A Lons1, A Arnould2, T Pommepuy1, E Drumez3, J Girard4. 1. Université Lille Nord de France, 59000 Lille, France; Service d'orthopédie C, hôpital Salengro, place de Verdun, CHU de Lille, 59000 Lille, France. 2. Université Lille Nord de France, 59000 Lille, France; Service d'orthopédie D, hôpital Salengro, place de Verdun, CHU de Lille, 59000 Lille, France. 3. Université Lille Nord de France, 59000 Lille, France; Unité biostatistiques pôle santé publique, maison régionale de la recherche clinique, CERIM, 154, rue du Docteur-Yersin, 59000 Lille, France. 4. Université Lille Nord de France, 59000 Lille, France; Département de médecine du sport, faculté de médecine de Lille, université de Lille 2, Lille, France; Service d'orthopédie C, hôpital Salengro, place de Verdun, CHU de Lille, 59000 Lille, France. Electronic address: j_girard_lille@yahoo.fr.
Abstract
BACKGROUND: Hip resurfacing (HR) is an alternative option to total hip arthroplasty (THA) in a population of selected patients (young and/or active). HYPOTHESIS: The short-term survivorship rate is as least as good as that for THA with no abnormal increase in serum metal ion levels. MATERIALS AND METHODS: A continuous prospective series of 502 hip resurfacings in 481 patients mean age 48.7 years old (±10.3; 18-68) (Conserve Plus, Wright Medical Technology) was analyzed clinically, radiologically and biologically (total blood chrome, cobalt and titanium metal ion levels). Mean follow up was 4.1 years (1.9-4.9). RESULTS: There were no dislocations. There were 5 cases of revision surgery with component replacement (including 2 infections). Implant survivorship using implant removal as the criteria (excluding infection) was 99.4% at 4 years (CI 95%: 98.1-99.8). The evaluation of metal ion levels showed a significant increase in cobalt from a preoperative level of 0.24 μg/L (0.01-3.6) to 0.86 μg/L (0.01-5.7) at the final follow-up (P<0.001). Chrome and titanium levels went from 0.68 μg/L (0.01-4.4) and 2.36 μg/L (0.39-7) to 1.28 μg/L (0.1-5.5) and 4.49 μg/L (1.29-8.21) respectively (P<0.001). All clinical scores had significantly improved at the final follow-up. Mean frontal plane cup inclination was 42.7° (35-62). DISCUSSION: In a selected population of young and/or active patients, the short-term results of hip resurfacing are excellent. At the postoperative 4-year follow-up the rate of complications (in particular the absence of dislocations) was less than that for THA in young and/or active patients. Certain conditions must be respected to obtain these results; frontal plane cup inclination of between 40 and 45°, a femoral head diameter of at least 48 mm and good quality femoral bone. LEVEL OF EVIDENCE: IV.
BACKGROUND: Hip resurfacing (HR) is an alternative option to total hip arthroplasty (THA) in a population of selected patients (young and/or active). HYPOTHESIS: The short-term survivorship rate is as least as good as that for THA with no abnormal increase in serum metal ion levels. MATERIALS AND METHODS: A continuous prospective series of 502 hip resurfacings in 481 patients mean age 48.7 years old (±10.3; 18-68) (Conserve Plus, Wright Medical Technology) was analyzed clinically, radiologically and biologically (total blood chrome, cobalt and titaniummetal ion levels). Mean follow up was 4.1 years (1.9-4.9). RESULTS: There were no dislocations. There were 5 cases of revision surgery with component replacement (including 2 infections). Implant survivorship using implant removal as the criteria (excluding infection) was 99.4% at 4 years (CI 95%: 98.1-99.8). The evaluation of metal ion levels showed a significant increase in cobalt from a preoperative level of 0.24 μg/L (0.01-3.6) to 0.86 μg/L (0.01-5.7) at the final follow-up (P<0.001). Chrome and titanium levels went from 0.68 μg/L (0.01-4.4) and 2.36 μg/L (0.39-7) to 1.28 μg/L (0.1-5.5) and 4.49 μg/L (1.29-8.21) respectively (P<0.001). All clinical scores had significantly improved at the final follow-up. Mean frontal plane cup inclination was 42.7° (35-62). DISCUSSION: In a selected population of young and/or active patients, the short-term results of hip resurfacing are excellent. At the postoperative 4-year follow-up the rate of complications (in particular the absence of dislocations) was less than that for THA in young and/or active patients. Certain conditions must be respected to obtain these results; frontal plane cup inclination of between 40 and 45°, a femoral head diameter of at least 48 mm and good quality femoral bone. LEVEL OF EVIDENCE: IV.
Authors: Panagiotis K Karampinas; Eustratios G Papadelis; John A Vlamis; Hlias Basiliadis; Spiros G Pneumaticos Journal: Eur J Orthop Surg Traumatol Date: 2017-01-03