Metal-on-metal resurfacing of the hip in patients under the age of 55 years with osteoarthritis

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

“…There is no clear consensus on the upper age limit for male patients considering hip resurfacing, but the most commonly used criteria was age younger than 65 years [35,37,48,76]. Several authors gave special consideration to male patients older than 65 years on a case-by-case basis depending on bone quality and patient activities [30,53,58,61,78], and one study included male patients up to age 89 years [68].…”

Section: Age and Gendermentioning

confidence: 99%

“…The indications for hip resurfacing are similar to primary THA, which includes end-stage arthritis recalcitrant to nonoperative treatments in healthy and willing patients. Most arthroplasty surgeons recommend patients refrain from running and participating in high-impact activities after THA [56], whereas many resurfacing surgeons [35,70] allow high-impact activities such as jogging, but the results of these activities have not been closely studied.…”

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.

“…The use of hip resurfacing arthroplasty (HRA) has been resurgent with the development of modern designs of metal-on-metal bearings since the late 1990s [2,4,7,8,11,15,21,28]. Recent studies reported revision rates of 1% to 5% at an average of 5 to 7 years in young and active patients after HRA [2,15,21,28].…”

Section: Introductionmentioning

confidence: 99%

Intraoperative Radiographs for Placing Acetabular Components in Hip Resurfacing Arthroplasty

Gross

Liu

Webb

2011

Background Various clinical and biomechanical studies suggest certain acetabular positions may be associated with higher wear and failure rates in modern metal-on-metal hip resurfacing arthroplasties. However, there are no widely available, reliable, and cost-effective surgical techniques that ensure surgeons are able to place an acetabular component within the safe range of inclination angles after hip resurfacing surgeries. Questions/purposes We investigated the accuracy of intraoperative radiographs to determine the acetabular inclination angle in resurfacing arthroplasty procedures. Patients and Methods The study group included the first 100 resurfacing arthroplasties performed after we started routinely checking the intraoperative acetabular inclination angles. The acetabular component was repositioned if the intraoperative acetabular inclination angle was out of the target range of 30°to 50°. The control group included the previous 100 resurfacing arthroplasties performed without the benefit of intraoperative radiographs. A posterior minimally invasive surgical approach was used in both groups. Demographics and diagnoses were similar in both groups. ResultsThe average (± SD) difference between the intraoperative and 6-week radiographs was 2.7°± 2.5°. The acetabular inclination angles at 6-week followup were within the targeted range more frequently in the study group than in the control group (outliers: 4% versus 29%). Conclusions These data suggest a single intraoperative radiograph is a quick, reliable, and cost-effective method for ensuring the acetabular inclination angle is within the targeted range. Level of Evidence Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.