Fracture of the Neck of the Femur After Surface Arthroplasty of the Hip

Amstutz, Harlan C.; Campbell, Pat; Duff, Michel J. Le

doi:10.2106/00004623-200409000-00003

Cited by 242 publications

(148 citation statements)

References 3 publications

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“…The authors attributed this finding to reduced activity levels, larger component size, and increased bone density in the obese patients. They note excessive weight in combination with poor implant positioning, especially the femoral component, can increase the risks for femoral neck fractures in this patient population [6,58].…”

Section: Obesitymentioning

confidence: 98%

“…Clinical disadvantages of hip resurfacing include the risk of femoral neck fracture [6,63], component malpositioning secondary to increased surgical complexity [20,24], femoral component loosening [5,8,18], decreased head-neck offset causing impingement [22,24], and metal ion production [36,59]. 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].…”

Section: Introductionmentioning

confidence: 99%

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Is Patient Selection Important for Hip Resurfacing?

Nunley¹,

Valle²,

Barrack³

2009

Clinical Orthopaedics &Amp; Related Research

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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.

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Section: Obesitymentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Is Patient Selection Important for Hip Resurfacing?

Nunley¹,

Valle²,

Barrack³

2009

Clinical Orthopaedics &Amp; Related Research

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show abstract

“…The clinical outcomes of hip resurfacing are extremely sensitive to patient selection [1,3,9,13,28,32] and the technical details of the surgical technique [9,30,36,43,44]. It is well established that notching of the femoral neck, exposed cancellous bone, and varus placement of the femoral component increase the likelihood of femoral neck fracture [5,9,27,36,43].…”

mentioning

confidence: 99%

The Learning Curve for Adopting Hip Resurfacing Among Hip Specialists

Nunley

Zhu

Brooks

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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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

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“…These included clinical factors such as weight [12,13,15], height [3], BMI, and diagnosis such as rheumatoid arthritis [4,20]. We also considered radiographic factors that have been a part of biomechanical analysis in other publications such as implant shaft angle [5,[11][12][13][14], implant size [3], head-neck ratio, neck-shaft angle [40], femoral cysts [3,12,13], and femoral offset [40,42]. Larger implant size has been believed to have a protective effect on implant survival; more time was required for disruption of the larger fixation area of larger femoral resurfacing components than smaller ones [31,35].…”

Section: Discussionmentioning

confidence: 99%

Hip Resurfacing Arthroplasty: Risk Factors for Failure Over 25 Years

Yue

Cabanela

Duffy

et al. 2008

Clin Orthop Relat Res

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Many early metal-on-polyethylene hip resurfacing arthroplasty designs were abandoned after reports of high short-term and midterm failure rates. To investigate factors associated with failure, we retrospectively reviewed our experience with early-design hip resurfacing implants in 75 patients during a 25-year period (median followup, 7.9 years; range, 0.1-25.2 years). Implant failure was defined as revision for any reason. One of 75 patients was lost to followup. The estimated rate of implant survival was 73% at 5 years, 34% at 10 years, 27% at 15 years, 12% at 20 years, and 8% at 25 years. Of the many clinical and radiographic factors considered, only age, implant type, and gender were associated with implant survival independent of other variables considered. Hip resurfacing arthroplasty showed poor overall long-term survival in this series. Particular attention should be paid to the identified risk factors as long-term followup data become available for modern designs.

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Fracture of the Neck of the Femur After Surface Arthroplasty of the Hip

Cited by 242 publications

References 3 publications

Is Patient Selection Important for Hip Resurfacing?

Is Patient Selection Important for Hip Resurfacing?

The Learning Curve for Adopting Hip Resurfacing Among Hip Specialists

Hip Resurfacing Arthroplasty: Risk Factors for Failure Over 25 Years

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