Total Hip Arthroplasty and Hip Resurfacing Arthroplasty in the Very Young Patient

Division of Pediatric Orthopaedic Surgery, Phoenix Children's Hospital, Phoenix, AZ 85016, USA.
Orthopedic Clinics of North America (Impact Factor: 1.25). 07/2012; 43(3):359-67. DOI: 10.1016/j.ocl.2012.05.005
Source: PubMed


Severe hip arthritis in an adolescent or very young adult can be a devastating disability that affects all aspects of a patient’s life. Newer treatment strategies in pediatric orthopedic surgery and hip preservation potentially could lessen the impact of this severe disorder in the future. Careful patient selection can lead to excellent outcomes for both THA and/or HRA in young patients. Further study will likely shed more light on whether HRA truly has more improved functional results than THA, and studies with longer follow-up that show definitive revision rates also should affect the future of HRA.

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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.
    Full-text · Article · Jan 2011 · Bulletin of the NYU hospital for joint diseases
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    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 · BMC Musculoskeletal Disorders
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    Full-text · Article · May 2014
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