Current Topics
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THE DURABILITY OF HIP RESURFACING
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.
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SHOULD YOU HAVE UNCEMENTED HIP RESURFACING?
Uncemented resurfacing components are a new development. The acetabular components used routinely are uncemented while the femoral components routinely have been cemented to bone.
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CURRENT STATUS OF UNCEMENTED FEMORAL COMPONENTS IN HIP RESURFACING
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.
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PERSPECTIVE ON METAL ON METAL TOTAL HIP REPLACEMENT
As a patient, there are two reasons you should consider a metal-on-metal total hip replacement. 1) Extremely durable surface that is unlikely to ever wear out. 2) Stability of the joint. Using a metal-on-metal bearing surface allows the manufacture of a large bearing hip joint that will not dislocate.
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METAL IONS, A SCIENTIFIC REVIEW
As a patient this is an excellent resource to know more about metal ions.
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THE CONTROVERSY REGARDING ADVERSE WEAR IN METAL-ON-METAL BEARING
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.
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HIP RESURFACING: A DURABLE SOLUTION. NEW TECHNIQUES PRESERVE HIP FUNCTION IN YOUNG, HIGHLY ACTIVE PATIENTS.
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?
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HIP HEMIRESURFACING: THERE NO LONGER IS ANY ROLE FOR THIS PROCEDURE
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.
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ARTHRITIS AND NON-OPERATIVE TREATMENT OPTION
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.
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LOW BACK PAIN AND NON-OPERATIVE TREATMENT OPTION
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.
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ACETABULAR COMPONENT INCLINATION ANGLE
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.
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WHAT IS THE BEST BEARING TYPE?
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.
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HIP RESURFACING vs. STANDARD TOTAL HIP REPLACEMENT
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.
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HIP RESURFACING SURVIVORSHIP, 2480 CASES OVER 10 YEARS
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.
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REFINED INTRAOPERATIVE XR TECHNIQUE TO ROUTINELY ACHIEVE AN AIA < 50°
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.
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INCIDENCE OF ADVERSE WEAR REACTIONS IN HIP RESURFACING ARTHROPLASTY: A COMPARISON WITH THE OXFORD STUDY
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).
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BONE HEALTH AND HIP RESURFACING
Osteoporosis is a chronic, progressive disease characterized by low bone mass, bone deterioration, and decreased bone strength leading to increased bone fragility, morbidity, and mortality.
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HIP RESURFACING IN WOMEN
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.