Resurfacing arthroplasty for hip dysplasia: A prospective randomised study
Shanghai Jiao Tong University, Department of Orthopedics, Shanghai Sixth People's Hospital, 600 Yi Shang Road, Shanghai 200233, China. The Bone & Joint Journal
(Impact Factor: 3.31).
06/2012; 94(6):768-73. DOI: 10.1302/0301-620X.94B6.28522
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.
Available from: Qais Naziri
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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.
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We conducted a systematic review of the literature in order to take stock of hip resurfacing according to the principle of "evidence based medicine". Our main objective was to compare the rate of revision of resurfacing implants with survival limits set by the National Institute of Clinical Excellence (NICE).
A systematic review was undertaken of all published (Medline, Cochrane, EMBASE) literature research databases up to July 2012 as recommended by the PRISMA statement. Data extraction focused on functional outcomes, complications and survival rates. The survival rates of implants were analysed according to the mean of the series in comparison to the NICE criteria.
Fifty-three studies were identified and included 26,456 cases with an average of 499.17 ± 856.7 (range, 38-5000) cases per study. The median survival was 95.57 % ± 3.7 % (range, 84-100). The percentage of studies which satisfied the criteria set by NICE was 69.8 %. In terms of cumulative revision rates pondered by the number of implants, BHR®, Conserve Plus® and Cormet® showed the best results. The mean postoperative score was 91.2 ± 7.72 (range, 68.3-98.6). There was no statistically significant difference between implants in terms of functional outcomes.
On the basis of the current evidence base, this review of the literature emphasises the importance of certain parameters that can improve the results of resurfacing. The type of implant seems to play an important role as does patient selection.
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ABSTRACT: Background: Hip surface replacement has been widely used in recent years, but there is great controversy on which works better, hip surface replacement or traditional total hip arthroplasty. Objective: To investigate and compare the advantages and disadvantages of hip surface replacement and total hip arthroplasty trough compressive analyzing the published literatures. Methods: The randomized controlled trials on the hip surface replacement and total hip arthroplasty from January 1900 to July 2012 were retrieved. The quality of the included randomized controlled trials was evaluated strictly. The RevMan5.1.6 was used for Meta-analysis Results and Conclusion: Ten randomized controlled trials were included. Results of Meta-analysis showed that there were no significant differences in operation time, intraoperative blood loss, 1 year postoperative Harris score, 1 year postoperative University of California at LosAngeles hip function score and serum levels of cobalt and chromium ion at 2 years after replacement between hip surface replacement and total hip arthroplasty. The average acetabulum anteversion angle in the hip surface replacement group was greater than that in the total hip arthroplasty group. The results indicate that there was no significant difference in the short-term follow-up between hip surface replacement and total hip arthroplasty, but the long-term effect needs to be evaluated with higher quality and larger sample clinical randomized controlled trials.
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