Outcome of primary resurfacing hip replacement: evaluation of risk factors for early revision

Prosser, Gareth; Yates, Piers; Wood, David; Graves, Stephen; Steiger, Richard de; Miller, Lisa N

doi:10.3109/17453671003685434

Cited by 107 publications

(113 citation statements)

References 24 publications

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“…In addition, older patients are generally considered less active and more likely to have poor bone quality compared with younger patients; this poor bone quality may increase the risk of femoral neck fracture or femoral component loosening [13,16,17], and therefore, excluding such patients as suitable candidates for hip resurfacing. Indeed, a report from the Australian registry demonstrated an increased risk of subsequent revision in patients undergoing hip resurfacing with increasing age, an observation contrary to the findings following conventional THR [18]. However, only a few studies have reported specifically on elderly patients undergoing hip resurfacing.…”

Section: Introductioncontrasting

confidence: 39%

Survival and functional outcome of the Birmingham Hip Resurfacing system in patients aged 65 and older at up to ten years of follow-up

Pailhé

Matharu

Sharma

et al. 2013

International Orthopaedics (SICOT)

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Purpose Limited evidence exists regarding the outcomes of hip resurfacing in elderly patients. The primary study aims were to determine the survival and functional outcome following Birmingham Hip Resurfacing (BHR) in patients ≥65 years at up to ten years of follow-up. Secondary aims were to explore factors affecting survival and functional outcome. Methods Between 1997 and 2012, data were prospectively collected on 180 BHR (162 patients; mean age 69.2 years; 62 % male) implanted by one designing surgeon. Mean follow-up was six (range one to 14.4) years with no loss to follow-up. Outcomes of interest were implant survival, functional outcome [Oxford Hip Score (OHS)] and radiological evidence of implant failure. Results Three hips were revised, giving an overall cumulative survival of 96.4 % [95 % confidence interval (CI) 90.3-100] at ten years. Survival of 111 male BHR was 98.9 % (95 % CI 94.8-100) at ten years (one revision) compared with 91.9 % (95 % CI 77.0-100) in 69 female BHR (two revisions). Survival was affected by age (p=0.014) and femoral head size (p=0.024) but not by gender (p=0.079). Median pre-operative OHS was 50.0 % [interquartile range (IQR) 37.5-68.8], improving to 4.4 % (IQR 0-10.4) postoperatively. Men had significantly better postoperative OHSs compared with women (median male OHS 2.1 % versus 6.3 % female OHS; p=0.021). Conclusions Good survival and functional outcomes were achieved with the BHR at ten years in men and women ≥65 years. Despite registry findings to the contrary, age alone should not be a contraindication for hip resurfacing in centres with expertise in this procedure.

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Section: Introductioncontrasting

confidence: 39%

Survival and functional outcome of the Birmingham Hip Resurfacing system in patients aged 65 and older at up to ten years of follow-up

Pailhé

Matharu

Sharma

et al. 2013

International Orthopaedics (SICOT)

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“…Identified risk factors for failure include female gender as a surrogate variable for component size [8,29,34], large femoral head defects [1], low BMI [27], older age at surgery [9], and component design [22,34]. Recently, high levels of sporting activities have also been associated with revision of hip resurfacing [28].…”

Section: Introductionmentioning

confidence: 99%

Socket Position Determines Hip Resurfacing 10-Year Survivorship

Amstutz

Duff

Johnson

2012

Clinical Orthopaedics &Amp; Related Research

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Background Modern metal-on-metal hip resurfacing arthroplasty designs have been used for over a decade. Risk factors for short-term failure include small component size, large femoral head defects, low body mass index, older age, high level of sporting activity, and component design, and it is established there is a surgeon learning curve. Owing to failures with early surgical techniques, we developed a second-generation technique to address those failures. However, it is unclear whether the techniques affected the long-term risk factors. Questions/purposes We (1) determined survivorship for hips implanted with the second-generation cementing technique; (2) identified the risk factors for failure in these patients; and (3) determined the effect of the dominant risk factors on the observed modes of failure. Methods We retrospectively reviewed the first 200 hips (178 patients) implanted using our second-generation surgical technique, which consisted of improvements in cleaning and drying the femoral head before and during cement application. There were 129 men and 49 women. Component orientation and contact patch to rim distance were measured. We recorded the following modes of failure: femoral neck fracture, femoral component loosening, acetabular component loosening, wear, dislocation, and sepsis. The minimum followup was 25 months (mean, 106.5 months; range, 25-138 months). Results Twelve hips were revised. Kaplan-Meier survivorship was 98.0% at 5 years and 94.3% at 10 years. The only variable associated with revision was acetabular component position. Contact patch to rim distance was lower in hips that dislocated, were revised for wear, or were revised for acetabular loosening. The dominant modes of failure were related to component wear or acetabular component loosening. Conclusions Acetabular component orientation, a factor within the surgeon's control, determines the long-term success of our current hip resurfacing techniques. Current techniques have changed the modes of failure from aseptic femoral failure to wear or loosening of the acetabular component.

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“…37,39 We analyzed only one implant design and size, while data from national registries show differences among implant designs and sizes, with a higher failure rate for smaller heads. 1 To investigate the effect of thermal necrosis on mechanical failure relative to these other factors would require mechanical modeling of femoral neck fracture in parametric analyses. In such FEA simulations, the failure load in a layer of necrotic bone could be compared with that of a resurfaced femur without necrosis.…”

Section: Discussionmentioning

confidence: 99%

“…The most common causes for revision of resurfacing arthroplasty are fracture, loosening, and lysis. 1 Although most fractures occur at the implant rim, 20% occur within the femoral component. 2 These fractures have been associated with bone necrosis, 3 often occurring in the bone-cement interface region.…”

mentioning

confidence: 99%

Effect of cementing technique and cement type on thermal necrosis in hip resurfacing arthroplasty—a numerical study

Janssen

Scheerlinck

2011

Journal Orthopaedic Research

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Femoral fractures within resurfacing implants have been associated with bone necrosis, possibly resulting from heat generated by cement polymerization. The amount of heat generated depends on cement mantle volume and type of cement. Using finite element analysis, the effect of cement type and volume on thermal necrosis was analyzed. Based on CT-data of earlier implantations, two different models were created: a thick mantle model, representing a low-viscosity ''cement filling'' technique, and a thin mantle model, representing a high viscosity ''cement packing'' technique. Six cement types were analyzed. The polymerization heat generation and its effect on bone necrosis were predicted. In the thin cement mantle models, no thermal necrosis was predicted. Thick cement mantle models produced thermal necrosis at the cement-bone interface depending on cement type. In the worst case, 6% of the bone at the cement-bone interface became necrotic, covering almost the entire cross-sectional area. The current findings suggest a potential thermal drawback of thick cement mantles, although it is unclear whether thermal bone necrosis significantly affects implant fixation or increases the fracture risk. Furthermore, our study showed distinct differences between the heat generated and resulting thermal damage caused by the various cement types. Keywords: finite element analysis; bone cement; thermal necrosis; hip resurfacing arthroplasty Hip resurfacing arthroplasty is an alternative for total hip arthroplasty (THA), with the proposed benefits of bone stock preservation and increased stability. The most common causes for revision of resurfacing arthroplasty are fracture, loosening, and lysis. 1 Although most fractures occur at the implant rim, 20% occur within the femoral component. 2 These fractures have been associated with bone necrosis, 3 often occurring in the bone-cement interface region. It has been hypothesized that this necrotic layer is caused by heat generated by polymerizing bone cement, inducing thermal damage to the bone. 4 Since polymerization of bone cement is an exothermic reaction, the amount of heat generated is proportional to its volume. As a result, hip resurfacings with larger amounts of cement in the femoral head display more fibrous tissue at the cement-bone interface. 5,6 The size and shape of the cement mantle depends on the cementing technique and the type of cement. [7][8][9] The use of low viscosity cement poured into the femoral component 10 leads to a relatively deep cement penetration into the femoral head, 7-9 and a large total cement volume especially when anchoring holes are used. 8 In contrast, when high viscosity cement is manually applied to the femoral head, a more homogeneous, thinner cement mantle is obtained. 8,11 Another factor affecting the temperature rise is the polymerization properties of the cement. 12,13 A fast polymerizing cement will cause a higher peak temperature that will last for a short time, while slower polymerizing cement will cause a lower peak temperature t...

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Outcome of primary resurfacing hip replacement: evaluation of risk factors for early revision

Cited by 107 publications

References 24 publications

Survival and functional outcome of the Birmingham Hip Resurfacing system in patients aged 65 and older at up to ten years of follow-up

Survival and functional outcome of the Birmingham Hip Resurfacing system in patients aged 65 and older at up to ten years of follow-up

Socket Position Determines Hip Resurfacing 10-Year Survivorship

Effect of cementing technique and cement type on thermal necrosis in hip resurfacing arthroplasty—a numerical study

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