Management of hip osteoarthritis in young active patients is made more challenging by the longevity required of the prostheses used and the level of activity they must endure. The aim of this study was to compare the functional outcomes and activity levels following hip resurfacing (HR) and uncemented total hip arthroplasty (UTHA) in young active patients matched for age, gender and activity levels. 255 consecutive hip arthroplasties performed in a teaching hospital were retrospectively reviewed from which were identified 58 UTHA patients and 58 HR patients, matched for age, gender and pre-operative activity level. Mean age of patients within UTHA was 58.5 years (34 – 65) and in HR was 57.9 years (43 – 68). No patients within the study were lost to follow-up. Mean follow-up was five years. Within each group there was a statistically significant improvement in the mean UCLA score following surgery (p=0.00). In the HR Group, mean UCLA score improved from 4.2 (1–8) to 6.7 (3–10) while in the UTHA group the mean UCLA score improved from 3.4 (1–7) to 5.8 (3–10). Mean OHS improved from 44.4 (31–57) to 16.6 (12–31) in the HR group and from 46.1 (16–60) to 18.8 (12–45) in the UTHA group, p = 0.00 each group. This study found no statistically significant difference in the levels of function (p= 0.82) or activity pursued (p= 0.60) after surgery between UTHA and HR in a population of patients matched for age, gender and pre-operative activity levels. This study has shown comparable outcomes with hip resurfacing and uncemented THA in terms of both functional outcomes and activity levels in a group of young active patients. The potential complications unique to hip resurfacing may be avoided by the use of uncemented THA. In addition, uncemented THA has a longer track record.
Modern methods of deformity correction such as the Taylor Spatial Frame (TSF) allow correction of deformities to within tolerances of 1° and 0.5mm. Plain X-radiography using orthogonal views is the current standard for the assessment for the evaluation of angular limb deformities. CT has been used for the assessment of torsional and axial deformities but its use has not been described for the measurement of angular deformities. Furthermore, dedicated correction planning software (SpatialCad™) may allow more accurate deformity definition. This study aims to evaluate the accuracy of CT and SpatialCad™ to measure angular deformities in vitro. A tibia sawbone was coated in radio-opaque paint. A TSF was mounted on it and an osteotomy made in the mid-diaphyseal region. Four deformities were created and imaged with plain radiography and CT. Four observers measured the deformities using paper and pencil, PACS and SpatialCad™ for plain radiographs and Spatial-Cad™ for the CT scout views. The variance of the mean response of observed differences between main treatment factors was measured using analysis of variance. There was no significant difference in variability (precision) between observers or methods of measurement. However, measurements made with PACS and Spatial-Cad™ on plain radiographs, but not CT scout views, were also accurate. There does not appear to be any evidence at present that the use of CT for measurement of angular limb deformity is justified over plain radiography. Spatial-Cad™ is designed to optimize deformity correction planning for use with TSF, but PACS appears to be adequate for use with other deformity correction systems.
The purpose of this study was to evaluate and assess the sporting and physical activities of patients who have undergone hip resurfacing. One hundred and seventeen patients who underwent hip resurfacing between 2003–2007 were reviewed. Demographic data such as age, sex and comorbidities were recorded. University of California and Los Angeles (UCLA) activity level ratings and Oxford hip scores were collected pre-and postoperatively for each patient. The sporting and physical activities of all patients were pre-and post-operatively recorded. The mean age of patients at surgery was 54 yrs and 56 yrs at review. The mean follow up time was 19 months. Following surgery there was a significant improvement in UCLA activity level scores from 4.4 to 6.8 (Wilcoxon Matched-pairs Signed rank test, p<
0.05). Oxford hip scores significantly improved from 43.4 to 17.7 following surgery. Eighty six patients regularly participated in sport before they became symptomatic with significant hip pain, and 75 regularly participated in sports after surgery. In total 87% of patients successfully returned to their regular sporting and physical activities following surgery. Many patients were returning to high impact sports including football, tennis, cricket and squash. The published medium-term survivorship of the Birmingham hip has given surgeons increasing confidence to use the prosthesis on a younger generation of patients. Our study has demonstrated that hip resurfacing can allow patients to remain extremely active.
The management of osteoarthritis of the hip in young active patients has always been challenging. This can be made more difficult because of the longevity required of the prostheses used and the level of activity they must endure. The aim of this study was to compare the functional outcomes and activity levels following hip resurfacing and uncemented THA in young active patients matched for age, gender and activity levels. A retrospective review of 255 consecutive hip arthroplasties performed in a teaching hospital was carried out. From this series we identified 58 patients who had undergone uncemented THA (Group A) and 58 patients who underwent hip resurfacing (Group B), matched for age, gender and pre-operative activity level. The mean age of patients within Group A was 58.5 years (34–65) and in Group B was 57.9 years (43–68). Mean pre-operative University of California at Los Angeles (UCLA) score in Group A was 3.4 (1–7) and in Group B was 4.2 (1–8). The mean pre-operative Oxford Hip Score (OHS) was 46.1 (16–60) and 44.4 (31–57) in Groups A and B respectively. Mean follow-up period was five years (4–7 years). In the hip resurfacing group, the mean UCLA score improved from 4.2 (1–8) to 6.7 (3–10), while in the uncemented THA group this improved from 3.4 (1–7) to 5.8 (3–10). Similarly, the mean OHS improved from 44.4 (31–57) to 16.6 (12–31) in the hip resurfacing group and from 46.1 (16–60) to 18.8 (12–45) in the uncemented THA group. This study found no statistically significant difference in the levels of function (p= 0.82) or activity pursued (p= 0.60) after surgery between uncemented THA and hip resurfacing in a population of patients matched for age, gender and pre-operative activity levels. Although there was statistically significant improvement in UCLA and OHS within each group, it was found that no group was better than the other. This study has shown comparable outcomes with hip resurfacing and uncemented THA in terms of both functional outcomes and activity levels in a group of young active patients. The potential complications unique to hip resurfacing may be avoided by the use of uncemented THA. In addition, uncemented THA has a longer track record.
