Incidence and Significance of Femoral Neck Narrowing in the First 500 Conserve® Plus Series of Hip Resurfacing Cases: A Clinical and Histologic Study

Takamura, Karren M.; Yoon, James P.; Ebramzadeh, Edward; Campbell, Patricia A.; Amstutz, Harlan C.

doi:10.1016/j.ocl.2011.01.002

Cited by 12 publications

(8 citation statements)

References 17 publications

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“…All three authors reviewed the patients' most recent AP radiographs to identify hips with radiolucencies around the metaphyseal stem. We also compared the patients' most recent radiographs with their first postoperative films to identify any narrowing of 10% or greater of the mediolateral femoral neck [16,17,27]. Component positioning (femoral stem-to-shaft angle, cup abduction angle, and cup anteversion angle) were measured as previously described [8].…”

Section: Methodsmentioning

confidence: 99%

Are There Long-term Benefits to Cementing the Metaphyseal Stem in Hip Resurfacing?

Amstutz

Duff

Bhaurla

2015

Clin Orthop Relat Res

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Background Cementing the metaphyseal stem during hip resurfacing surgery improves the initial fixation of the femoral component. However, there may be long-term detrimental effects such as stress shielding or an increased risk of thermal necrosis associated with this technique. Questions/purposes We compared (1) long-term survivorship free from radiographic femoral failure, (2) validated pain scores, and (3) radiographic evidence of component fixation between hips resurfaced with a cemented metaphyseal stem and hips resurfaced with the metaphyseal stem left uncemented. Methods We retrospectively selected all the patients who had undergone bilateral hip resurfacing with an uncemented metaphyseal stem on one side, a cemented metaphyseal stem on the other side, and had both surgeries performed between July 1998 and February 2005. Fortythree patients matched these inclusion criteria. During that period, the indications for cementing the stem evolved in the practice of the senior author (HCA), passing through four phases; initially, only hips with large femoral defects had a cemented stem, then all stems were cemented, then all stems were left uncemented. Finally, stems were cemented for patients receiving small femoral components (\48 mm) or having large femoral defects (or both). Of the 43 cemented stems, two, 13, 0, and 28 came from each of those four periods. All 43 patients had complete followup at a minimum of 9 years (mean, 143 ± 21 months for the uncemented stems; and 135 ± 22 months for the cemented stems; p = 0.088). Survivorship analyses were performed with Kaplan-Meier and Cox proportional hazards ratios using radiographic failure of the femoral component as the endpoint. Pain was assessed with University of California Los Angeles (UCLA) pain scores, and radiographic femoral failure was defined as complete radiolucency around the metaphyseal stem or gross migration of the femoral component. Results There were four failures of the femoral component in the press-fit stem group while the cemented stem group had no femoral failures (p = 0.0471). With the numbers available, we found no differences between the two groups regarding pain relief or radiographic appearance other than in patients whose components developed loosening. Conclusions Cementing the metaphyseal stem improves long-term implant survival and does not alter long-term pain relief or the radiographic appearance of the proximal femur as had been a concern based on the results of finite element studies. We believe that patients with small component sizes and large femoral head defects have more to gain from the use of this technique which adds surface area for fixation, and there is no clinical downside to cementing the stem in patients with large component sizes.

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Section: Methodsmentioning

confidence: 99%

Are There Long-term Benefits to Cementing the Metaphyseal Stem in Hip Resurfacing?

Amstutz

Duff

Bhaurla

2015

Clin Orthop Relat Res

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“…Narrowing of the femoral neck was assessed by two of the authors (DJL and MH) using a previously described technique. 18 Statistical analysis. Kaplan-Meier survival analysis with 95% confidence intervals (CI) and Cox proportional hazard modelling was performed using SPSS v16.0 software (SPSS Inc., Chicago, Illinois).…”

Section: Methodsmentioning

confidence: 99%

Ten-year clinical, radiological and metal ion analysis of the Birmingham Hip Resurfacing

Holland

Langton

Hashmi

2012

The Journal of Bone and Joint Surgery. British volume

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We present the clinical results and survivorship of consecutive 100 Birmingham Hip Resurfacings in 90 patients at a minimum follow-up of ten years. All procedures were carried out by an independent surgeon who commenced a prospective study in 1998. Patients were assessed clinically using the Western Ontario and McMaster Universities osteoarthritis index, Short-Form 36, Harris hip score and University of California, Los Angeles activity score. Radiological analysis was performed by an independent observer and blood metal ion levels concentrations were measured at ten years post-operatively in 62 patients. The median acetabular component inclination was 46.2° (34° to 59°) and anteversion 11.0° (0° to 30°). The median chromium concentration in the unilateral group was 1.74 (0.41 to 15.23) and for the bilateral group was 2.98 (1.57 to 18.01). The equivalent values for cobalt were 1.67 (0.54 to 20.4) and 1.88 (1.38 to 19.32). In total there were eight failures giving an overall survival at ten years of 92% (95% confidence interval (CI) 86.7 to 97.3). BHR in male patients had an improved survivorship of 94.6% (95% CI 89.4 to 100) compared with females at 84.6% (95% CI 70.7 to 98.5), but this did not reach statistical significance (p = 0.119). Four of the nine BHRs with a bearing diameter of 42 mm failed. The overall results were consistent with data produced from other centres in that the clinical outcome of large male patients was extremely encouraging, whereas the survival of the smaller joints was less satisfactory.

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“…The femoral implant was considered to be valgus if the femoral shaft angle was greater than the femoral neck-shaft angle by [5°and varus if it was less by [5°. The abduction angle of the acetabular component and femoral neck narrowing [15] was also recorded. The position of the stem relative to the femoral neck was assessed on the lateral radiographs.…”

Section: Radiological Assessmentmentioning

confidence: 99%

Metal-on-metal hip resurfacing: correlation between clinical and radiological assessment, metal ions and ultrasound findings

et al. 2014

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Incidence and Significance of Femoral Neck Narrowing in the First 500 Conserve® Plus Series of Hip Resurfacing Cases: A Clinical and Histologic Study

Cited by 12 publications

References 17 publications

Are There Long-term Benefits to Cementing the Metaphyseal Stem in Hip Resurfacing?

Are There Long-term Benefits to Cementing the Metaphyseal Stem in Hip Resurfacing?

Ten-year clinical, radiological and metal ion analysis of the Birmingham Hip Resurfacing

Metal-on-metal hip resurfacing: correlation between clinical and radiological assessment, metal ions and ultrasound findings

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