Reducing the failure rate of hip resurfacing in dysplasia patients: a retrospective analysis of 363 cases

2017

J Orthop Surg Res

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BackgroundThe Nordic registry reports patients under 50 years old with total hip replacements realize only 83% 10-year implant survivorship. These results do not meet the 95% 10-year survivorship guideline posed by the UK’s National Institute for Health and Care Excellence (NICE) in 2014.MethodsThe purpose of this study is threefold: First, we evaluate if metal-on-metal hip resurfacing arthroplasty meets these high standards in younger patients. Next, we compare outcomes between age groups to determine if younger patients are at higher risk for revision or complication. Lastly, we assess how outcomes between sexes changed over time. From January 2001 to August 2013, a single surgeon performed 1285 metal-on-metal hip resurfacings in patients younger than 50 years old. We compared these to an older cohort matched by sex and BMI.ResultsKaplan-Meier implant survivorship was 96.5% at 10 years and 96.3% at 12 years; this did not differ from implant survivorship for older patients. Implant survivorship at 12 years was 98 and 93% for younger men and women, respectively; survivorship for women improved from 93 to 97% by using exclusively Biomet implants. There were four (0.3%) adverse wear-related failures, with no instances of wear or problematic ion levels since 2009. Activity scores improved from 5.4 ± 2.3 preoperatively to 7.6 ± 1.9 postoperatively (p < 0.0001), with 43% of patients reporting a UCLA activity score of 9 or 10.ConclusionsHip resurfacing exceeds the stricter 2014 NICE survivorship criteria independently in men and women even when performed on patients under 50 years old.

Section: Methodsmentioning

confidence: 99%

Metal-on-metal hip resurfacing in patients younger than 50 years: a retrospective analysis

Gaillard

2017

J Orthop Surg Res

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“…All procedures were performed using a posterior approach as described previously [ 26 ]. Before 2009, acetabular components were positioned with an acetabular inclination angle (AIA) under 55°, based on research by De Smet [ 27 ].…”

Section: Methodsmentioning

confidence: 99%

Acetabular Debonding: An Investigation of Porous Coating Delamination in Hip Resurfacing Arthroplasty

Robinson

Gaillard-Campbell

Advances in Orthopedics

2018

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Background To date, there have been no published investigations on the cause of acetabular debonding, a rare failure phenomenon in metal-on-metal hip resurfacing where the acetabular porous coating delaminates from the implant while remaining well fixed to the pelvic bone. Purposes This study aims to summarize the current understanding of acetabular debonding and to investigate the discrepancy in rate of debonding between two implant systems. Patients and Methods To elucidate potential causes of debonding, we retrospectively analyzed a single-surgeon cohort of 839 hip resurfacing cases. Specifically, we compared rate of debonding and manufacturing processes between two implant systems. Results Group 1 experienced significantly more cases of debonding than Group 2 cases (4.0% versus 0.0%, p value<0.0001). Implant manufacturing processes differed in surface coating, heat treatment, postmanufacturing treatment, and apex thickness. Debonded implants were more likely to have missed RAIL guidelines (p=0.04). Conclusions We identified implant system, postoperative time, and acetabular component placement as variables contributing to rate of debonding. We recommend minimizing acetabular inclination angle according to RAIL guidelines. Further, we evaluated manufacturing differences between the two implant systems but did not have access to proprietary data to identify the cause of debonding. Both implants met ASTM standards, yet only the Group 1 implant debonded. This suggests the second implant had greater fatigue shear strength. Because the Group 2 implant achieved a more durable interface that did not debond, we suggest the ASTM F1160 standard for fatigue shear strength be increased to that achieved by its manufacturer. Level of Evidence II A retrospective evaluation of prospectively collected data.

“…The senior author performed all HRA operations through the posterior approach, as described previously [22]. Over time, the approach was modified to enhance the procedure as improvements were found [10,22,23].…”

Section: Surgical Proceduresmentioning

confidence: 99%

Interventions for Improving Hip Resurfacing Outcomes in Women: A High-Volume, Retrospective Study

Gaillard

The Journal of Arthroplasty

2017

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