched asymptomatic patients who had received a conventional hip replacement. Total body bone mineral density was 5% higher (mean difference 0.05 g/cm2, P = 0.02) and bone turnover was 14% lower (TRAP 5b, mean difference −0.56IU/L, P = 0.006; osteocalcin, mean difference −3.08 ng/mL, P = 0.03) in the hip resurfacing versus conventional hip replacement group. Cardiac ejection fraction was 7% lower (mean absolute difference −5%, P = 0.04) and left ventricular end-diastolic diameter was 6% larger (mean difference 2.7 mm, P = 0.007) in the hip resurfacing group versus those patients who received a conventional hip replacement. The urinary fractional excretion of metal was low (cobalt 5%, chromium 1.5%) in patients with MoMHR, but creatinine clearance was normal. Diuretic prescription was associated with a 40% increase in the fractional excretion of chromium (mean difference 0.5%, P = 0.03). There was no evidence of difference in neuropsychological, renal tubular, hepatic or endocrine function between groups (P>0.05). Our findings of differences in bone and cardiac function between patient groups suggest that chronic exposure to low elevated metal concentrations in patients with well-functioning MoMHR prostheses may have systemic effects. Long-term epidemiological studies in patients with well-functioning metal on metal hip prostheses should include musculoskeletal and cardiac endpoints to quantitate the risk of clinical disease.
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Affiliation(s)
- Jennifer R. Prentice
- Department of Human Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Matthew J. Clark
- Department of Human Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Nigel Hoggard
- Department of Human Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Allison C. Morton
- Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Claire Tooth
- Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Martyn N. Paley
- Department of Human Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Ian Stockley
- Department of Orthopaedics, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Marios Hadjivassiliou
- Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - J. Mark Wilkinson
- Department of Human Metabolism, University of Sheffield, Sheffield, United Kingdom
- Department of Orthopaedics, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
- * E-mail:
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Penny JØ, Varmarken J, Ovesen O, Nielsen C, Overgaard S. Metal ion levels and lymphocyte counts: ASR hip resurfacing prosthesis vs. standard THA: 2-year results from a randomized study. Acta Orthop 2013; 84:130-7. [PMID: 23597114 PMCID: PMC3639332 DOI: 10.3109/17453674.2013.784657] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Wear particles from metal-on-metal arthroplasties are under suspicion for adverse effects both locally and systemically, and the DePuy ASR Hip Resurfacing System (RHA) has above-average failure rates. We compared lymphocyte counts in RHA and total hip arthroplasty (THA) and investigated whether cobalt and chromium ions affected the lymphocyte counts. METHOD In a randomized controlled trial, we followed 19 RHA patients and 19 THA patients. Lymphocyte subsets and chromium and cobalt ion concentrations were measured at baseline, at 8 weeks, at 6 months, and at 1 and 2 years. RESULTS The T-lymphocyte counts for both implant types declined over the 2-year period. This decline was statistically significant for CD3(+)CD8(+) in the THA group, with a regression coefficient of -0.04 × 10(9)cells/year (95% CI: -0.08 to -0.01). Regression analysis indicated a depressive effect of cobalt ions in particular on T-cells with 2-year whole-blood cobalt regression coefficients for CD3+ of -0.10 (95% CI: -0.16 to -0.04) × 10(9) cells/parts per billion (ppb), for CD3+CD4+ of -0.06 (-0.09 to -0.03) × 10(9) cells/ppb, and for CD3(+)CD8(+) of -0.02 (-0.03 to -0.00) × 10(9) cells/ppb. INTERPRETATION Circulating T-lymphocyte levels may decline after surgery, regardless of implant type. Metal ions-particularly cobalt-may have a general depressive effect on T- and B-lymphocyte levels. Registered with ClinicalTrials.gov under # NCT01113762.
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Affiliation(s)
- Jeannette Ø Penny
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense,Department of Orthopaedics, Hospital South – Naestved, Region Zealand
| | | | - Ole Ovesen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense
| | - Christian Nielsen
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark.
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense
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