Early results of primary Birmingham hip resurfacings

Patient demand and surgeon interest in hip resurfacing has recently increased, but surgeons in the United States are relatively inexperienced with this procedure. We determined the learning curve associated with hip resurfacing and compared the rate of early complications of the first 650 hip resurfacings between five experienced hip surgeons and a national safety survey database study we previously published, which included 89 surgeons and 537 hip resurfacings. Patient demographics and adverse events were recorded. Specific features on pre-and postoperative radiographs were measured in a blinded fashion by a single observer. There were 13 major complications (2.0%), which is 3.7 times lower than our national safety survey complication rate of 7.4%. All fractures occurred in the first 25 cases performed. The complication rate was higher for the first 25 procedures (5.6%) compared with the second 25 procedures (1

Section: Discussionsupporting

confidence: 83%

The Learning Curve for Adopting Hip Resurfacing Among Hip Specialists

Nunley

Zhu

Brooks

et al. 2010

“…Radiographic features such as stem shaft angle and abduction of the socket are important for failures in SRA [1,8,27], but their influence as a predictor for failure will not be noticed if they are not captured in the database. Postoperative complications (eg, nerve palsy [6,26]) can be considered as important modes of failure. The overall complication rate varied from 0% to 18% in a metaanalysis of 13 trials with 3594 SRAs.…”

Section: Discussionmentioning

confidence: 99%

Hip Resurfacing Data from National Joint Registries: What Do They Tell Us? What Do They Not Tell Us?

Corten

MacDonald

2010

Current-generation metal-on-metal hip resurfacing implants (SRAs) have been in widespread global use since the 1990s, and in the United States, specific implants have recently been approved for clinical use. Many recent publications describe short-term survivorship achieved by either implant-designing surgeons or high-volume centers. National joint replacement registries (NJRRs) on the other hand report survivorship achieved from the orthopaedic community at large. We therefore reviewed SRA survivorship from national registry data and compared with that reported from individual centers. Additionally, we compared SRA survivorship reported by registries and compared prognosticators for failure with those of conventional total hip arthroplasty (THA). Although resurfacing was associated with an overall increased failure rate in comparison to THA (Australian registry 5-year cumulative revision rate [CRR], 3.7% and 2.7%, respectively), there were exceptions to this. Male patients younger than 65 years with primary osteoarthritis had equivalent results with SRA and THA (Australian registry 5-year CRR, 2.5% and 2.8%, respectively). Head size over 50 mm in diameter was a predictor of surface replacement arthroplasty survivorship and only females with a head diameter of 50 mm or greater (14% of females) had a comparable survivorship to males. Diagnoses other than primary osteoarthritis bear a higher risk of early revision of SRA as compared with THA. Revision of SRA does not lead to reproducible results with rerevision rates of 11% at 5 years. Given these predictors of failure, our review of data from the NJRR suggests stringent patient selection criteria might enhance the survival rates of SRA.

“…Several studies [13,24,59] have described uncommon clinical scenarios in which hip resurfacing may have a unique advantage over standard THA. A summary of these indications includes (1) patients with proximal femoral deformity from previous disease, fracture, or surgery that makes standard femoral stem prosthesis placement difficult; (2) patients with a high risk of joint sepsis because of prior infection or immunosuppression; (3) patients with a neuromuscular disorder in which a larger diameter femoral component may reduce the dislocation risk; (4) retained hardware that would be difficult to remove before placement of a stemmed femoral component; and (5) patients with a historically high risk of implant-related failure with THA (sickle cell disease with sclerotic femoral bone and alcoholism with a higher dislocation rate).…”

Section: Discussionmentioning

confidence: 99%

“…In the 1970s, hip resurfacing with metal femoral components and cemented polyethylene acetabular components was popular, but early failures (30% to 56%) [50,85] within 5 years resulting from osteolysis and component loosening caused them to fall out of favor [7,50,85]. Although the short-and midterm results (93%-97% survivorship at mean 5 years) of contemporary metal-on-metal resurfacing implants surpass previous resurfacing designs [13,29,37,49,61,72,75,84,86], there are no long-term results (longer than 10 years) available for these current-generation hip resurfacing implants.…”

Section: Introductionmentioning

confidence: 99%

Is Patient Selection Important for Hip Resurfacing?

Nunley¹,

Valle²,

Barrack³

2009

The optimal implant option for hip arthroplasty in the young, active patient remains controversial. There has been renewed interest for metal-on-metal hip resurfacing due to improved design and manufacturing of implants, better materials, enhanced implant fixation, theoretical advantages over conventional total hip arthroplasty, and recent Food and Drug Administration approval of two devices. Recent studies indicate satisfactory short-and midterm clinical results (1-to 10-year followup) with low complication rates, but there is a learning curve associated with this procedure, a more extensive surgical approach is necessary, and long-term results have yet to be determined. Proper patient selection may help avoid complications and improve patient outcomes. Patient selection criteria in the literature appear based predominantly on theoretical considerations without any consensus on stratifying patient risk. The most commonly reported complications encountered with hip resurfacing include femoral neck fracture, acetabular component loosening, metal hypersensitivity, dislocation, and nerve injury. At the time of clinical evaluation, patient age; gender; diagnosis; bone density, quality, and morphology; activity level; leg lengths; renal function; and metal hypersensitivity are important factors when considering a patient for hip resurfacing. Based on our review, we believe the best candidates for hip resurfacing are men under age 65 with osteoarthritis and relatively normal bony morphology. Level of Evidence: Level V, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.