Dysplasia has long been identified as a high-risk group for total hip replacement(THR). The underlying causes include younger age, underlying joint deformity, and greater tissue laxity. A higher failure rate has also been identified for hip resurfacing arthroplasty (HRA) in these patients. Many experts have advised avoiding HRA in these patients, although comparative studies are not available. We do not practice patient selection, because THR has not been proven any more reliable for these patients. Instead, we have taken the approach of studying the causes of failure and finding methods to improve the results of HRA in dysplasia patients. We have identified three primary failure modes for the young women who typically have dysplasia: failure of initial acetabular ingrowth (FAI), adverse wear related failure (AWRF), and early femoral failure (EFF: femoral neck fracture and head collapse). Improvements in technique to address all of these failure modes were in place by 2008: acetabular components with supplemental fixation for severe deformities (trispike), guidelines and intraoperative x-ray techniques to eliminate malpositioned acetabular components resulting in edge-loading, uncemented femoral fixation and a bone management protocol that has eliminated early femoral failure. Group I includes 142 cases done before 2008 and Group II includes 168 cases with minimum 2-year follow-up done after this date. Two-year failure rates improved from 5% (8/142) to 0.6% (1/168) and 5-year Kaplan-Meier survivorship improved from 93% to 99%. In Group II we have had only one failure (femoral neck fracture) in 168 dysplasia cases with 2–5 year follow-up. There have been no failures of acetabular ingrowth, no AWRF, no femoral head collapse, no failures of femoral ingrowth, no femoral loosenings, no dislocations and no nerve palsies. All acetabular components placed since 2008 meet our published RAIL (relative acetabular inclination limit) guidelines, which we have shown to be 99% reliable in avoiding high on levels and AWRF. Both groups were 70% female. With a mean bearing size 48mm (high-risk for HRA). There was also no differences in DEXA scan T score, BMI, ASA score, length of incision (4 inches) HHS, or patients participating in impact sports (UCLA activity score 9&10). In Group II the mean age was 3 years greater (52), the mean operative time was 20 minutes shorter (96 minutes), estimated blood loss was 120 ml less (140ml) and the mean hospital stay was one day shorter (2 days) probably reflective of greater experience in this single surgeon series. We have demonstrated that with sufficient surgeon experience and properly designed implants, hip resurfacing can be performed with a failure rate that is lower than most reports on THR for this disorder.
Uncemented acetabular component fixation has been considered the most reliable fixation method in contemporary metal-on-metal hip resurfacing arthroplasty (HRA). During prospective long-term follow-up of a HRA device, we have encountered a surprisingly high incidence of this complication and wish to alert surgeons and manufacturers of this problem. The study group was comprised of all 373 HRAs performed by a single surgeon using this hybrid hip resurfacing implant from May 2001 to March 2005. The acetabular component features a dual-coated bone ingrowth surface of plasma-sprayed titanium plus hydroxylappatite. There were a total of 34 revisions identified at the time of this study.Introduction:
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Metal-on-metal total hip arthroplasty (THA) implants have been widely debated due to the adverse wear issue related to the bearing surfacing. However, more recent studies have shown that the high metal ion problems that occur after surgery with this type of implant may not be exclusively related to the all metal bearing surfaces, but mainly due to the recently modified connecting tapers. Biomet is one of few companies who have not changed their original taper design for their THA implants. The purpose of this study was to present our up to eight-year clinical results. Between November 2004 and April 2011, all of the 196 cases in 167 patients (77 male vs. 89 female) performed by a single surgeon were included in this study. The Biomet Magnum/Jumbo metal-on-metal total hip arthroplasty implants were utilized for all of the cases. The average age was 59 ± 11 years at the time of surgery. Thirteen patients deceased from causes unrelated to THA. The primary diagnosis was OA in 124 cases; followed by AVN in 41 cases, dysplasia in 12 cases and other causes in the remaining 19 cases. The average acetabular component sizes were 54 ± 4 mm. Clinical and radiographic examinations were performed prospectively, and the results were analyzed.Background:
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More and more metal-on-metal hip resurfacing arthroplasty (HRA) implants have been used for active younger patients because of its higher success rate and better function outcomes for this group of patients compared to the traditional total hip arthroplasty (THA). One of the advantages of HRA is femoral neck preservation, which provides better bone structure in case a revision is necessary in the future. However, some believe that the outcomes after revision of hip resurfacing were not as good as the traditional THA. The purpose of this study was to provide our outcomes of the revisions, due to various causes, from over 3000 HRAs. Between May 2001 and April 2013, a single surgeon performed 3180 HRA. During that same period, 88 required revision (2.8%). Among them, the primary causes of the revision were acetabular component loosening in 22 cases; femoral component loosening in 21; femoral neck fracture in 19; adverse wear in eight; deep infection in four; and other causes for the rest. 68 of these revisions were performed by the same surgeon, while the remainder were revised elsewhere. 53 among these 68 cases had reached a minimum follow-up of two years and were included in this report. In 96%(51/53) of cases, the revision bearing was a large metal type including in 6/8 cases of adverse wear failure. There were eight cases of adverse wear with ion levels elevated above 10 μg/L, metalosis and inflammatory reaction seen at the time of revision. All of these cases had acetabular inclination angles larger than 50°. 7/8 of these cases were revised to another large metal bearing with improved acetabular component position. We analyzed the clinical scores, complications and radiographic results and compared them between these groups.Introduction:
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One reason that young and active patients choose hip resurfacing arthroplasty (HRA) rather than stemmed total hip arthroplasty (THA) is that they wish to return to high impact sports after their operation. Few studies have addressed the outcome in hip arthroplasty patients who choose to participate in high impact sports post-operatively. We therefore wanted to determine if the durability of HRA in highly active patients was decreased. From 5/2001 to 5/2011, a single surgeon performed 2434 HRA cases in 2013 patients. The study group consists of all patients that had a UCLA Activity score of 9 or 10 at any point after surgery in our prospective database. There were 936 (38%) cases in 776 patients who reported participating in high impact sports at some point after surgery. This group was compared to the entire database. The mean age of the study group was 50 ± 8 years, which was significantly younger than the entire group (Introduction:
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