Revision surgery for failed hip resurfacing

Between 1996 and 2002, we treated 60 patients (65 hips) by hip resurfacing. The notes and radiographs of these cases were studied retrospectively and the modalities of failure identified. At a mean follow-up of 51 months, 14 of these cases (22%) required revision surgery. One patient had died from unrelated causes and one was lost to follow-up. At the time of primary surgery, the mean age of the patients in our series was 55 years. The commonest mechanism of failure in our series was fractured neck of femur (six cases). Four of these occurred in females over the age of 60. None of the fractured necks of femur were associated with trauma. There were four cases of loose acetabular components and one case of progressive AVN (avascular necrosis). Two patients required revision surgery for ongoing hip pain and one required a two-stage revision for early deep infection.

Download Full-text

Computer-assisted navigation in Birmingham hip resurfacing: A case report

SAGE Open Medical Case Reports ◽

10.1177/2050313x18819641 ◽

2018 ◽

Vol 6 ◽

pp. 2050313X1881964

Author(s):

Ritesh Shah ◽

Jessica R Benson ◽

Jeffrey M Muir

Keyword(s):

Case Report ◽

Acetabular Component ◽

Revision Surgery ◽

Present Report ◽

Hip Resurfacing ◽

Computer Assisted ◽

Assisted Navigation ◽

Birmingham Hip Resurfacing ◽

Component Loosening ◽

Acetabular Loosening

Component malpositioning during Birmingham hip resurfacing increases the risk for component wear, metallosis, component loosening, and the likelihood of dislocation and revision surgery. Computer-assisted navigation can increase the accuracy to which components are placed, and the utilization of this technology in Birmingham hip resurfacing is increasing. The present report summarizes the accuracy of acetabular component positioning in a Birmingham hip resurfacing case utilizing navigation. Intraoperative C-arm fluoroscopy following the use of the navigation tool confirmed excellent seating, positioning, and stability of the acetabular component. In addition, post-operative antero-posterior radiographs confirmed device accuracy and revealed a stable joint with no evidence of acetabular loosening or femoral fracture. Computer-assisted navigation may therefore be an effective tool to improve the accuracy of component positioning during Birmingham hip resurfacing.

Download Full-text

Sex-specific risk factors determine the survivorship of female and male patients after metal-on-metal hip resurfacing

Hip International ◽

10.1177/1120700019868781 ◽

2019 ◽

Vol 30 (3) ◽

pp. 309-318

Author(s):

Harlan C Amstutz ◽

Michel J Le Duff

Keyword(s):

Risk Factors ◽

Revision Surgery ◽

Hip Resurfacing ◽

Female Group ◽

Severe Dysplasia ◽

Preparation Technique ◽

Contact Patch ◽

Female Patients ◽

Specific Risk ◽

Male Patients

Background: The need for revision surgery after hip resurfacing arthroplasty (HRA) is more prevalent for women than for men. However, there is a paucity of information to explain this observation. We aimed (1) to determine sex-specific risk factors leading to revision surgery; and (2) to correlate these risk factors to the dominant modes of failure of HRA. Methods: 1101 patients (1375 consecutive hips) including 292 women (355 hips) and 809 men (1020 hips) with a mean age of 51.3 years were included regardless of bone quality. The contact patch to rim distance was computed. Results: A contact patch to rim (CPR) distance of ⩽7 mm, an aetiology of developmental dysplasia, a postoperative abduction-adduction arc of ⩾95°, and a metaphyseal stem left uncemented were risk factors associated with revision surgery for female patients, while a CPR distance of ⩽10 mm, a component size of ⩽46 mm, an age at surgery of ⩽55 years, and an early femoral preparation technique were risk factors for male patients. Hips with no risk factors from the female group had a survivorship of 98.7% at 15 years, matching or exceeding the results of all male subgroups. However the risk factors in the female group increased the risk of revision much more than in the male group. Conclusions: In the absence of risk factors, the survivorship of HRA in female patients is equal to that of males. Many female patients can safely benefit from HRA by excluding severe dysplasia and optimising surgical technique.

Download Full-text

What are the results of revised hip resurfacing arthroplasties?

The Bone & Joint Journal ◽

10.1302/0301-620x.102b10.bjj-2020-0147.r2 ◽

2020 ◽

Vol 102-B (10) ◽

pp. 1289-1296

Author(s):

Harlan C. Amstutz ◽

Michel Le Duff

Keyword(s):

Quality Of Life ◽

Los Angeles ◽

Revision Surgery ◽

Short Form ◽

Perioperative Complications ◽

Hip Resurfacing ◽

Long Term Outcome ◽

The Mean

Aims Hip resurfacing arthroplasty (HRA) is typically indicated for young and active patients. Due to the longevity of arthroplasty, these patients are likely to undergo revision surgery during their lifetime. There is a paucity of information on the long-term outcome of revision surgeries performed after failed HRA. The aim of our study was to provide survivorship data as well as clinical scores after HRA revisions. Methods A total of 42 patients (43 hips) were revised after HRA at our centre to a variety of devices, including four HRA and 39 total hip arthroplasties (THAs). In addition to perioperative complications, University of California, Los Angeles (UCLA) hip scores and 12-Item Short-Form Health Survey questionnaire (SF-12) quality of life scores were collected at follow-up visits after the primary HRA and after revision surgery. Results The mean follow-up time after revision surgery was 8.3 years (0.3 to 19.1). The mean UCLA pain and function scores post-revision were comparable with the best scores achieved by the patients after the index HRA, but UCLA activity scores were lower after revision. SF-12 physical component scores were comparable between timepoints, but the mental component score decreased after revision. Six patients underwent unilateral re-revision surgery at a mean follow-up time of 7.8 years (0.3 to 13.7). Using the time to any re-revision as endpoint, the Kaplan-Meier survivorship was 85.3% at 13 years. Conclusion Patients undergoing revision after HRA can expect to achieve function and quality of life similar to their best after their primary surgery, while the risk of re-revision is low. Cite this article: Bone Joint J 2020;102-B(10):1289–1296.

Download Full-text