Adverse local tissue reactions associated with abnormal wear considerably slowed down the general use of metal-on-metal (MoM) hip resurfacing arthroplasty (HRA), now limited to a few specialized centres. In this study, we provide the clinical results of 400 consecutive MoM HRAs implanted more than 20 years ago in one such centre. A total of 355 patients (400 hips) were treated with Conserve Plus HRA between November 1996 and November 2000. There were 96 female (27%) and 259 male patients (73%). Their mean age was 48.2 years (SD 10.9). The University of California, Los Angeles (UCLA) hip scores and 12-item Short Form Survey (SF-12) quality of life scores were reported. Survivorship was assessed using Kaplan-Meier analyses.Aims
Methods
Hip resurfacing arthoplasty (HRA) showed promising early and mid-terms results at the beginning of the new millennium. Adverse local tissue reactions associated with metal debris considerably slowed down the implantation of HRA which use is now limited to a few specialized centers. The long term success of this procedure, however, is still largely unknown. This study aimed to provide the clinical results of a series of 400 consecutive HRA with a minimum follow-up of 20 years. All patients treated with Conserve®Plus HRA between November 1996 and November 2000 were retrospectively selected and 355 patients (400 hips) were included. The clinical results of this series was previously reported in 2004 at a follow up of 2 to 6 years[1]. There were 96 women (27%) and 259 men (73%). Mean age at surgery was 48.2 ± 10.9 years. Long-term survivorship was assessed with Kaplan-Meier survival estimates. UCLA hip scores and SF-12 quality of life scores were collected at follow-up visits. Radiographic positioning of the acetabular component was assessed with the computation of the contact patch to rim (CPR) distance. Radiolucencies about the metaphyseal stem and around the acetabular component were recorded to assess the quality of the component fixation.Background
Methods
In previous studies, we identified multiple factors influencing the survivorship of hip resurfacing arthroplasties (HRAs), such as initial anatomical conditions and surgical technique. In addition, the University of California, Los Angeles (UCLA) activity score presents a ceiling effect, so a better quantification of activity is important to determine which activities may be advisable or detrimental to the recovered patient. We aimed to determine the effect of specific groups of sporting activities on the survivorship free of aseptic failure of a large series of HRA. A total of 661 patients (806 hips) representing 77% of a consecutive series of patients treated with metal-on-metal hybrid HRA answered a survey to determine the types and amounts of sporting activities they regularly participated in. There were 462 male patients (70%) and 199 female patients (30%). Their mean age at the time of surgery was 51.9 years (14 to 78). Their mean body mass index (BMI) was 26.5 kg/m2 (16.7 to 46.5). Activities were regrouped into 17 categories based on general analogies between these activities. Scores for typical frequency and duration of the sessions were used to quantify the patients’ overall time spent engaging in sporting activities. Impact and cycle scores were computed. Multivariable models were used.Aims
Patients and Methods
This study presents the long-term survivorship, risk factors for prosthesis survival, and an assessment of the long-term effects of changes in surgical technique in a large series of patients treated by metal-on-metal (MoM) hip resurfacing arthroplasty (HRA). Between November 1996 and January 2012, 1074 patients (1321 hips) underwent HRA using the Conserve Plus Hip Resurfacing System. There were 787 men (73%) and 287 women (27%) with a mean age of 51 years (14 to 83). The underlying pathology was osteoarthritis (OA) in 1003 (75.9%), developmental dysplasia of the hip (DDH) in 136 (10.3%), avascular necrosis in 98 (7.4%), and other conditions, including inflammatory arthritis, in 84 (6.4%).Aims
Patients and Methods
A contact patch to rim (CPR) distance of <
10 mm has been
associated with edge-loading and excessive wear. However, not all
arthroplasties with a low CPR distance show problems with wear.
Therefore, CPR distance may not be the only variable affecting the
post-operative metal ion concentrations. We used multiple logistic regression to determine what variables
differed between the patients who had high and low cobalt (CoS)
and chromium (CrS) serum ion concentrations within a cohort of patients
with low (<
10 mm) CPR distances. A total of 56 patients treated
with unilateral hip resurfacing arthroplasty (HRA) had CoS and CrS
ion studies performed more than one year after surgery. The mean
age of the patients at the time of surgery was 51.7 years (29 to
70), with 38 women (68%) and 18 men (32%).Aims
Patients and Methods
Hip resurfacing arthroplasty (HRA) is an alternative to conventional
total hip arthroplasty for patients with osteonecrosis (ON) of the
femoral head. Our aim was to report the long-term outcome of HRA,
which is not currently known. Long-term survivorship, clinical scores and radiographic results
for 82 patients (99 hips) treated with HRA for ON over a period
of 18 years were reviewed retrospectively. The mean age of the 67
men and 15 women at the time of surgery was 40.8 years (14 to 64).
Patients were resurfaced regardless of the size of the osteonecrotic
lesion.Aims
Patients and Methods
Obtaining fixation in DDH with Surface arthroplasty (SA) with a two part polyethylene (PE ) socket was technically challenging. Although dislocation was rare there was a high loosening rate secondary to polyethylene wear. The purpose of this study was to evaluate the results of Conserve Plus metal-on-metal SA in Crowe class I and II Developmental Dysplasia of the Hip patients. 54 patients (59 hips), 72% females, average age43.7 years (15 to 63.8) met these inclusion creteria with 2 years of follow-up minimum. Seven hips were Crowe type II and fifty-two were type I. Harlan C. Amstutz, John Antoniades, Michel J. Le Duff, Paul E. Beaulé The results of MMSA are much improved over those of prior generations of SA and socket fixation is stable even in Crowe type II with the porous coated acetabular components without adjuvant fixation despite incomplete acetabular coverage of the socket. The hips have-been stable even with important range of motion. Recent short term failure and radiolucencies have been eliminated by improved technique despite a high incidence of femoral cysts and reduced area of fixation.
The purpose of this study was to review our entire primary THR experience using large diameter femoral heads in order to prevent dislocation. 83 hips in 77 patients (average age 61years) had a total hip replacement using femoral heads at least 36 mm in diameter. Average follow-up was 4.4 years (range 1 to 17). 22% of the bearings used were conventional UHMWPE, 25% Metal on Metal (two thirds of which were one-piece sockets), and 53% cross-linked polyethylene. UCLA hip scores improved significantly (p<
0.001) to 9.4, 8.4, 7.5, and 5.2, for pain, walking, function and activity respectively. All of the hips were stable at last follow-up although 3 hips had to be revised: 2 for instability in the early post-op period for poorly positioned socket and one for acetabular component aseptic loosening, which was rectified by revision surgery. Two out of these 3 hips had an etiology of DDH. The dislocations occurred in hips reconstructed with a head size less of 36mm only and none of the hips that dislocated had to be revised with a constrained acetabular liner. As the safety of new wear-resistant joint bearings has improved, an increase of femoral head size leads to a lower prevalence of dislocation in THR potentially without adverse wear consequences. However, adequate positioning of the acetabular component remains a key factor in the success of this type of hip arthroplasty. Metal-on-metal, which provides the largest ball size for a given socket diameter, especially with a one-piece socket, best addresses component-to-component impingement by increasing the range of motion. Bone-to-bone impingement risks are also minimized as the travel distance to dislocation is increased by maximizing the head diameter and minimizing the socket shell thickness.
The purpose of the present study was to analyze the-clinical and radiographic factors which determine the enduring fixation of metal on metal hybrid surface arthroplasty. The first 500 hips (in 436 patients) of a consecutive series of over 700 Conserve® plus were reviewed clinically and radiographically. The patients were 48.6 years-old in average, 74% were male and the dominant etiology was idiopathic osteoarthritis (64.6%). All femoral components were cemented but the femoral metaphyseal stem was cemented in 112 hips and press-fit in the remaining 388. Average follow-up was 4.8 years (range, 2.7 to 7.8 years). Eighteen hips were converted to a THR, 11 of them for aseptic loosening of the femoral component at an average follow-up of 40.5 months. Put in positives mention fx and loose incidence, survor ship details of loose and fx for other At last review, 14 hips presented metaphyseal stem radiolucencies and 16 hips (3.2%) showed a narrowing of the neck of 10% or more at the interface with the femoral component. None of the components with cemented stems showed femoral radiolucencies, neck narrowing, or were revised for aseptic loosening. Cementing the femoral stem significantly (p = 0.013) reduces the chances of early femoral failure or appearance of a metaphyseal stem radiolucency. Risk factors for loosening or radioluciences included cysts >
1 cm, small femoral head size, female gender, early cases (before improved acrylic fixation including femoral suctioning measures were instituted) and reduced stem shaft angle. Metal-on-metal surface arthroplasty provides a stable, bone conserving, low morbidity and wear resistant prosthetic solution well suited for young and highly active patients.
Because the femoral head/neck junction is preserved in hip resurfacing, patients may be at greater risk of impingement, leading to abnormal wear patterns and pain. We assessed femoral head/neck offset in 63 hips undergoing metal-on-metal hip resurfacing and in 56 hips presenting with non-arthritic pain secondary to femoroacetabular impingement. Most hips undergoing resurfacing (57%; 36) had an offset ratio ≤ 0.15 pre-operatively and required greater correction of offset at operation than the rest of the group. In the non-arthritic hips the mean offset ratio was 0.137 (0.04 to 0.23), with the offset ratio correlating negatively to an increasing α angle. An offset ratio ≤ 0.15 had a 9.5-fold increased relative risk of having an α angle ≥ 50.5°. Most hips undergoing resurfacing have an abnormal femoral head/neck offset, which is best assessed in the sagittal plane.