Resurfacing Hip Arthroplasty Is a Safe and Effective Alternative to Total Hip Arthroplasty in Young Patients: A Systematic Review and Meta-Analysis

Two-Year Results of Ceramic-on-Ceramic Hip Resurfacing in an International Multicenter Cohort

INTRODUCTION

Hip resurfacing arthroplasty (HRA) is a bone-conserving alternative to total hip arthroplasty. We present the two-year clinical and radiographic follow-up of a novel ceramic-on-ceramic (CoC) HRA in an international multicenter cohort.

METHODS

Patients undergoing HRA between September 2018 and January 2021 were prospectively included. Patient-reported outcome measures (PROMS) in the form of the Forgotten Joint Score (FJS), Hip Disability and Osteoarthritis Outcome Score (HOOS) Jr., Western Ontario and McMaster Universities Arthritis Index (WOMAC), Oxford Hip Score (OHS), and University of California, Los Angeles (UCLA) Activity Score were collected preoperatively, and at 1- and 2-years post-operation. Serial radiographs were assessed for migration, component alignment, evidence of osteolysis or loosening, and heterotopic ossification formation.

RESULTS

The study identified 200 patients who reached a minimum 2-year follow-up (mean 3.5 years). Of these, 185 completed PROMS follow-up at 2 years. There was a significant improvement in HOOS (P < 0.001) and OHS (P < 0.001) between the pre-operative, 1-year, and 2-year outcomes. Patients also reported improved pain (P < 0.001), function (P < 0.001), and reduced stiffness (P < 0.001) as measured by the WOMAC score. Patients had improved activity scores on the UCLA Active Score (P < 0.001), with 45% reporting a return to impact activity at 2 years. At 1 and 2 years, the FJS was not significantly different (P = 0.38). There was no migration, osteolysis, or loosening of any of the implants. The mean acetabular cup inclination angle was 41.3 degrees, and the femoral component shaft angle was 137 degrees. No fractures were reported over the 2-year follow-up, with only 1 patient reporting a sciatic nerve palsy. There were 2 revisions, one for unexplained pain at 3 months due to acetabular component malposition and one at 33.5 months for acetabular implant failure.

CONCLUSION

The CoC resurfacing at 2 years post-operation demonstrates promising results with satisfactory outcomes in all recorded PROMS. Further long-term data is needed to support the widespread adoption of this prosthesis as an alternative to other HRA bearings.

Is there still an indication for the Birmingham Hip Resurfacing in femoral head osteonecrosis?

PURPOSE

Osteonecrosis of the femoral head (ONFH) is a progressive hip disease. Hip resurfacing arthroplasty (HRA) is a preferred surgical procedure among hip arthroplasty performed in young patients. The aim of this study is to show the long-term clinical and radiological results of HRA procedures performed for patients suffering from ONFH.

METHODS

Forty-five patients who underwent hip resurfacing with the diagnosis of femoral head osteonecrosis were included in the study. The Harris Hip Score (HHS) was used for clinical scoring of the patients. The blood chromium, cobalt, white blood cell (WBC) count, and CRP levels of patients were checked. Ultrasonography (USG) was performed for all patients at mid-term control checked for pseudo-tumours. For the radiological evaluation, acetabular inclination, stem shaft angle, prothesis-to-neck ratio, osteolysis zones, and heterotopic ossification were used.

RESULTS

The mean age of the patients was 46.6 ± 9.3 years, and the mean follow-up period was 11.83 ± 2.9 years. The mean HHS was 90.3 ± 12.8 for final follow-up. The mean WBC value was 8.2 109/L, mean CRP value was 6.3 mg/L, mean chromium value was 4.9 µg/L, and mean cobalt value was 1.8 µg/L. Inclination changing 0.2°(p = 0.788), stem shaft angle changing 0.7°(p = 0.424), and neck-to-prosthesis ratio changing 0.01°(p = 0.075). No pseudo-tumours were detected in any patients in USG examination.

CONCLUSION

HRA provides long-term implant survival and excellent clinical outcomes for end-stage ONFH patients with low complication rates.

Advances in Hip Replacement Surgery

Total hip arthroplasty (THA) is one of the most successful types of surgical operation, with some considering it "the operation of the century" [...].