This study reviews the short-term results of 36 hip resurfacings performed to treat avascular necrosis (AVN) of the femoral head over a four-year period. The mean age of the 32 patients, 30 men and two women, was 41 years (25 to 50). Treatment options were discussed with patients, who usually preferred resurfacing to osteotomy, vascular fibular grafting, or total hip arthroplasty. No hips were revised, but in one patient both hips will probably be revised because of symptoms arising from anterior impingement between the femoral neck and acetabular cup rim. The other patients had no or minimal symptoms. One manual labourer and one truck driver (the patient with symptoms of impingement) have been unable to resume their previous work. Another manual labourer returned to permanent light duty. All the others resumed levels of work and sports activity comparable to their previous activities. Resurfacing of the hip is generally advocated for young, active patients. It is therefore an option for treatment of AVN, which typically occurs in the fourth and fifth decades, most commonly in physically and economically active males.
The aim of this retrospective study was to compare the rate of recovery and eventual level of function following total hip arthroplasty (THA) and hip resurfacing. Participants were 47 patients who had undergone THA and 43 who had undergone hip resurfacing. In all cases medical records were reviewed and function assessed, using the Harris hip score, visual assessment of gait and a functional score. The rate of recovery, as measured by functional activities and range of motion, was notably better in patients who underwent hip resurfacing than in patients who underwent THA. No significant discrepancy was found in the presence of deformity and the levels of postoperative pain following either procedure. We conclude that the hip resurfacing procedure may have important advantages over conventional THA, including more rapid mobilisation, higher levels of final function, increased range of motion, less physical limitation and shorter hospital stays. An important advantage is that the hip resurfacing procedure allows patients to resume work and sport earlier.
In a study of 76 consecutive hip resurfacing arthroplasty procedures, the reasons for choosing this procedure rather than total hip arthroplasty (THA) were reviewed. Patient age, preoperative diagnosis, presence of bone deficiency and other technical factors were considered. The mean age of patients, 79% of whom were men, was 44 years (20 to 76). The preoperative diagnosis in 59% of patients was osteoarthritis and in 37% avascular necrosis. The decision to resurface the hip rather than to perform THA was influenced primarily by the patient’s choice. In 43 cases (57%), the patient had prior knowledge of the procedure and specifically that it be considered. Other important considerations were the patient’s level of physical activity, the expectation of non-compliance with mobilisation and rehabilitation, the expectation of instability of the hip, the quality of bone and the surgeon’s experience with the surgical technique. As experience of the procedure grew, the mean age of patients who underwent resurfacing arthroplasty increased. The early clinical results of resurfacing indicate that the range of motion is less than in hip replacement, that the resurfaced hip demands less care against dislocation or wear, and that the patient mobilises and rehabilitates more rapidly and reaches a higher level of physical ability than with THA. As mid-term and long-term results become available, the indications for and prevalence of hip resurfacing arthroplasty are likely to increase.
For one year (July 1999-July 2000), the rate of post-operative infection in patients undergoing joint arthroplasty was recorded (including wound, chest UTI etc). Standard precautions against infection used in most orthopaedic units in the UK were employed. In July 2000 elective orthopaedic beds were ‘ring-fenced’. Only elective orthopaedic patients who had negative swabs for MRSA in the community were admitted. Eradication therapy was commenced in the community if appropriate. Trauma and other specialties’ patients were excluded. In addition to standard precautions, nurses wore a disposable apron and gloves for each intervention. Antibacterial hand cleanser was installed by each bed, and staff expected to use it after each consultation. Doctors left jackets at the door and donned clean white coats for ward rounds. These were left on the ward and laundered daily. New cleaning regimes were adopted. Pre ring-fencing, 417 joint replacements were performed and 60 patients were cancelled due to no bed. There were 43 post-op infections, 9 of which were MRSA. In the year post ring-fencing, 488 joint replacements were performed; there were no cancellations due to bed shortage. There were 15 post-op infections and no MRSA. Eight patients swabbed positive for MRSA in the community, and were admitted after eradication therapy with no infections post-op. We concluded that ‘ring-fencing’ of elective orthopaedic beds reduced cancellations, reduced the overall infection rate and abolished MRSA. We have continued to ring-fence elective beds following this study, and recommend these precautions be employed in all units dealing with elective orthopaedic patients.
Resurfacing arthroplasty of the hip is a relatively new procedure. This paper reports the technical and clinical problems one surgeon encountered in the first 50 consecutive resurfacing arthroplasties of the hip. The mean age of the 14 women and 32 men at the time of surgery was 44.8 years (20 to 65). Four patients underwent bilateral arthroplasty. Technical problems included failure of the acetabular component to seat fully in six hips and failure of the femoral component to seat fully in four. There was varus malalignment of the femoral component in three cases, retention of the alignment pin in one, and retention of a cable fragment in one. Surgical complications included one case of intra-operative femoral neck fracture, one transection of the psoas tendon during capsulotomy, and a femoral nerve palsy, which recovered after six months. Postoperative problems included superficial wound inflammation in five hips and one dislocation. There were radiological signs of impingement of the femoral neck on the acetabular rim in four cases and clinical symptoms of impingement in one. An undisplaced fracture of the femoral neck that occurred eight weeks after surgery was successfully managed conservatively by keeping the limb non-weight-bearing. Despite these problems, only one patient retains any noteworthy symptoms, apparently due to impingement of the femoral neck on the acetabular rim. Modest malalignment or seating failure appears to be of minimal clinical consequence. Patients typically mobilise rapidly and are able to return to a high level of physical activity. It is possible to avoid most technical problems by taking specific precautions.
