SurfaceHippy | Surgeons experience with hip resurfacing shows very LOW complication rate

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Surgeons experience with hip resurfacing shows very LOW complication rate

Posted on the ORTHOSuperSite November 16, 2011

Surgeons experience with hip resurfacing shows 1.3% complication rate

Excerpt:
"The retrospective study, which analyzed 925 hip resurfacings performed by Edwin Su, MD, between 2004 and 2009 with a minimum follow-up of 2 years, looked at three implants: Wright Medical’s Conserve Plus Total Resurfacing Hip System, Biomet Orthopedics’ ReCap Femoral Resurfacing System and Smith & Nephew’s Birmingham Hip Resurfacing System. Conserve Plus and the Biomet ReCap were used as part of clinical trials, while the Birmingham hip was used after FDA approval of the implant in 2006. Clinical scores and radiographs were obtained at 1 month, 3 months, 1 year, and every subsequent year. The hips in the study had a minimum of 2 year follow up, both radiographically and clinically....

The study showed 12 revisions (1.3%) at a minimum followup of 24 months. The K-M survival curve overall for the procedure, using all 3 different implants, was 98.6% at 68 months. Su noted that these results compared favorably to other published papers that describe short-term failure rates of 8% and 13% for the procedure. The Conserve Plus series had six revisions out of 157 cases (3.8%), which involved two cup loosenings, three femoral loosenings and an adverse metal reaction. The Birmingham series had six revisions out of 748 cases (0.8%), and the ReCap had no revisions.....

Limitations for the study include the limited amount of data collected for certain implants, such as the ReCap, which had 20 implants compared to the Conserve Plus (157 implants) and the Birmingham series (748 implants). The Conserve Plus series also had a longer follow-up compared with the Birmingham series.

“For a surgeon contemplating adopting resurfacing, one must be concerned about the learning curve,” Su said. “The exposure is more difficult, it is more time-consuming, and it is more sensitive to technical errors.” However, with careful patient selection, proper surgical training, and a good implant, the success rate can be excellent. "

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by Joseph Daniel, FRCS; Chandra Pradhan, FRCS; Hena Ziaee, BSc (Hons); Derek J.W. McMinn, FRCS

Abstract

This is a 1.2- to 5.3-year survival and clinicoradiologic study of patients with the Birmingham Mid-Head Resection (BMHR) device (Smith & Nephew Orthopaedics, Warwick, United Kingdom). Sixty consecutive hips implanted with this device between 2003 and 2007 were reviewed with hip outcome questionnaires, clinical examination, and radiographs at a minimum follow-up of 1 year. There were no revisions, mechanical failures, or signs of femoral neck stress shielding. All hips were functioning well and showed no significant adverse clinical or radiographic features. Birmingham Mid-Head Replacement offers the prospect of circumventing the need for a more invasive procedure such as hip replacement in patients who would benefit from a conservative arthroplasty but lack femoral head bone quality, which is a prerequisite for a successful hip resurfacing.

The results of conventional hip replacement in young patientswith osteoarthritis have not been encouraging even with improvementsin the techniques of fixation and in the bearing surfaces. Modernmetal-on-metal hip resurfacing was introduced as a less invasivemethod of joint reconstruction for this particular group.

This is a series of 446 hip resurfacings (384 patients) performedby one of the authors (DJWM) using cemented femoral componentsand hydroxyapatite-coated uncemented acetabular components witha maximum follow-up of 8.2 years (mean 3.3). Their survivalrate, Oxford hip scores and activity levels are reviewed.

ORLANDO, Fla. — Despite the problems seen with some hip resurfacing implants, hip resurfacing is still a viable alternative to hip replacement in appropriately selected patients, a surgeon here said.

“Many of the reasons not to perform hip resurfacing are based upon fear: fear of fracture, fear of difficulty of the technique, fear of metal reactivity and sensitivity. I implore you that we should not allow fear to triumph over reason,” Edwin P. Su, MD, said during a presentation at the 2010 Current Concepts in Joint Replacement Winter Meeting.

In support of hip resurfacing

Su presented several factors in favor of hip resurfacing. Hip resurfacing preserves bone, as was observed in a cadaveric study he and his colleagues performed that compared hip resurfacing and hip replacement to determine the extent of bone loss.

A COMPARATIVE STUDY OF ARTICULAR SURFACE REPLACEMENT AND BIRMINGHAM HIP RESURFACING ARTHROPLASTIES

There have been no large comparative studies of the blood levelsof metal ions after implantation of commercially available hipresurfacing devices which have taken into account the effectsof femoral size and inclination and anteversion of the acetabularcomponent. We present the results in 90 patients with unilateralarticular surface replacement (ASR) hip resurfacings (mean timeto blood sampling 26 months) and 70 patients with unilateralBirmingham Hip Resurfacing (BHR) implants (mean time 47 months).

The whole blood and serum chromium (Cr) and cobalt (Co) concentrationswere inversely related to the size of the femoral componentin both groups (p < 0.05). Cr and Co were more strongly influencedby the position of the acetabular component in the case of theASR, with an increase in metal ions observed at inclinations> 45° and anteversion angles of < 10° and >20°.

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News

80-percent of US surgeons choose the BHR hip as it outperforms all other metal-on-metal resurfacing devices

Memphis, Tenn. (May 3, 2010) – Recent new data¹ presented at this year’s American Academy of Orthopaedic Surgeons (AAOS) annual meeting reinforces the BIRMINGHAM HIP™ Resurfacing (BHR) System as a safe and effective hip resurfacing device. The multi-site study, performed by orthopedic surgeons practicing at nine Canadian academic centers, showed that three years after surgery, 99.91% of their 3,400 hip resurfacing patients experienced no implant failure due to metal wear debris. The BHR Hip was the most used resurfacing device in this study.

FDA on Metal Metal Implants

Follow-Up for Metal-on-Metal Hip Patients Developing Local Signs/Symptoms

Clinical and Imaging Evaluation

If you have a patient with the presence of local symptoms such as pain or decrease in joint function that appear more than three months after metal-on-metal (MoM) hip implant surgery, you should conduct a thorough evaluation.

Guide your clinical evaluation by the symptoms and physical findings, including an assessment for well-known emergent complications including joint infection, implant loosening, peri-prosthetic fracture and dislocation.
Recognize that localized lesions associated with reactions to metal debris may also present with pain or a variety of other signs/symptoms including:
- Local nerve palsy
- Palpable mass
- Local swelling
- Joint dislocation or subluxation