The Biomechanical Results of Total Hip Resurfacing Arthroplasty

Silva, Maurício; Lee, Kee Haeng; Heisel, Christian; Rosa, Mylene A dela; Schmalzried, Thomas P.

doi:10.2106/00004623-200401000-00007

Cited by 170 publications

(84 citation statements)

References 13 publications

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“…alternative prosthetic solution to conventional THA for patients with end-stage osteoarthritis [1,10,15,18,30,33,37,38]. 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].…”

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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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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“…There are a number of theoretical advantages of hip resurfacing over conventional THA, including preservation of bone stock [1,20,64], less stress shielding [47], less thigh pain [88], fewer dislocations [26,87], reduced osteolysis [87], improved biomechanics [44,81,89], retention of proprioception, and ease of revision in comparison to THA [1,14,64,75]. 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].…”

Section: Introductionmentioning

confidence: 99%

Is Patient Selection Important for Hip Resurfacing?

Nunley¹,

Valle²,

Barrack³

2009

Clinical Orthopaedics &Amp; Related Research

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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.

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“…These included clinical factors such as weight [12,13,15], height [3], BMI, and diagnosis such as rheumatoid arthritis [4,20]. We also considered radiographic factors that have been a part of biomechanical analysis in other publications such as implant shaft angle [5,[11][12][13][14], implant size [3], head-neck ratio, neck-shaft angle [40], femoral cysts [3,12,13], and femoral offset [40,42]. Larger implant size has been believed to have a protective effect on implant survival; more time was required for disruption of the larger fixation area of larger femoral resurfacing components than smaller ones [31,35].…”

Section: Discussionmentioning

confidence: 99%

“…One author (EJY) reviewed all radiographic records to record information using methods similar to those described by Silva et al [42]. Preoperative neck-shaft angle, head diameter, neck diameter, head-neck ratio, and femoral offset were measured, and the presence of any femoral cysts larger than 1 cm was recorded.…”

Section: Methodsmentioning

confidence: 99%

Hip Resurfacing Arthroplasty: Risk Factors for Failure Over 25 Years

Yue

Cabanela

Duffy

et al. 2008

Clin Orthop Relat Res

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Many early metal-on-polyethylene hip resurfacing arthroplasty designs were abandoned after reports of high short-term and midterm failure rates. To investigate factors associated with failure, we retrospectively reviewed our experience with early-design hip resurfacing implants in 75 patients during a 25-year period (median followup, 7.9 years; range, 0.1-25.2 years). Implant failure was defined as revision for any reason. One of 75 patients was lost to followup. The estimated rate of implant survival was 73% at 5 years, 34% at 10 years, 27% at 15 years, 12% at 20 years, and 8% at 25 years. Of the many clinical and radiographic factors considered, only age, implant type, and gender were associated with implant survival independent of other variables considered. Hip resurfacing arthroplasty showed poor overall long-term survival in this series. Particular attention should be paid to the identified risk factors as long-term followup data become available for modern designs.

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The Biomechanical Results of Total Hip Resurfacing Arthroplasty

Cited by 170 publications

References 13 publications

Socket Position Determines Hip Resurfacing 10-Year Survivorship

Socket Position Determines Hip Resurfacing 10-Year Survivorship

Is Patient Selection Important for Hip Resurfacing?

Hip Resurfacing Arthroplasty: Risk Factors for Failure Over 25 Years

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