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Kovochich M, Finley BL, Novick R, Monnot AD, Donovan E, Unice KM, Fung ES, Fung D, Paustenbach DJ. Understanding outcomes and toxicological aspects of second generation metal-on-metal hip implants: a state-of-the-art review. Crit Rev Toxicol 2019; 48:853-901. [DOI: 10.1080/10408444.2018.1563048] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Oak SR, Strnad GJ, O'Rourke C, Higuera CA, Spindler KP, Brooks PJ. Mid-Term Results and Predictors of Patient-Reported Outcomes of Birmingham Hip Resurfacing. J Arthroplasty 2017; 32:110-118. [PMID: 27480827 DOI: 10.1016/j.arth.2016.06.049] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 06/14/2016] [Accepted: 06/23/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Birmingham hip resurfacing (BHR) is the only Food and Drug Administration approved resurfacing option currently available in the United States. While adequate BHR outcomes are established, there is a paucity of US-based literature demonstrating factors critical to improve patient reported outcomes (PROs). This study answers: (1) What is the implant survivorship in a large US cohort? (2) Which preoperative factors result in higher PRO scores over 5 years postoperatively? METHODS A retrospective 541 hip single-surgeon cohort with mean of 6.2 years follow-up (range 5-8.1) was collected. Preoperative patient/implant variables, including postoperative radiographic acetabular inclination and femoral component position, clinical outcomes, and follow-up PRO questionnaire information were collected. Validated PROs included the Hip Disability and Osteoarthritis Outcome Score (HOOS), Veterans Rand-12, and University of California Los Angeles (UCLA) activity. PROs were modeled with ordinary least squares then used to create nomograms. RESULTS Average patient age was 53 years with 391 (72%) males. Seven hips were revised, resulting in an overall survival of 98.8% at 5 years. Predictive modeling identified preoperative variables (sex, body mass index, smoking, and comorbidity) that had statistically significant associations with HOOS pain (P = .049), HOOS activities of daily living (P = .017), UCLA activity (P < .001), and Veterans Rand-12 physical (P < .001) PROs at latest follow-up. Nomograms predicted follow-up PROs using preoperative patient-specific variables. CONCLUSION This study documents excellent survival of the largest reported single-center cohort of BHRs in the United States with a mean 6.2 years follow-up. Multivariate modeling shows male nonsmokers with low body mass index, and no comorbidities will have less hip pain, better function in daily life, higher activity, and better general physical health after BHR arthroplasty.
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Affiliation(s)
- Sameer R Oak
- Cleveland Clinic Orthopaedic and Rheumatologic Institute, Cleveland, Ohio
| | - Gregory J Strnad
- Cleveland Clinic Orthopaedic and Rheumatologic Institute, Cleveland, Ohio
| | - Colin O'Rourke
- Cleveland Clinic Quantitative Health Sciences, Cleveland, Ohio
| | - Carlos A Higuera
- Cleveland Clinic Orthopaedic and Rheumatologic Institute, Cleveland, Ohio
| | - Kurt P Spindler
- Cleveland Clinic Orthopaedic and Rheumatologic Institute, Cleveland, Ohio
| | - Peter J Brooks
- Cleveland Clinic Orthopaedic and Rheumatologic Institute, Cleveland, Ohio
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Reito A, Lainiala O, Elo P, Eskelinen A. Prevalence of Failure due to Adverse Reaction to Metal Debris in Modern, Medium and Large Diameter Metal-on-Metal Hip Replacements--The Effect of Novel Screening Methods: Systematic Review and Metaregression Analysis. PLoS One 2016; 11:e0147872. [PMID: 26930057 PMCID: PMC4773181 DOI: 10.1371/journal.pone.0147872] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 11/25/2015] [Indexed: 11/18/2022] Open
Abstract
Metal-on-metal (MoM) hip replacements were used for almost a decade before adverse reactions to metal debris (ARMD) were found to be a true clinical problem. Currently, there is a paucity of evidence regarding the usefulness of systematic screening for ARMD. We implemented a systematic review and meta-analysis to establish the prevalence of revision confirmed ARMD stratified by the use of different screening protocols in patients with MoM hip replacements. Five levels of screening were identified: no screening (level 0), targeted blood metal ion measurement and/or cross-sectional imaging (level 1), metal ion measurement without imaging (level 2), metal ion measurement with targeted imaging (level 3) and comprehensive screening (both metal ions and imaging for all; level 4). 122 studies meeting our eligibility criteria were included in analysis. These studies included 144 study arms: 100 study arms with hip resurfacings, 33 study arms with large-diameter MoM total hip replacements (THR), and 11 study arms with medium-diameter MoM THRs. For hip resurfacing, the lowest prevalence of ARMD was seen with level 0 screening (pooled prevalence 0.13%) and the highest with level 4 screening (pooled prevalace 9.49%). Pooled prevalence of ARMD with level 0 screening was 0.29% and with level 4 screening 21.3% in the large-diameter MoM THR group. In metaregression analysis of hip resurfacings, level 4 screening was superior with regard to prevalence of ARMD when compared with other levels. In the large diameter THR group level 4 screening was superior to screening 0,2 and 3. These outcomes were irrespective of follow-up time or study publication year. With hip resurfacings, routine cross-sectional imaging regardless of clinical findings is advisable. It is clear, however, that targeted metal ion measurement and/or imaging is not sufficient in the screening for ARMD in any implant concepts. However, economic aspects should be weighed when choosing the preferred screening level.
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Affiliation(s)
- Aleksi Reito
- Coxa Hospital for Joint Replacement, Biokatu 6b, 33900 Tampere, Finland
- * E-mail:
| | - Olli Lainiala
- Coxa Hospital for Joint Replacement, Biokatu 6b, 33900 Tampere, Finland
| | - Petra Elo
- Coxa Hospital for Joint Replacement, Biokatu 6b, 33900 Tampere, Finland
| | - Antti Eskelinen
- Coxa Hospital for Joint Replacement, Biokatu 6b, 33900 Tampere, Finland
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de Villiers D, Hothi H, Khatkar H, Meswania J, Blunn G, Skinner J, Hart A. Lessons from retrievals: Retrievals help understand the reason for revision of coated hip arthroplasties. Proc Inst Mech Eng H 2015; 229:804-11. [PMID: 26503841 DOI: 10.1177/0954411915611427] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Coatings have been applied to all surfaces of hip implants with the majority performing well in the laboratory, but there are few reports of their performance in humans. The rationale for coating the metal-on-metal bearing surfaces includes a reduction in metal ion release and risk of adverse reaction to metal debris; yet there are no reports of retrieved coated metal-on-metal hip implants despite the concern that they may delaminate. The aim of this study was to better understand the performance of coated hip implants in humans through findings of three coated metal-on-metal hip resurfacings, retrieved after failure for unexplained pain. Analysis of these implants included quantification of the amount and mechanism of coating loss which was correlated with clinical, imaging and blood data. In all cases, there were large areas of complete coating loss in which the metal substrate was exposed and found to be rougher than the coated areas. The coating loss gave rise to third body abrasive wear of the coating and the exposed metal, the latter of which led to high blood levels of cobalt and chromium. Coating of the bearing surfaces of metal-on-metal hip resurfacings, therefore, do not prevent metal ion release when implanted into humans. This is an example of a need for increased retrieval analysis of newly introduced implants and expansion of laboratory testing regulations to better reflect the clinical environment.
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Affiliation(s)
- Danielle de Villiers
- Institute of Orthopaedics and Musculoskeletal Science, University College London, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Harry Hothi
- Institute of Orthopaedics and Musculoskeletal Science, University College London, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Harman Khatkar
- Institute of Orthopaedics and Musculoskeletal Science, University College London, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Jayantilal Meswania
- Institute of Orthopaedics and Musculoskeletal Science, University College London, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Gordon Blunn
- Institute of Orthopaedics and Musculoskeletal Science, University College London, Royal National Orthopaedic Hospital, Stanmore, UK
| | - John Skinner
- Institute of Orthopaedics and Musculoskeletal Science, University College London, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Alister Hart
- Institute of Orthopaedics and Musculoskeletal Science, University College London, Royal National Orthopaedic Hospital, Stanmore, UK
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Cadossi M, Tedesco G, Sambri A, Mazzotti A, Giannini S. Hip Resurfacing Implants. Orthopedics 2015; 38:504-9. [PMID: 26270748 DOI: 10.3928/01477447-20150804-07] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 08/04/2014] [Indexed: 02/03/2023]
Abstract
EDUCATIONAL OBJECTIVES As a result of reading this article, physicians should be able to: 1. Describe the advantages of hip resurfacing. 2. Describe the disadvantages of hip resurfacing. 3. Identify the population in which hip resurfacing is most often indicated. 4. Demonstrate how to properly postoperatively manage patients with metal-on-metal prostheses. Hip resurfacing offers a suitable solution for young patients affected by hip disease who have high function demands and good bone quality. Bone stock preservation, restoration of the normal proximal femur anatomy, the lack of stress shielding, and the possibility of resuming sporting activity are proven advantages of hip resurfacing. However, there are some disadvantages, such as fracture of the femoral neck, onset of neck narrowing, and possible complications due to the metal-on-metal bearings, including pseudotumors, peri-implant osteolysis, and chronic elevation of metal ions in serum levels. Recent data suggest that the ideal candidate for hip resurfacing is an active male, younger than 65 years, with primary or posttraumatic osteoarthritis, and with a femoral head diameter larger than 50 to 54 mm. Based on these selection criteria, the literature reports implant survival to be similar to that of total hip arthroplasty. The current authors' experience confirms a low failure rate and excellent functional outcomes, with metal ion serum levels becoming stable over time in well-functioning implants. Proper surgical technique, correct patient selection, and the right choice of a well-established prosthetic model are essential elements for the long-term success of these implants.
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Mokka J, Mäkelä KT, Virolainen P, Remes V, Pulkkinen P, Eskelinen A. Cementless total hip arthroplasty with large diameter metal-on-metal heads: short-term survivorship of 8059 hips from the Finnish Arthroplasty Register. Scand J Surg 2014; 102:117-23. [PMID: 23820688 DOI: 10.1177/1457496913482235] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Population-based register data from the National Joint Register of Australia and England and Wales have revealed that the mid-term outcome of cementless large diameter head metal-on-metal total hip arthroplasty is inferior to that of conventional cemented metal-on-polyethylene total hip arthroplasty. The aim of this study was to compare the results of cementless large diameter head metal-on-metal total hip arthroplasty with conventional cemented arthroplasty in Finland. The second aim of this study was to compare the cementless large diameter head metal-on-metal models with each other. MATERIAL AND METHODS Based on the data extracted from the Finnish Arthroplasty Register, the risk of revision of 8059 cementless large diameter head metal-on-metal total hip arthroplasties performed during 2002-2009 was analyzed using Cox regression model. The revision risk of these hips was compared to that of 16,978 cemented metal-on-polyethylene total hip arthroplasties performed during the same time period. RESULTS In the Cox regression analysis, there was no difference in revision risks between cementless large diameter head metal-on-metal total hip arthroplasty and cemented metal-on-polyethylene total hip arthroplasty (relative risk = 0.90, confidence interval = 0.74-1.10, p = 0.3). However, in female patients aged 55 years or above, cementless large diameter head metal-on-metal total hip replacements showed a significantly increased risk of revision as compared to cemented total hip replacements (relative risk = 1.33, confidence interval = 1.04-1.70). Compared to the reference implant in this study (cementless Synergy stem combined with Birmingham Hip Resurfacing [BHR] cup), the CementLess Spotorno (CLS) stem combined with Durom cup had a 2.9-fold (95% confidence interval = 1.17-6.90) increased risk of revision. CONCLUSIONS We found that cementless large diameter head metal-on-metal total hip arthroplasty had short-term survivorship compared with cemented total hip arthroplasty at a nation-wide level. However, in female patients aged 55 years or above, cementless large diameter head metal-on-metal total hip arthroplasty showed inferior results. Furthermore, implant design had an influence on revision rates. Longer follow-up time is needed to assess the success of large diameter head metal-on-metal total hip arthroplasty.
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Affiliation(s)
- J Mokka
- Department of Orthopaedics and Traumatology, Surgical Hospital, Turku University Hospital, Turku, Finland
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7
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Sugano N, Iida H, Akiyama H, Takatori Y, Nagoya S, Hasegawa M, Kabata T, Hachiya Y, Yasunaga Y. Nationwide investigation into adverse tissue reactions to metal debris after metal-on-metal total hip arthroplasty in Japan. J Orthop Sci 2014; 19:85-9. [PMID: 24338047 DOI: 10.1007/s00776-013-0490-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 10/12/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Adverse reactions to metal debris (ARMD) after receiving metal-on-metal (MoM) hip implants is a recent concern. However, no epidemiologic study has examined ARMD for MoM hip implants in Japan. The purposes of this study were to research the incidence of ARMD and to identify poorly performing MoM hip implants in Japan. METHODS From 2000 to 2011, 7 companies provided 23,226 MoM implants in Japan. A questionnaire regarding ARMD was sent to 101 hospitals at which 62% of the 23,226 MoM implants had been used. RESULTS Replies to the questionnaire were received from 82 hospitals. In these hospitals, surface hip replacement types (SRs) were used in 606 hips and stemmed types were used in 12,961 hips. ARMD were reported in 3 hips (0.5%) with SRs and 160 hips (1.2%) with stemmed types. ARMD in the 3 hips with SRs were asymptomatic and no revisions were performed. Among AMRD with stemmed implants, revision was performed in 83 hips and excision of an ARMD lesion was performed in 3 hips. The remaining 74 hips were asymptomatic and careful follow-up was continued. A significant difference in reoperation rate was evident between SRs (0%) and stemmed types (0.7%). Incidences of ARMD were significantly higher with Ultamet (P = 0.005), Conserve (P < 0.001), and Cormet (P < 0.001) MoM bearing couples than with Metasul bearings. CONCLUSIONS The incidence of ARMD in large surgical volume hospitals in Japan from 2000 to 2011 was estimated to be 0.5% with SRs and 1.2% with stemmed types. The reoperation rate was significantly higher with stemmed types than with SRs. Three brands of MoM stemmed implants were identified as showing a higher incidence of ARMD.
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Affiliation(s)
- Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Yamadaoka 2-2 Suita, Osaka, 565-0871, Japan,
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Survival and functional outcome of the Birmingham Hip Resurfacing system in patients aged 65 and older at up to ten years of follow-up. INTERNATIONAL ORTHOPAEDICS 2013; 38:1139-45. [PMID: 24370976 DOI: 10.1007/s00264-013-2240-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 12/01/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE Limited evidence exists regarding the outcomes of hip resurfacing in elderly patients. The primary study aims were to determine the survival and functional outcome following Birmingham Hip Resurfacing (BHR) in patients ≥65 years at up to ten years of follow-up. Secondary aims were to explore factors affecting survival and functional outcome. METHODS Between 1997 and 2012, data were prospectively collected on 180 BHR (162 patients; mean age 69.2 years; 62 % male) implanted by one designing surgeon. Mean follow-up was six (range one to 14.4) years with no loss to follow-up. Outcomes of interest were implant survival, functional outcome [Oxford Hip Score (OHS)] and radiological evidence of implant failure. RESULTS Three hips were revised, giving an overall cumulative survival of 96.4 % [95 % confidence interval (CI) 90.3-100] at ten years. Survival of 111 male BHR was 98.9 % (95 % CI 94.8-100) at ten years (one revision) compared with 91.9 % (95 % CI 77.0-100) in 69 female BHR (two revisions). Survival was affected by age (p = 0.014) and femoral head size (p = 0.024) but not by gender (p = 0.079). Median pre-operative OHS was 50.0 % [interquartile range (IQR) 37.5-68.8], improving to 4.4 % (IQR 0-10.4) postoperatively. Men had significantly better postoperative OHSs compared with women (median male OHS 2.1 % versus 6.3 % female OHS; p = 0.021). CONCLUSIONS Good survival and functional outcomes were achieved with the BHR at ten years in men and women ≥65 years. Despite registry findings to the contrary, age alone should not be a contraindication for hip resurfacing in centres with expertise in this procedure.
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Junnila M, Kostensalo I, Virolainen P, Remes V, Matilainen M, Vahlberg T, Pulkkinen P, Eskelinen A, Itälä A, Mäkelä K. Hip resurfacing arthroplasty versus large-diameter head metal-on-metal total hip arthroplasty: comparison of three Designs from the Finnish Arthroplasty Register. Scand J Surg 2013; 103:54-9. [DOI: 10.1177/1457496913495345] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background and Aims: Large headed metal-on-metal total hip arthroplasty may produce more metal ions than hip resurfacing arthroplasty. Increased metal-ion levels may be associated with higher revision rates due to adverse reaction to metal debris. The purpose of our study was to compare the survivorship of three hip resurfacing arthroplasty designs with their analogous cementless large-diameter head metal-on-metal total hip arthroplasties. Material and Methods: Based on data obtained from the Finnish Arthroplasty Register, the revision risks of three metal-on-metal hip resurfacing arthroplasty/total hip arthroplasty design couples performed during 2001–2011 were analyzed using the Cox regression model. Results: In the Cox regression analysis for compared design pairs adjusted for age, gender, operated side, head size, diagnosis, and implant, there was no statistically significant difference in revision risk between ReCap hip resurfacing arthroplasty and Bimetric/ReCap total hip arthroplasty (risk ratio = 1.43, confidence interval = 0.95–2.14, p = 0.09) or between Birmingham hip resurfacing arthroplasty and Synergy/Birmingham hip resurfacing total hip arthroplasty (risk ratio = 1.35, confidence interval = 0.75–2.43, p = 0.31). However, the revision risk of Corail and Summit/articular surface replacement total hip arthroplasty (ASR HRA) was significantly increased compared to ASR HRA. (risk ratio = 0.73, confidence interval = 0.54–0.98, p = 0.04). Conclusion: We conclude that the short-term revision risk of large headed metal-on-metal total hip arthroplasties was not increased compared to analogous hip resurfacing arthroplasties in two out of three devices studied at a nationwide level. There may be implant-related factors having an effect on the success of single manufacturer devices. However, more information on the incidence of adverse soft-tissue reactions in these patient cohorts is needed.
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Affiliation(s)
- M. Junnila
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland
| | - I. Kostensalo
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland
| | - P. Virolainen
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland
| | - V. Remes
- Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, Helsinki, Finland
| | - M. Matilainen
- Department of Biostatistics, Turku University, Turku, Finland
| | - T. Vahlberg
- Department of Biostatistics, Turku University, Turku, Finland
| | - P. Pulkkinen
- Department of Public Health, Helsinki University, Helsinki, Finland
| | - A. Eskelinen
- Coxa Hospital for Joint Replacement, Tampere, Finland
| | - A. Itälä
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland
| | - K. Mäkelä
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland
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Correlation between groin pain and cup design of hip-resurfacing implants: a prospective study. INTERNATIONAL ORTHOPAEDICS 2013; 38:923-8. [PMID: 24323353 DOI: 10.1007/s00264-013-2226-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 11/22/2013] [Indexed: 12/27/2022]
Abstract
PURPOSE Cup design has been incriminated as the source of groin pain after hip resurfacing but has not been well described; thus, it was assessed in a prospective study looking at three implant types. METHODS A group-match was done between three groups of hip resurfacing devices according to age, sex, body mass index, activity level, osteoarthritis aetiology and pre-operative scores. RESULTS The global groin pain rate was 5.7 % at six months and 2.7 % at last follow-up. Groin pain rate was significantly different between the three groups (p = 0.004) and had a strong influence on the subjective results (p = 0.04). No groin pain emerged between six months and last follow-up. No clinical differences were noted in Harris hip score and Merle d'Aubigné-Postel score at last follow-up. However, the Oxford hip score and Devane activity score were significantly lower for cups with macrostructures. CONCLUSION The low groin pain rate in this prospective cohort was probably secondary to the specific surgical technique used and seems to be correlated with cup design. Macrostructures on the external part of the cup could be significantly harmful.
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Karas S. Outcomes of birmingham hip resurfacing: a systematic review. Asian J Sports Med 2012; 3:1-7. [PMID: 22461959 PMCID: PMC3307960 DOI: 10.5812/asjsm.34717] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 10/03/2011] [Indexed: 11/16/2022] Open
Abstract
Purpose We performed a systematic review to assess the functional outcomes of Birmingham Hip Resurfacing as reported in peer-reviewed literature. Methods We performed a computerized search on the data sources up to February 2011. The following text and key words were searched: “Birmingham hip”, “Birmingham hip resurfacing” and “Hip resurfacing”. Each of these key words was again searched with “outcomes” following them. We also hand searched the bibliographies of the retrieved articles and our own files to identify specifically relevant articles. Results Fourteen retrospective studies and three prospective studies were included for review. Each of these studies was evaluated by the criteria given by Sackett and AACPDM. The design, patient criteria, intervention, outcomes, duration of follow up and results of the research were reported. Conclusions Although the technique of BHR does allow the femur to be spared, claims that it may allow patients to be more active need to be further investigated.
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Thomas MS, O'Hara JN, Davies AM, James SLJ. Profunda femoris pseudoaneurysm following Birmingham hip resurfacing: an important differential diagnosis for a periarticular cystic mass. Skeletal Radiol 2012; 41:853-6. [PMID: 22197889 DOI: 10.1007/s00256-011-1341-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 11/23/2011] [Accepted: 11/28/2011] [Indexed: 02/02/2023]
Abstract
Vascular injury following hip resurfacing arthroplasty is rare: we present a case of profunda femoris pseudoaneurysm complicating hip resurfacing arthroplasty performed via an anterolateral approach. Over recent years, it has been recognized that an adverse reaction to metal debris from metal-on-metal arthroplasties can also result in the development of cystic masses around the hip. This case highlights a potential rare differential diagnosis that needs to be considered when imaging cystic mass lesions around the postoperative hip. Imaging can provide a definitive diagnosis if this entity is considered and its appearances recognized, resulting in appropriate management of this potentially limb- and life-threatening complication.
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Affiliation(s)
- M S Thomas
- Department of Radiology, The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK.
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13
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Klotz M, Breusch S, Hassenpflug M, Bitsch R. Fünf- bis Zehn-Jahresergebnisse für den Oberflächenersatz des Hüftgelenks. DER ORTHOPADE 2012; 41:442-51. [DOI: 10.1007/s00132-012-1899-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Revision rate of Birmingham Hip Resurfacing arthroplasty: comparison of published literature and arthroplasty register data. INTERNATIONAL ORTHOPAEDICS 2012; 36:1349-54. [PMID: 22350138 DOI: 10.1007/s00264-012-1502-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 01/17/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Hip resurfacing arthroplasty has gained popularity for treating young and active patients who have arthritis. There are two major data sources for assessing outcome and revision rate after total joint arthroplasty: sample-based clinical trials and national arthroplasty registers. The purpose of this study was to evaluate the outcome of the Birmingham Hip Resurfacing (BHR) arthroplasty in terms of revision rate as reported in clinical studies and recorded by national arthroplasty registers. METHODS A comprehensive literature research was performed from English-language, peer-reviewed journals and annual reports from national joint arthroplasty registers worldwide. Only publications from MEDLINE-listed journals were included. The revision rate was used as the primary outcome parameter. In order to allow for direct comparison of different data sets, calculation was based on revisions per 100 observed component years. For statistical analysis, confidence intervals (CI) were calculated. RESULTS A total of 18,708 implants, equivalent to 106,565 observed component years, were analysed in the follow-up studies. The register reports contained 9,806 primary cases corresponding to 44,294 observed component years. Statistical analysis revealed a significant difference in revisions per 100 observed component years between the development team (0.27; CI: 0.14-0.40) and register data (0.74; CI: 0.72-0.76). CONCLUSION The BHR arthroplasty device shows good results in terms of revision rate in register data as well as in clinical studies. However, the excellent results reported by the development team are not reproducible by other surgeons. Based on the results of our study, we believe that comprehensive national arthroplasty registers are the most suitable tool for assessing hip arthroplasty revision rate.
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15
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Cementation and interface analysis of early failure cases after hip-resurfacing arthroplasty. INTERNATIONAL ORTHOPAEDICS 2012; 36:1333-40. [PMID: 22234704 DOI: 10.1007/s00264-011-1464-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 12/06/2011] [Indexed: 12/12/2022]
Abstract
PURPOSE The use of inappropriate cementation techniques has been suggested as an adverse factor for the long-term survival of hip-resurfacing arthroplasty. Inadequate initial fixation, thermal osteonecrosis and interface biological reactions are possible causes of failure. We analysed morphological changes associated with the cementation technique in a large collection of retrieved femoral components. METHODS One hundred and fifty femoral components (mean time to failure of 8.3 months±11.0) obtained at revision surgery were analysed morphometrically and histopathologically. Cement mantle and penetration were quantified in six different regions of interest. Histopathological analysis of the bone-cement interface was performed on undecalcified processed bone tissue. RESULTS The vast majority of the cases differed substantially from laboratory-based cement-penetration depth recommendations. Fifty-nine cases had a fibrous membrane at the cement-bone interface. This membrane was significantly thicker in cases with osteonecrosis compared to cases viable bone. CONCLUSIONS Our results demonstrate that most failures were cemented inappropriately. We suggest that poor cementation was an important adverse factor; however, the cause of the failures was obviously multifactorial. The thickness of the fibrous membrane at the cement-bone interface differed significantly between cases with osteonecrosis and specimens with viable bone tissue.
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Assessment of inter- and intra-observer reliability in the determination of radiographic version and inclination of the cup in metal-on-metal hip resurfacing. INTERNATIONAL ORTHOPAEDICS 2011; 36:519-25. [PMID: 21837449 DOI: 10.1007/s00264-011-1328-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 07/13/2011] [Indexed: 10/17/2022]
Abstract
PURPOSE Determination of the cup orientation after metal-on-metal hip resurfacing may provide important information in the postoperative follow-up. We present a mathematical method based on a previously described approach to assess the version and inclination of the cup in the metal-on-metal bearing without a separate software computation from plain radiographs. The aim of the study was to assess the intra- and inter-observer reliability of this method. METHODS Calculation of version and inclination were done twice for 20 hip resurfacings by four observers. Intra-observer reliability was estimated by mean error and correlation of the two sets of measurement for version and inclination. Bland-Altman plots, intra-class coefficient and mean error were used to assess the inter-observer reliability of the measurements. RESULTS Intra-observer correlation for version measurement ranged from 0.74 to 0.94. Correlation for inclination varied between 0.94 and 0.97. Upper and lower limits of agreement in Bland-Altman plots for version measurements between observers ranged from 4.1 to 7.2 degrees and from -3.2 to -8.3 degrees, respectively. For inclination measurements the upper and lower limits ranged from 3.1 to 5.3 degrees and from -2.7 to -6.0 degrees. CONCLUSIONS Mean errors, correlation coefficients and 95% limits of agreement were on an acceptable level. We believe that this method is applicable for clinical use.
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McMinn DJW, Daniel J, Ziaee H, Pradhan C. Indications and results of hip resurfacing. INTERNATIONAL ORTHOPAEDICS 2011; 35:231-7. [PMID: 21079954 PMCID: PMC3032116 DOI: 10.1007/s00264-010-1148-8] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Revised: 10/21/2010] [Accepted: 10/21/2010] [Indexed: 01/25/2023]
Abstract
The best indication for hip resurfacing is a young active patient with severe hip arthritis, good hip morphology and reasonable bone quality. With revision of either component for any reason as the endpoint, there were 68 revisions in our series of 3,095 consecutive Birmingham Hip Resurfacings (BHR) (1997-2009), including all diagnoses in all ages. This equates to a revision rate of 2.2% and survivorships of 99, 97 and 96% at five, ten and 13 years, respectively. In patients under 55 years with osteoarthritis, the survivorship is 99 and 98% at ten and 13 years. These results provide medium-term evidence that BHR when performed well in properly selected patients offers excellent outcomes and implant survivorship. Small changes to implant materials and design can affect joint function and survivorship significantly as seen from the withdrawal of certain resurfacing devices recently from clinical use. The clinical history of one device cannot be extrapolated to other devices.
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Affiliation(s)
- D. J. W. McMinn
- The McMinn Centre, 25 Highfield Road, Edgbaston, Birmingham, B15 3DP UK
| | - J. Daniel
- The McMinn Centre, 25 Highfield Road, Edgbaston, Birmingham, B15 3DP UK
| | - H. Ziaee
- The McMinn Centre, 25 Highfield Road, Edgbaston, Birmingham, B15 3DP UK
| | - C. Pradhan
- The McMinn Centre, 25 Highfield Road, Edgbaston, Birmingham, B15 3DP UK
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Malek IA, Hashmi M, Holland JP. Socio-economic impact of Birmingham hip resurfacing on patient employment after ten years. INTERNATIONAL ORTHOPAEDICS 2010; 35:1467-70. [PMID: 21113593 DOI: 10.1007/s00264-010-1168-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Revised: 11/04/2010] [Accepted: 11/05/2010] [Indexed: 10/18/2022]
Abstract
Birmingham hip resurfacing is an attractive option for treatment of arthritis in young and active patients. The aim of this study was to assess the socio-economic impact of Birmingham hip resurfacing on their employment and work intensity at ten years. A cohort of 90 consecutive patients with 100 Birmingham hip resurfacing, performed by single surgeon, were reviewed prospectively. The mean age was 51 years at surgery. Prospective review was undertaken from surgery until the tenth post-operative year. Overall, 90% of patients were in the same employment following surgery. Two patients who were employed before surgery were unemployed. Three patients had to decrease their work intensity but were still employed. Three out of five disabled patients regained employment following surgery. Seventy-eight patients were able to continue their employment with no or minimal restriction. Birmingham hip resurfacing allows the majority of patients to continue their same employment at similar intensity ten years following surgery.
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Affiliation(s)
- Ibrahim A Malek
- Department of Orthopaedics, Freeman Hospital, Newcastle Upon Tyne, UK.
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Bone mineral density in the femoral neck increases after hip resurfacing: a cohort with five-year follow-up. INTERNATIONAL ORTHOPAEDICS 2010; 35:1303-7. [PMID: PMID: 20730585 PMCID: PMC3167457 DOI: 10.1007/s00264-010-1115-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Revised: 08/09/2010] [Accepted: 08/10/2010] [Indexed: 10/19/2022]
Abstract
Hip resurfacing is an effective treatment modality for arthritis of the hip in carefully selected patients; however, its use remains controversial due to its higher revision rates compared with conventional total hip replacement surgery. The most frequent reason for revision is femoral neck fracture, and preoperative bone mineral density is an important factor when considering the option of hip resurfacing. Whilst reduction in bone mineral density following total hip replacement is well documented, little is known about the long-term changes in femoral neck bone mineral density after hip resurfacing. We followed 15 patients (ten male and five female) who underwent unilateral hip resurfacing for osteoarthritis with standardised dual energy X-ray absorbiometry scans at two weeks, three months, one year, two years and five years postoperatively to determine changes in the femoral neck bone mineral density. Both males and females initially had decreases in bone mineral density at three months postoperatively, but had gradual mean increases to 119% of their initial measurements by five years. This study demonstrates that femoral neck bone mineral density increases after hip resurfacing and that this increase continues for at least five years.
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