Resurfacing arthroplasty for hip dysplasia: A prospective randomised study

ArticleinThe Bone & Joint Journal 94(6):768-73 · June 2012with6 Reads
DOI: 10.1302/0301-620X.94B6.28522 · Source: PubMed
Abstract
In this prospective study a total of 80 consecutive Chinese patients with Crowe type I or II developmental dysplasia of the hip were randomly assigned for hip resurfacing arthroplasty (HRA) or total hip replacement (THR). Three patients assigned to HRA were converted to THR, and three HRA patients and two THR patients were lost to follow-up. This left a total of 34 patients (37 hips) who underwent HRA and 38 (39 hips) who underwent THR. The mean follow-up was 59.4 months (52 to 70) in the HRA group and 60.6 months (50 to 72) in the THR group. There was no failure of the prosthesis in either group. Flexion of the hip was significantly better after HRA, but there was no difference in the mean post-operative Harris hip scores between the groups. The mean size of the acetabular component in the HRA group was significantly larger than in the THR group (49.5 mm vs 46.1 mm, p = 0.001). There was no difference in the mean abduction angle of the acetabular component between the two groups. Although the patients in this series had risk factors for failure after HRA, such as low body weight, small femoral heads and dysplasia, the clinical results of resurfacing in those with Crowe type I or II hip dysplasia were satisfactory. Patients in the HRA group had a better range of movement, although neck-cup impingement was observed. However, more acetabular bone was sacrificed in HRA patients, and it is unclear whether this will have an adverse effect in the long term.
    • "We found no significant complications due to high ion levels in blood or metallosis . The implant survival and the functional outcomes score are comparable to those observed in other patients managed with metal-on-metal surface arthroplasty [12,13]. In this study, the traditional posterolateral approach was used to perform the hip resurfacing arthroplasty, and no secondary avascular necrosis after resurfacing of the femoral head occurred. "
    [Show abstract] [Hide abstract] ABSTRACT: Background Metal-on-metal resurfacing arthroplasty is an attractive alternative to conventional total hip arthroplasty in patients with osteoarthritis secondary to developmental dysplasia of the hip (DDH). The purpose of this study was to assess the mid-term clinical outcome and mid-term survivorship of Metal-on-metal resurfacing arthroplasty in patients suffering from osteoarthritis secondary to DDH. Material/Methods Between May 2003 and Dec. 2005, 15 operations using ASR™ and 19 using Corin were performed in 29 patients to treat advanced osteoarthritis secondary to DDHs. There were 6 males (20.7%) and 23 females (79.3%), with an average age of 47.2 years (range, 36–64 years). Clinical and radiographic results were observed. All patients were followed up at the 1st, 2nd, 3rd, 6th, and 12th months after surgery and annually thereafter. Results The overall survival was 88.2% at a minimum follow-up of 8 years, but the survival was 91.2% after excluding the infections as the cause of component loosening and failure. The mean Harris hip score improved from 48.27±3.13 (range, 14–71) to 89.63±3.42 (range, 65–100) at latest follow-up. The flexion was from 75.14±8.05° to 107.21±9.34. Only 4 failed because of deep infection, femoral neck fracture, and aseptic loosening. Conclusions Metal-on-metal resurfacing arthroplasty showed perfect results at a minimum of 8-years of follow-up in our study, and may be a reasonable option for osteoarthritis secondary to developmental dysplasia of the hip (DDH).
    Article · Nov 2014
    • "However, there is still disagreement about whether such findings are truly benefits of the procedure itself or reflect the higher pre-operative activity levels in patients treated with the resurfacing arthroplasty. Studies that can compare functional results of resurfacing hip arthroplasty to standard total hip arthroplasty across different patient populations and activity levels can give surgeons the further ability to make informed and patient-based decisions regarding their prosthesis selection [15,17181921222324252627. Due to controversy over potential advantages or superiority of clinical outcomes of either of these arthroplasty procedures, this study examined the outcomes of patients who had undergone a resurfacing hip arthroplasty compared to all standard total hip arthroplasty procedures performed during the same period of time. "
    [Show abstract] [Hide abstract] ABSTRACT: Background The purpose of this study was to evaluate the clinical and radiographic outcomes of hip resurfacing patients and compare them to standard primary total hip arthroplasty procedures performed during the same period of time. Methods One hundred and fourteen consecutive men who had a mean age of 50 years (range, 20 to 85 years) and who had undergone 120 hip resurfacing arthroplasties between 2007 and 2009 were compared to 117 consecutive men (120 hips) who had undergone a standard total hip arthroplasty during the same time period. The mean follow-up was 42 months (range, 24 to 55 months) for both groups. Outcomes evaluated included implant survivorship, hip scores, activity levels, and complication rates. Results In the resurfacing hip arthroplasty cohort, implant survivorship was 98% with two patients requiring a revision surgery one for femoral neck fracture and another for femoral head loosening. In comparison, implant survivorship was 99% in the standard total hip arthroplasty cohort, with 1 revision due to peri-prosthetic fracture which was successfully treated with a femoral component revision. In the resurfacing and standard hip arthroplasty cohorts, the mean post-operative Harris hip scores had improved to 96 and 94 points, respectively and were statistically similar. The resurfacing cohort had achieved a significantly higher mean post-operative University of California Activity Score (6.7 versus 5 points). There were no differences in the complication rates between the two cohorts. Conclusion When patients meet the appropriate selection criteria in the hands of experienced and high-volume arthroplasty surgeons, hip resurfacing provides excellent results at short- to mid-term follow-up.
    Full-text · Article · May 2013
  • [Show abstract] [Hide abstract] ABSTRACT: Metal-on-metal hip resurfacing has provided an alternative to standard total hip arthroplasty in younger, more active patients. However, detractors argue that many of the benefits of resurfacing can be obtained with the use of larger femoral heads. The purported advantages of the resurfacing procedure include preservation of femoral bone stock, increased range of motion, decreased dislocation rate, excellent performance in high-activity patients, and a potentially easier revision than total hip arthroplasty. The purpose of this study was to examine the outcomes of patients who had hip resurfacing and to compare them to all total hip arthroplasty procedures performed during the same time period. In November 2007, the senior investigator (MAM), a high-volume joint arthroplasty surgeon, who had exceeded all resurfacing learning curves, transitioned to a new hip resurfacing system. The study cohort of 67 resurfacing patients (73 hips) had a mean age of 51 years (range, 21 to 84 years), consisted of 63 males and 4 females, had a mean body mass index of 28 kg/m2 (range, 20 to 47 kg/m2), and had a minimum 2-year follow-up. Revision and complication rates were determined, as well as clinical outcomes using various clinical rating systems, including Harris hip scores. These outcomes were compared to another cohort of 137 standard primary total hip arthroplasties performed during the same time period. Survivorship in the hip resurfacing cohort was 100%, compared with 98% in the total hip arthroplasty group (p = 0.55). The three failures were comprised of one peri-prosthetic fracture treated with a femoral component revision and two cases of acetabular loosening, for which the acetabular component only was revised. Following revision, all patients were doing well at the most recent follow-up of 2 years. One patient who underwent resurfacing arthroplasty developed a right sciatic nerve palsy that was treated with nerve decompression. The patient regained full motor and sensory function and was doing well at the most recent follow-up. The mean Harris hip score in the resurfacing patients improved from 32 points (range, 18 to 45) to 97 points (range, 70 to 100), at a mean of 30 months (range, 24 to 37) follow-up. Excellent results continue to be demonstrated with hip resurfacing systems, with equal, early survivorship when compared to total hip arthroplasty. For patients who meet the appropriate selection criteria and in the hands of an experienced, high-volume arthroplasty surgeon hip resurfacing provides excellent early results.
    Full-text · Article · Jan 2011
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