Surface replacement conversion

Abstract

Surface hip replacement (SHR) is generally used in younger, active patients as an alternative conventional total hip replacement in part because of the ability to preserve femoral bone. This major benefit of surface replacement will only hold true if revision procedures of SHRs are found to provide good clinical results. A retrospective review of SHR revisions between 2007 and 2012 was presented, and the type of revision and aetiologies were recorded. There were 55 SHR revisions, of which 27 were in women. At a mean follow-up of 2.3 years (0.72 to 6.4), the mean post-operative Harris hip score (HHS) was 94.8 (66 to 100). Overall 23 were revised for mechanical reasons, nine for impingement, 13 for metallosis, nine for unexplained pain and one for sepsis. Of the type of revision surgery performed, 14 were femoral-only revisions; four were acetabular-only revisions, and 37 were complete revisions. We did not find that clinical scores were significantly different between gender or different types of revisions. However, the mean post-operative HHS was significantly lower in patients revised for unexplained pain compared with patients revised for mechanical reasons (86.9 (66 to 100) versus 99 (96 to 100); p = 0.029). There were two re-revisions for infection in the entire cohort. Based on the overall clinical results, we believe that revision of SHR can have good or excellent results and warrants a continued use of the procedure in selected patients. Close monitoring of these patients facilitates early intervention, as we believe that tissue damage may be related to the duration of an ongoing problem. There should be a low threshold to revise a surface replacement if there is component malposition, rising metal ion levels, or evidence of soft-tissue abnormalities.

Poor Survivorship and Frequent Complications at a Median of 10 Years After Metal-on-Metal Hip Resurfacing Revision

“…First, although our cohort size is similar to previous studies [9, 26, 37], some subgroup analyses may have been affected by small numbers. However, given the limited long-term data reported after MoMHR revision, we consider our findings important and recommend these can be used until larger studies become available.…”

“…More recently Su and Su [37] reported inferior patient-reported outcomes in MoMHRs revised for unexplained pain compared with other indications. The present study observed no difference in the proportion of complications or implant survivorship in MoMHRs revised for pseudotumor compared with other indications.…”

Revision of Metal-on-metal Hip Arthroplasty with Well Fixed and Positioned Acetabular Component Using a Dual-mobility Head and Review of Literature

“…Therefore there were several surgeons that thought to retain the acetabular component for conversion of failed femoral component [10]. Pritchett J.W.…”

“…There is sufficient evidence of significant linear relationship between the concentration of cobalt/chromium in blood/serum and wear rates appeared in explanted prosthetic components [10, 41]. The normalitzation of blood ions concentration occurs during the first year after revision [17].…”

“…In the Hospital for Special Surgery, New York, Su EP. et al , take >7μ/L cobalt or chromium level as a cut off to consider the diagnosis of accelerated wear (metallosis) [10]. …”