BACKGROUND Hip resurfacing arthroplasty(HRA)is an alternative to total hip arthroplasty(THA)that is typically reserved for young active patients because it preserves bone.However,the benefits of HRA only hold true if ...BACKGROUND Hip resurfacing arthroplasty(HRA)is an alternative to total hip arthroplasty(THA)that is typically reserved for young active patients because it preserves bone.However,the benefits of HRA only hold true if conversion THA after failed HRA provides acceptable outcomes.AIM To compare patient reported outcomes for conversion THA after HRA failure to primary THA.METHODS A retrospective review of 36 patients(37 hips)that underwent conversion THA for failed HRA between October 2006 and May 2019 by a single surgeon was performed.Patient reported outcomes[modified Harris Hip Score(mHHS),University of California Los Angeles(UCLA)activity score]were obtained via an email-based responder-anonymous survey.Outcomes were compared to normative data of a primary THA cohort with similar demographics.Subgroup analysis was performed comparing outcomes of conversion THA for adverse local tissue reaction(ALTR)vs all other causes for failure.RESULTS The study group had a lower mHHS than the control group(81.7±13.8 vs 90.2±11.6,P<0.01);however,both groups had similar UCLA activity levels(7.5±2.3 vs 7.2±1.6,P=0.51).Patients that underwent conversion for non-ATLR causes had similar mHHS(85.2±11.5 vs 90.2±11.6,P=0.11)and higher UCLA activity levels(8.5±1.8 vs 7.2±1.6,P<0.01)compared to the control group.Patients that underwent conversion for ATLR had worse mHHS(77.1±14.5 vs 90.2±11.6,P<0.01)and UCLA activity levels(6.1±2.3 vs 7.2±1.6,P=0.05)when compared to the control group.CONCLUSION Patient outcomes equivalent to primary THA can be achieved following HRA conversion to THA.However,inferior outcomes were demonstrated for ALTR-related HRA failure.Patient selection and perhaps further studies examining alternative HRA bearing surfaces should be considered.展开更多
Background: Resurfacing-type total hip replacement (THR) has been successfully developed over the past 50 years through collaborative efforts between engineers and surgeons. Much of the development was pursued by indi...Background: Resurfacing-type total hip replacement (THR) has been successfully developed over the past 50 years through collaborative efforts between engineers and surgeons. Much of the development was pursued by individuals or groups, each of which participated in adding further refinements to the implants, instruments and surgical procedures, thus minimizing the serious problems of wear, osteolysis, loosening and femoral neck fractures. The purpose of this study is to explore the development process to optimize the resurfacing total hip replacement into its current application. Methods: In the early 1980s, cementless resurfacing implants were developed using “thin shell” technology to minimize bony resection of the acetabulum and femoral head. Femoral components utilized short, non-porous coated, tapered straight stems to reduce shear stresses in the femoral neck to prevent fractures and stress shielding, while mechanically stabilizing and aligning the components. Acetabular components were anatomically designed to be recessed inside bony borders to avoid neck-cup impingement and loosening. Initially, ultrahigh molecular weight polyethylene (UHMWPE) was used as a bearing, but due to high levels of wear and osteolysis, it was replaced by wear-resistant highly crossed-linked polyethylene (HXLPE) in 2008. Results: Use of HXLPE as a bearing material in both Co-Cr-Mo and titanium nitride (TiN) ceramic-coated resurfacing implants has led to excellent patient outcomes for more than 10 years. In clinical studies, 87% of patients with bilateral total hip replacements prefer their resurfacing-type total hip over their stem-type total hip. The author’s own personal resurfacing total hips, now at 8 and 5 years, respectively, provide “normal” function and no radiographic osteolysis. Conclusions: After 45 years of active evaluation, including mechanical design considerations, prosthetic design development, clinical and radiographic analysis of results, as well as availability of components cleared by the FDA 510 K process, the author has stated a personal preference for the BP Resurfacing Hip System. His excellent mid-term results in both of his resurfaced hips are similar to the long-term results presented in published studies.展开更多
文摘BACKGROUND Hip resurfacing arthroplasty(HRA)is an alternative to total hip arthroplasty(THA)that is typically reserved for young active patients because it preserves bone.However,the benefits of HRA only hold true if conversion THA after failed HRA provides acceptable outcomes.AIM To compare patient reported outcomes for conversion THA after HRA failure to primary THA.METHODS A retrospective review of 36 patients(37 hips)that underwent conversion THA for failed HRA between October 2006 and May 2019 by a single surgeon was performed.Patient reported outcomes[modified Harris Hip Score(mHHS),University of California Los Angeles(UCLA)activity score]were obtained via an email-based responder-anonymous survey.Outcomes were compared to normative data of a primary THA cohort with similar demographics.Subgroup analysis was performed comparing outcomes of conversion THA for adverse local tissue reaction(ALTR)vs all other causes for failure.RESULTS The study group had a lower mHHS than the control group(81.7±13.8 vs 90.2±11.6,P<0.01);however,both groups had similar UCLA activity levels(7.5±2.3 vs 7.2±1.6,P=0.51).Patients that underwent conversion for non-ATLR causes had similar mHHS(85.2±11.5 vs 90.2±11.6,P=0.11)and higher UCLA activity levels(8.5±1.8 vs 7.2±1.6,P<0.01)compared to the control group.Patients that underwent conversion for ATLR had worse mHHS(77.1±14.5 vs 90.2±11.6,P<0.01)and UCLA activity levels(6.1±2.3 vs 7.2±1.6,P=0.05)when compared to the control group.CONCLUSION Patient outcomes equivalent to primary THA can be achieved following HRA conversion to THA.However,inferior outcomes were demonstrated for ALTR-related HRA failure.Patient selection and perhaps further studies examining alternative HRA bearing surfaces should be considered.
文摘Background: Resurfacing-type total hip replacement (THR) has been successfully developed over the past 50 years through collaborative efforts between engineers and surgeons. Much of the development was pursued by individuals or groups, each of which participated in adding further refinements to the implants, instruments and surgical procedures, thus minimizing the serious problems of wear, osteolysis, loosening and femoral neck fractures. The purpose of this study is to explore the development process to optimize the resurfacing total hip replacement into its current application. Methods: In the early 1980s, cementless resurfacing implants were developed using “thin shell” technology to minimize bony resection of the acetabulum and femoral head. Femoral components utilized short, non-porous coated, tapered straight stems to reduce shear stresses in the femoral neck to prevent fractures and stress shielding, while mechanically stabilizing and aligning the components. Acetabular components were anatomically designed to be recessed inside bony borders to avoid neck-cup impingement and loosening. Initially, ultrahigh molecular weight polyethylene (UHMWPE) was used as a bearing, but due to high levels of wear and osteolysis, it was replaced by wear-resistant highly crossed-linked polyethylene (HXLPE) in 2008. Results: Use of HXLPE as a bearing material in both Co-Cr-Mo and titanium nitride (TiN) ceramic-coated resurfacing implants has led to excellent patient outcomes for more than 10 years. In clinical studies, 87% of patients with bilateral total hip replacements prefer their resurfacing-type total hip over their stem-type total hip. The author’s own personal resurfacing total hips, now at 8 and 5 years, respectively, provide “normal” function and no radiographic osteolysis. Conclusions: After 45 years of active evaluation, including mechanical design considerations, prosthetic design development, clinical and radiographic analysis of results, as well as availability of components cleared by the FDA 510 K process, the author has stated a personal preference for the BP Resurfacing Hip System. His excellent mid-term results in both of his resurfaced hips are similar to the long-term results presented in published studies.
