Young women who desire a more functional hip replacement were recently dealt a large blow when the smaller sizes of the Birmingham Hip Resurfacing (BHR) device were withdrawn from the market by Smith Nephew Richards because the 10-year revision rate for women was higher than for men in most large registry analyses.
A recent Article in the Lancet medical journal has criticized hip resurfacing arthroplasty (HRA) as less durable than cemented 28mm total hip replacement (THR). I take exception to the inappropriate conclusion that the authors drew from this highly flawed study.
This lecture reviews the 15 year history of modern metal-metal hip surface replacement as it relates to uncemented femoral components. The results of McMinn, Wagner, Villar, Spriggins and Griffin, Fern are reviewed. The specific types of implants used are highlighted.
Traditionally, a larger more extensive approach has been required for hip surface replacement (HSR) than for standard stemmed total hip replacement. As we have gained experience with HSR, a minimally invasive surgical technique (MIS) using the posterior approach has been developed.
This lecture reviews the advantages and disadvantages of cement vs. cementless (porous) fixation in general and speculates why cement fixation was initially chosen on the femoral side of hip resurfacing. The possible advantages of uncemented fixation are discussed.
Abstract for the Third Annual US Comprehensive Course on Total Hip Resurfacing Arthroplasty in Baltimore, MD, September 2009: SESSION 7: TIPS TO GET STARTED by Thomas P. Gross, M.D.
Uncemented resurfacing components are a new development. The acetabular components used routinely are uncemented while the femoral components routinely have been cemented to bone.
Minimal two-year follow-up outcome of uncemented resurfacing components are a new development. A Comparison of cement vs. bone ingrowth. At 2 years of follow-up cemented and uncemented femoral resurfacing is equivalent. Femoral cement failure is the most common late cause of failure in hip resurfacing (3% at 8 years). Wear-related failures with the Corin or Biomet implant systems are rare in my experience.
As a patient this is an excellent resource to know more about metal ions.
I have used over 3000 metal bearings in primary total hip and hip resurfacing as well as revision surgery. I have revised 2 for adverse wear 7 years after implantation. I know that most other high volume hip resurfacing surgeons have a similar experience.
An energetic 35-year-old woman who manages a house full of kids and runs 10k races is not a candidate for hip replacement surgery, right? But what if she is?
It is my opinion that there no longer is any role for this procedure. The FDA does not realize this; they continue to approve implants for hemi-resurfacing. Typically these femoral hemi-resurfacing implants are best used off-label together with an acetabular component for total resurfacing.
Arthritis simply means an inflammation of joints. Almost everyone has suffered from this at one point in their lives. There are many types of arthritis. Sometimes it only involves a single joint, other times it can affect many at the same time.
Pain in or around the lumbar spine is a common problem suffered by most people at some point in their life. Most episodes will pass with time and a few simple measures. If these conservative measures fail after one to two months trial, or if the problems become severe, I would recommend evaluation by a back specialist.
This is a complex issue that defies simple explanation in non-technical terms. The bottom line is that patients with hip resurfacing should not worry about this. They should keep their regular follow-up appointments with their surgeons to monitor their implant every other year.
As a patient there are four reasons you should consider a metal-on-metal bearing total hip replacement or resurfacing. Wear, breakage, stability, and bone preservation.
There is much controversy among orthopedic joint replacement specialists about this topic. When summarizing the scientific literature, it appears that both resurfacing and replacement using modern bearings have a similar overall 95% survivorship rate at 10 years. Longer‐term results are not available.
Dr. Gross has now performed over 2500 Hip Surface Replacement (HSR) procedures over the last 12 years. Most failures occur during the first 6 months of the healing period. However, there is a slow rate of failure that occurs over time. Therefore the overall failure rate increases for a group of patients as the length of follow-up increases.
A steep acetabular inclination angle is the primary cause of adverse wear related failure with well-designed metal-on-metal bearing hip resurfacing arthroplasties (HRA). One recent study demonstrated that positioning acetabular components of stemmed total hip arthroplasties (THA) within the “Lewinnek safe zone” is difficult; only 62% had AIA within the safe zone.
A steep acetabular inclination angle is the primary cause of adverse wear related failure with well-designed metal-on-metal bearing hip resurfacing arthroplasties (HRA).