Birmingham hip resurfacing (original) (raw)
Related papers
Birmingham hip resurfacing: IS ACETABULAR BONE CONSERVED?
Journal of Bone and Joint Surgery - British Volume, 2008
Hip resurfacing is a bone-conserving procedure with respect to proximal femoral resection, but there is debate in the literature as to whether the same holds true for the acetabulum. We have investigated whether the Birmingham hip resurfacing conserves acetabular bone. Between 1998 and 2005, 500 Birmingham hip resurfacings were performed by two surgeons. Between 1996 and 2005 they undertook 700 primary hip replacements, with an uncemented acetabular component. These patients formed the clinical material to compare acetabular component sizing. The Birmingham hip resurfacing group comprised 350 hips in men and 150 hips in women. The uncemented total hip replacement group comprised 236 hips in men and 464 hips in women. Age- and gender-matched analysis of a cohort of patients for the sizes of the acetabular components required for the two types of replacement was also undertaken. Additionally, an analysis of the sizes of the components used by each surgeon was performed. For age-matche...
A randomised study comparing resection of acetabular bone at resurfacing and total hip replacement
Journal of Bone and Joint Surgery - British Volume, 2006
We have undertaken a prospective, randomised study to compare conservation of acetabular bone after total hip replacement and resurfacing arthroplasty of the hip. We randomly assigned 210 hips to one of the two treatment groups. Uncemented, press-fit acetabular components were used for both. No significant difference was found in the mean diameter of acetabular implant inserted in the groups (54.74 mm for total hip replacement and 54.90 mm for resurfacing arthroplasty). In seven resurfacing procedures (6.8%), the surgeon used a larger size of component in order to match the corresponding diameter of the femoral component. With resurfacing arthroplasty, conservation of bone is clearly advantageous on the femoral side. Our study has shown that, with a specific design of acetabular implant and by following a careful surgical technique, removal of bone on the acetabular side is comparable with that of total hip replacement.
Surface Replacement of the Hip Can Result in Decreased Acetabular Bone Stock
Clinical Orthopaedics and Related Research®, 2011
Background The recent interest in hip resurfacing arthroplasty is motivated by its potential advantages over THA. One advantage of hip resurfacing arthroplasty is that it conserves bone on the femoral side; however, it is unclear whether it does so on the acetabular side. Questions/purposes We determined whether the amount of acetabular reaming and acetabular bone removal required for hip resurfacing arthroplasty is equal to, less than, or greater than that for THA. Patients and Methods We prospectively evaluated the femoral neck size of 180 hips at the time of primary THA in an identical manner to when carrying out a hip resurfacing arthroplasty. Based on the femoral neck measurement, we determined the minimum cup size that would be used and reamer size required if the hip was undergoing a resurfacing. We compared this to the reamer size actually required to prepare the acetabulum for the THA cup. We calculated the difference between the predicted reaming size for resurfacing and the actual reaming size to determine the effect of resurfacing on acetabular bone stock. Results Overall, 71%, 57%, and 41% of THAs would have had extra acetabular bone removed to implant a hip resurfacing arthroplasty cup with a line-to-line (0-mm), 1-mm, or 2-mm press fit, respectively. Conclusions When compared to THA, hip resurfacing arthroplasty commonly results in additional acetabular bone resection.
Journal of Bone and Joint Surgery - British Volume, 2010
The survivorship of contemporary resurfacing arthroplasty of the hip using metal-on-metal bearings is better than that of first generation designs, but short-term failures still occur. The most common reasons for failure are fracture of the femoral neck, loosening of the component, osteonecrosis of the femoral head, reaction to metal debris and malpositioning of the component. In 2008 the Australian National Joint Registry reported an inverse relationship between the size of the head component and the risk of revision in resurfacing hip arthroplasty. Hips with a femoral component size of ≤ 44 mm have a fivefold increased risk of revision than those with femoral components of ≥ 55 mm irrespective of gender. We have reviewed the literature to explore this observation and to identify possible reasons including the design of the implant, loading of the femoral neck, the orientation of the component, the production of wear debris and the effects of metal ions, penetration of cement and v...
Metal on metal hip resurfacing versus uncemented custom total hip replacement - early results
2010
Introduction: There is no current consensus on the most appropriate prosthesis for treating symptomatic osteoarthritis (OA) of the hip in young, active patients. Modern metal on metal hip resurfacing arthroplasty (HR) has gained popularity as it is theoretically more stable, bone conserving and easier to revise than total hip arthroplasty. Early results of metal on metal resurfacing have been encouraging. We have compared two well matched cohorts of patients with regard to function, pain relief and patient satisfaction. Methods: This prospective study compares 2 cohorts of young, active patients treated with hip resurfacing (137 patients, 141 hips) and custom uncemented (CADCAM) stems (134 patients, 141 hips). All procedures were performed by a single surgeon. Outcome measures included Oxford, WOMAC and Harris hip scores as well as an activity score. Statistical analysis was performed using the unpaired student's t-test.
Resurfacing is Comparable to Total Hip Arthroplasty at Short-term Followup
Clinical Orthopaedics and Related Research, 2009
Metal-on-metal total hip resurfacing arthroplasty has had excellent reported results at early to midterm followup, and some studies suggest that outcomes are comparable to conventional THA. We compared the clinical and radiographic outcomes of two closely matched groups of 54 patients who underwent resurfacing and conventional THA, respectively. Each group consisted of 36 men and 18 women who had a mean age of 52 years and a mean body mass index of 29 kg/m 2 . At a minimum followup of 24 months (mean, 40 months; range, 24-60 months), the mean Harris hip scores increased similarly in both groups (from 52 to 90 points and from 50 to 91 points for the resurfacing and conventional groups, respectively). Radiographic outcomes, revision rates, complications, pain scores, and satisfaction ratings of the two groups were similar. The patients who underwent resurfacing had higher postoperative weighted activity scores than the patients who underwent conventional THA, although they had higher preoperative weighted activity scores as well. The early outcomes of resurfacing are comparable to those of conventional THA.
Survivorship and risk factors for revision of metal-on-metal hip resurfacing
Bone & Joint Open
AimsMetal-on-metal hip resurfacing (MoM-HR) has seen decreased usage due to safety and longevity concerns. Joint registries have highlighted the risks in females, smaller hips, and hip dysplasia. This study aimed to identify if reported risk factors are linked to revision in a long-term follow-up of MoM-HR performed by a non-designer surgeon.MethodsA retrospective review of consecutive MoM hip arthroplasties (MoM-HRAs) using Birmingham Hip Resurfacing was conducted. Data on procedure side, indication, implant sizes and orientation, highest blood cobalt and chromium ion concentrations, and all-cause revision were collected from local and UK National Joint Registry records.ResultsA total of 243 hips (205 patients (163 male, 80 female; mean age at surgery 55.3 years (range 25.7 to 75.3)) with MoM-HRA performed between April 2003 and October 2020 were included. Mean follow-up was 11.2 years (range 0.3 to 17.8). Osteoarthritis was the most common indication (93.8%), and 13 hips (5.3%; 7M...
Annals of Joint
Background: A randomized controlled trial (RCT) comparing nine different hip resurfacing designs was set up at an independent hip resurfacing center to assess the possible differences between the designs. There was one operating surgeon. All surgeries were performed between 2007 and 2011. Methods: The RCT was setup to include 180 patients scheduled for a unilateral hip resurfacing arthroplasty (HRA) who had no other metal implants and normal renal function, randomized to receive 1 of 9 different HRA designs (20 per group). Surgical data (instrumentation), clinical and radiographic outcome and metal ion levels in whole blood and serum chromium (Cr) and cobalt (Co) at preoperative, 3, 6, 12, 24 and 60 months intervals were compared. Results: During the course of the study three designs were discontinued: the ASR after withdrawal from the market and the DUROM and MITCH because of cup fixation problems. Patients already recruited and operated were kept in the study for follow-up. The other groups were ACCIS, ADEPT, BHR, Conserve Plus, Conserve Plus Aclass, and RECAP. A total of 129 patients were included in the RCT. There was no significant difference in gender between the HRA groups (P=0.435). There were more men (61.1%) included than women (38.9%). There were 9 revisions (7%) at a mean of 31.3 months (range, 11-60 months). Harris Hip Scores had a range of 86-100 (mean 98) with a median of 100 over 5 years. There was a high correlation between the whole blood and serum levels for Cr and Co (P<0.001). In all groups except ACCIS, Cr and Co ion concentrations increased from baseline (preoperative) till the 1-year follow-up (running-in phase) and subsequently levelled off (steady-state). Outliers occurred more often in the RECAP and ASR groups. Conclusions: Clinical and radiographical follow-up showed little differences. Overall the revision ratio, at a minimum of 8 years of follow-up was 7%. Thus, in our series, the implants of 9 different hip resurfacing designs, including the ones that were withdrawn from the market, have globally performed well with <1% failure per year. In general, metal ion levels below the proposed acceptable limits were found with all HRA designs. The difference in ion levels between the resurfacing designs may reflect differences in clearance, metallurgy and coverage angle. Outliers occurred more often with designs with a smaller coverage angle. The lower ion levels with the DUROM design are probably related to its highest coverage angle and its metallurgy.