Femoral side‐only revision options for the Birmingham resurfacing arthroplasty

Abstract

Background: The Birmingham Hip Resurfacing (BHR) system (Smith and Nephew) was developed as an alternative to conventional total joint replacement for younger, more active patients. Among other complications exists the risk for femoral component failure. The only marketed revision option for such a complication involves exchange of all components for a total replacement arthroplasty. This presents as a considerable and potentially unnecessary operative burden where revision of only the femoral prosthesis would suffice. We have analysed revision options for BHR in the context of periprosthetic femoral fractures with a stable acetabular component. Methods: Technical details of dual mobility hip systems available in Australia were collated and analysed to assess for potential 'off label' use with an existing BHR acetabular component. These data were then compared with the custom-made Smith and Nephew dual mobility implant with respect to clearance and sizing. Results: Two dual mobility articulation modalities from two companies were identified as appropriate for potential usage with four products analysed in detail. These two demonstrated acceptable sizing and clearance measurements. Conclusion: Comparison between readily available dual mobility prostheses with custom-made implants showed off label dual mobility prosthetic use to be a viable alternative for femoral-only revisions with in situ BHR. Single component revision has several advantages which include: a less complex surgical procedure, shorter operative time, decreased blood loss and the expectation of resultant lower morbidity. Furthermore, this less complex revision surgery should give comparable results to that of primary total hip arthroplasty.

Trends and developments in hip and knee arthroplasty technology

“…23,24 The use of a dual mobility articulation also has a role in revision surgery given their increased stability. They have been used successfully for femoral only revision of large head metal on metal hip arthroplasty 25 as well as for alternative revision indications with dual mobility articulations demonstrating superior survivorship compared to fixed-bearing implants. 26…”

Modern Trends in the Developments of Hip and Knee Arthroplasty

“…На сьогодні відомо, що середньорічне зношування лайнерів із подвійною рухомістю становить 38 мм 3 /рік, що не перевищує показник аналогічних цементних імплантатів [19]. Ендопротези з подвійною рухомістю були успішно використані для ревізії стегнового компонента з великою головкою в парі тертя «метал -метал» під час протезування кульшового суглоба [20]. Такі імплантати демонструють вищий рівень виживаності після ревізійних операцій порівняно зі стандартними (fixed-bearing implants) [21].…”

Partieller oder vollständiger Wechsel in der Hüftrevisionsendoprothetik?

“…Bei isolierter Revision einer femoralen Oberflächenersatzkomponente und belassener Pfanne wird immer wieder der Einsatz von Dual-Mobility-Köpfen propagiert [24,25]. Es gibt bislang jedoch keine langfristigen Erfahrungen und bei häufig bereits vorliegendem Pfannenabrieb sowie möglicherweise nicht passender Clearance ist der Erfolg dieses Verfahrens mehr als fraglich [26].…”