The outcome and survival of metal-on-metal hip resurfacing in patients aged less than 50 years

Abstract

Aims The aim of this study was to report the implant survival and patient-reported outcome measures (PROMs) in a consecutive series of patients aged less than 50 years at the time of arthroplasty using the Birmingham Hip Resurfacing system (BHR), with a minimum follow-up of ten years. Patients and Methods A total of 226 patients with osteoarthritis of the hip, who underwent BHR and presented to a single surgeon, were included in the study. Survival of the implant was confirmed by cross-checking with the Australian Orthopaedic Association National Joint Replacement Registry. Kaplan–Meier survival curves with 95% confidence intervals (CIs) were constructed. Pre- and postoperative PROMs were compared with t-tests, and postoperative scores were compared using anchor analysis with age and gender matched normative data. Results At median follow-up of 12 years (interquartile range (IQR) 10 to 13), six BHRs were revised, with a cumulative rate of survival of 96.8% (95% confidence interval (CI) 94.2 to 99.4) at 15 years, and with a significantly lower (p = 0.019) cumulative rate of revision than the national average for the same device at ten years. Most revisions (n = 4) were undertaken early, less than three years postoperatively, and occurred in women. Patient-reported general health (Veteran’s Rand-36), disease state (Western Ontario and McMaster Universities Osteoarthritis Index), function (modified Harris Hip Score) and level of activity (Tegner activity score) maintained significant (p < 0.01 for each) improvements beyond ten years postoperatively and were equal to, or exceeded, age- and gender-matched normative data in more than 80% of the patients. Conclusion Longer term PROMs after BHR, from a single surgeon, for patients aged less than 50 years remain under-reported. We found that the outcome after a BHR, at a minimum of ten years postoperatively, remained satisfactory, particularly for self-reported hip function.

Preliminary report of clinical experience with metal-on-highly-crosslinked-polyethylene hip resurfacing

“…Scholes et al 39 reported implant survival of 96.8% (95% CI 94.2 to 99.4) at 15 years in a cohort of 226 patients who underwent a BHR aged less than 50 years. Furthermore, patients experienced and maintained significant improvements in health and hip function scores, and activity scales beyond ten years postoperatively, and were equal to, or exceeded, age- and sex-matched normative data in more than 80% of patients.…”

“…Furthermore, patients experienced and maintained significant improvements in health and hip function scores, and activity scales beyond ten years postoperatively, and were equal to, or exceeded, age- and sex-matched normative data in more than 80% of patients. 39…”

Total Hip Arthroplasty for the Sequelae of Femoral Neck Fractures in the Pediatric Patient

“…These modalities include femoral head core decompression, osteotomy, electrical stimulation, and bone grafting with muscle-pedicle bone grafts, vascular-pedicle bone grafts, and free vascularized bone grafts [10,[19][20][21]. If hip joint reconstruction is deemed necessary, hip resurfacing (HR) and THA remain the primary treatment modalities [56][57][58][59][60][61]. HR has had poor results historically [56,61], but more recent studies using meticulous patient selection in young adults have demonstrated satisfactory short-to medium-term outcomes.…”

Percutaneous Radiofrequency Hip Joint Denervation

“…Another reason to delay THA is its failure rate -5-15% [28][29][30][31] -with 7-28% of patients left with post-operative CHP [32][33][34]. As THA implants have a life expectancy ranging from 10 to 25 years [30,[35][36][37] many surgeons consider that under 50 years of age it is wiser to delay this surgical procedure as much as possible [38][39][40][41]. When THAs are not advisable, hip joint denervation is an option that has been performed for over one hundred years.…”