The femoral head/neck offset and hip resurfacing

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: Discussionmentioning

confidence: 95%

The Learning Curve for Adopting Hip Resurfacing Among Hip Specialists

Nunley

Zhu

Brooks

et al. 2010

“…One of us (RBB) reviewed these radiographs for periprosthetic lucency or loosening according to the systems of DeLee and Charnley [7] for acetabular lucency and Gruen et al [9] for femoral periprosthetic lucency, uncovered anterior components that may lead to iliopsoas tendonitis [25] or evidence of impingement (insufficient head neck offset ratio) of the residual femoral neck after total hip resurfacing [2,18]. It should be noted that substantial interobserver variability exists in assessment of periprosthetic lucency.…”

Section: Methodsmentioning

confidence: 99%

The Prevalence of Groin Pain After Metal-on-Metal Total Hip Arthroplasty and Total Hip Resurfacing

Bartelt

Yuan

Trousdale

et al. 2010

112

Background Groin pain after total hip arthroplasty (THA) or total hip resurfacing arthroplasty can be troubling for patients and surgeons. Potential sources of pain include infection, loosening, metal hypersensitivity, or impingement of bony structures or the iliopsoas tendon. Questions/purposes We compared the rate of groin pain after THA or hip resurfacing using metal-on-metal to those of other bearing surfaces. Methods We identified 347 (334 patients) primary total hip (n = 301) or resurfacing (n = 46) arthroplasties. Complete preoperative, operative, and postoperative data were available for 282 hips. We retrospectively reviewed the charts for the presence or absence of groin pain at a minimum of 1 year after surgery with a specific focus on etiologic factors. The minimum followup was 12 months (mean, 14 months; range 12 to 24 months). Results The rate of groin pain was 7% (15 of 217 patients) after THA with conventional bearing surfaces, 15% (4 of 26 patients) with metal-on-metal THA and 18% (7 of 39 patients) with total hip resurfacing. Younger patients were more likely to report groin pain postoperatively and more likely to have metal-on-metal bearing surfaces.Conclusions Our data at short-term followup suggest increased rates of groin pain after metal-on-metal THA or resurfacing arthroplasty versus THA using polyethylene or ceramic bearing surfaces. The reasons are not clear but they appear to be associated with younger age. Potential factors include impingement, activity level and possibly higher expectations for patients receiving metal-on-metal bearing surfaces that may make those patients more likely to report postoperative pain.

“…A recent study reported approximately 57% of hips undergoing resurfacing had decreased head-neck offset (B 0.15) on preoperative radiographs [22]. In comparison to total hip arthroplasty, hip resurfacing preserves the femoral headneck junction.…”

Section: Femoroacetabular Impingementmentioning

confidence: 99%

“…Therefore, failure to restore adequate headneck offset may lead to femoroacetabular impingement and pain postoperatively. Hip resurfacing patients with impingement may experience abnormal wear patterns and pain, especially with malpositioned implants [22]. Adequate removal of femoral neck osteophytes is important to restore head-neck offset, prior to femoral head preparation, to ensure accurate component sizing and positioning, which will minimize the potential for postoperative impingement [24].…”

Section: Femoroacetabular Impingementmentioning

confidence: 99%

“…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%

See 1 more Smart Citation

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.