Long-term results of metal-on-metal hip resurfacing in patients 65 years of age or older.

BACKGROUND: Metal-on-metal hip resurfacing arthroplasty (MMHRA) is typically used in young and active patients because they have the most to gain from this bone-preserving procedure. However, there is very little long-term data on the performance of MMHRA in patients 65 years of age or older because of the efficacy of conventional total hip arthroplasty in this patient population. METHODS: 109 patients (124 hips) age ⩾65 years were treated with Conserve Plus MMHRA. There were 83 male and 26 female patients. Their mean age at surgery was 69.5 (range 65-83) years. UCLA hip scores, SF-12 quality of life score were collected at follow-up visits. Radiographic and survivorship analyses were performed. RESULTS: SF-12 scores and UCLA scores were maintained over time except for a small decrease in activity. 4 patients underwent revision surgery. The 15-year Kaplan-Meier survivorship of the cohort was 93.7%. All revisions surgeries were successful at a mean follow-up time of 113 (range 30-218) months. Unusual radiographic findings from our previous publication did not progress over time except for 1 hip that showed a complete radiolucency around the acetabular component. CONCLUSIONS: Our results clearly show that HRA is a viable prosthetic solution with many advantages for all active patients, regardless of their age at the time of surgery.

The 20-year results of the first 400 Conserve Plus hip resurfacing arthroplasties.

AIMS: 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. METHODS: 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. RESULTS: The mean follow-up was 16.5 years (0.1 to 24.0), including 34 patients (37 hips) who died. The mean UCLA hip scores were 9.3 (2 to 10), 9.1 (3 to 10), 9.0 (3 to 10), and 6.9 (2 to 10) for pain, walking, function, and activity, respectively. The mean SF-12 scores were 48.4 (16.0 to 62.1) for the physical component and 48.5 (10.5 to 66.5) for the mental component, and did not differ from those of the general population of the USA. A total of 60 hips in 55 patients were revised. Using revision for any indication as the endpoint, the Kaplan-Meier survivorship was 83.5% at 20 years. A diagnosis of developmental dysplasia (hazard ratio (HR) 2.199 (95% confidence interval (CI) 1.140 to 4.239); p = 0.019) and a low BMI (HR 0.931 (95% CI 0.873 to 0.994); p = 0.032) were risk factors for revision. Female sex was a risk factor only because of hip dysplasia and small component size. There were no cases of metal sensitivity associated with revision surgery. Radiological analysis showed persistent fixation in all but one hip. CONCLUSION: The 83.5% 20-year survivorship of this initial series surpasses that of total hip arthroplasties in use 20 years ago in these young patients, suggesting satisfactory lifelong durability of the device for almost all of the remaining patients. Cite this article: Bone Joint J 2021;103-B(7 Supple B):25-32.

What are the results of revised hip resurfacing arthroplasties?

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.

Analgesic consumption evolution at the emergency department of a university hospital (2006-2017): a defined daily doses based analysis.

OBJECTIVE: Pain management in the emergency department (ED) is a key issue that must be regularly evaluated. Practice evaluation gold standard remains patient file analysis, but is highly time consuming. The aim of this study is to evaluate the interest of a defined daily dose (DDD) based analysis in the evaluation of pain management in the ED. METHODS: A local indicator was elaborated based on the DDD concept: the defined dose per admission (DDA). Unlike the DDD that corresponds to a standardised total dose administered over a day, the DDA represents the average total dose administrated to a patient throughout the stay in the ED. A DDA was assigned to every analgesic, from step 1 to step 3. Oral and injectable forms were studied, but transdermal forms were not considered. DDA values were assimilated to the existing DDDs when these were officially established by the WHO. When values were not defined by the WHO, mean values observed in local practice were selected. Annual numbers of patients admitted to the ED and quantities of each analgesic supplied by the pharmacy ward were annually extracted from respective data files. Paediatric patients being treated at a specific separate ED, only adults were considered throughout the study. Raw quantities of analgesics used each year were converted to their equivalent amounts in DDA, and then expressed in numbers of DDA per 100 admissions (DDA/100A). This indicator allowed us to describe relative evolutions of analgesics prescriptions from 2006 to 2017. RESULTS: Analgesic overall use rose from 18.4 to 30.2 DDA/100A between 2006 and 2017, representing a prescription increase of 64%. Throughout the study, step 1 analgesics rose from 10.8 to 19.3 DDA/100A (+79%), step 3 from 1.8 to 5.4 (+200%) and step 2 remained stable around 5.6 DDA/100A. The integration of orodispersible paracetamol tablets in 2013 allowed us to halve the consumption of injectable paracetamol in the long term and had no effect on classic paracetamol oral forms such as tablets or capsules. Tramadol increased from 41% to 78% among step 2 analgesics after the withdrawal of dextropropoxyphene in 2011. Codeine use shows a steady decline from 1.9 DDA/100A in 2011 to 0.72 in 2017. DISCUSSION/CONCLUSION: The DDA concept appears to be an effective tool for assessing long-term analgesic-use trends at hospital EDs. This tool can also mitigate one major bias at EDs, that is the lack of traceability of analgesic administration in emergency contexts. This tool could be adjusted by integrating the average length of stay in the ED.

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

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.

Effects of physical activity on long-term survivorship after metal-on-metal hip resurfacing arthroplasty: is it safe to return to sports?

AIMS: 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. PATIENTS AND METHODS: 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. RESULTS: We found no association between any category of activity and a decrease in survivorship. Impact and hip cycle scores also failed to show any association with revision for aseptic failure or wear. CONCLUSION: Return to sporting activities after surgery is safe for patients treated with well-designed and well-implanted HRA. Cite this article: Bone Joint J 2019;101-B:1186-1191.

Is a cementless fixation of the femoral component suitable for metal-on-metal hip resurfacing arthroplasty?

BACKGROUND: Hip resurfacing arthroplasty (HRA) typically uses a hybrid design (cemented femoral component and cementless acetabular shell) but has recently been performed with fully cementless components. There is a paucity of information on the clinical performance of these cementless designs. METHODS: The UCLA clinical scores, SF-12 quality of life scores, complication rates, survivorship and radiographic signs of loosening or gross stress shielding of 39 hips (39 male patients) implanted with cementless HRA were compared with those of 40 hips (37 male patients) implanted with hybrid HRA during the same time frame. RESULTS: There were no significant differences in postoperative clinical and quality of life scores, complication rates, or radiographic signs of loosening between the 2 groups. The 5-year Kaplan-Meier survivorship was 97.2% for the cementless group and 100% for the hybrid group. This difference was not significant (p = 0.3694). There were no femoral component failures in any of the 2 groups. CONCLUSIONS: At a mean follow-up of 6 years, there is no tangible difference between the performance of cementless HRA compared to hybrid HRA. The absence of learning curve associated with this device and the potential for better preservation of femoral neck bone mineral density suggest that this technology is well suited for young patients with good bone quality seeking to resume an active lifestyle including high-impact activities.

Contact patch to rim distance: the quintessential tool for metal-on-metal bearing in vivo performance analysis - a review.

With metal-on-metal (MoM) bearings, fluid film lubrication is disrupted when the contact patch area between the femoral head and the cup is close to the edge of the acetabular component, making the calculation of the contact patch to rim (CPR) distance a key variable in the study of the performance of MoM bearings. A few research centers have used models of varying complexity to calculate the CPR distance and determine its relationship with assessments of component wear. In this review, we aimed to summarise the current knowledge related to the application of CPR distance calculations in the study of in vivo performance of MoM bearings. Our systematic search of the US National Library of Medicine yielded 9 relevant publications in which 3 different models were used for the computation of the CPR distance. The 3 models show different levels of complexity and their use is mainly dependent upon the size of the subject sample and the nature of the data collected as a dependent variable. The studies reviewed consistently showed a strong inverse correlation between CPR distance and wear or metal ion levels suggesting that any study aiming to determine the risk factors for MoM hip devices needs to include an assessment of CPR distance. Cup anteversion can be measured reliably with various tools and should not be an obstacle to the use of this essential variable that is CPR distance.

Effects of Previous Osteotomy on Outcome of Hip Resurfacing Arthroplasty.

The effect of previous conservative surgeries on the outcome of metal-on-metal hip resurfacing arthroplasty (HRA) has not been studied. This study compared postoperative clinical scores and survivorship results of hips with and without previous osteotomies in a population of patients who underwent HRA. A total of 1101 patients (1375 hips) with a mean age of 51.3 years at the time of surgery underwent HRA at a single center. Sixty-nine patients had undergone prior surgery on the operated hip including 14 osteotomies (1 pelvic, 6 femoral, and 7 combined pelvic and femoral osteotomies). Mean follow-up was comparable for patients with prior osteotomy and patients in the control group (101 months vs 96 months, P=.6916); however, patients with prior osteotomies were much younger at the time of surgery (34 years vs 51 years, P=.0001). Kaplan-Meier survival estimates were calculated, and the Cox proportional hazard ratio was used to adjust for the covariates that differed between the 2 groups and affected the survivorship of hip resurfacing. Patients who underwent prior osteotomy showed lower pain and activity scores. In addition, patients who underwent prior osteotomy had a greater chance of revision than the rest of the cohort (hazard ratio, 3.87; 95% confidence interval, 1.54-9.68; P=.004). For patients in whom the natural anatomy or the bone quality of the hip has been severely altered by a prior osteotomy, HRA may be contraindicated if good component fixation cannot be achieved and hip biomechanics restored. [Orthopedics. 2017; 40(4):e609-e616.].

Correlation between serum metal ion levels and adverse local tissue reactions after Conserve® Plus hip resurfacing arthroplasty.

BACKGROUND: Adverse local tissue reactions (ALTR) have been associated with the use of metal-on-metal (MoM) bearings and the monitoring of cobalt (Co) and chromium (Cr) ion levels in blood or serum may be the best way to evaluate in vivo the wear of these bearings. However, the relationship between Co and Cr ion concentrations and the formation of ALTR remains unclear. METHODS: We investigated the relationship between ALTR and serum Co and Cr ion levels and identified the clinical factors influencing the formation of ALTR in patients treated with MoM hip resurfacing arthroplasties. 228 patients with unilateral Conserve® Plus MoM hip resurfacing had serum metal ion studies performed more than 1 year after surgery. Metal artifact reduction sequence magnetic resonance imaging (MARS MRI) was performed on subjects at risk for ALTR as determined by a screening protocol. RESULTS: 12 patients had ALTR. Logistic regression showed a strong association of ALTR with elevated ion levels and with low (<10 mm) contact patch to rim distance. CONCLUSIONS: MoM bearings require enough functional coverage of the socket by design and then precise implantation to maximise functional coverage of the femoral ball, enhance lubrication, and avoid edge-loading wear.

The Natural History of Osteoarthritis: What Happens to the Other Hip?

BACKGROUND: Idiopathic osteoarthritis (OA) is a common diagnosis leading to hip arthroplasty. Patients undergoing unilateral hip arthroplasty often wonder whether their other hip will follow the same path as the one that was operated on, and if so, when? There also are limited data available to predict from AP radiographs which contralateral hips will have OA develop and which will not. QUESTIONS/PURPOSES: We sought (1) to determine the incidence of contralateral osteoarthritic degeneration in a group of patients who were treated with unilateral hip arthroplasty; and (2) to identify clinical and radiographic features associated with the development of contralateral OA. METHODS: Between 1998 and 2010, we performed 398 hip arthroplasties on patients with unilateral primary hip OA, who at the time of surgery did not have any symptoms in the contralateral hip. Of those, 367 (92%) had a minimum 2-year radiographic followup (mean, 11 years; range, 2-17 years). The 31 patients dropped from the study for lack of radiographic followup had comparable preoperative features as the study group. We performed a radiographic analysis on the baseline AP radiographs to see what factors were associated with arthritis progression, and we performed Kaplan-Meier survivorship analysis with contralateral hip pain and contralateral THA as the endpoints. RESULTS: Kaplan-Meier survival estimates indicated that 10 years after the baseline evaluation, 59% (95% CI, 53%-65%) of the patients remained free of symptoms on the contralateral hip and 81% (95% CI, 75%-85%) remained free of an arthroplasty on the contralateral hip. Sex, age, weight, or BMI were not associated with the development of OA on the contralateral hip with the numbers available. Reduced minimum joint space width (hazard ratio, 0.299; 95% CI, 0.237-0.378), low center-edge angle (hazard ratio, 0.941; 95% CI, 0.915-0.968), low head-to-neck ratio (hazard ratio, 1.555; 95% CI, 1.088-2.223), and the presence of osteophytes (hazard ratio, 1.453; 95% CI, 1.001-2.110) were associated with the development of contralateral OA. In hips with a center-edge angle greater than 25°, a head-to-neck ratio of 1.3 or less increased the chances of development of OA by 86% (hazard ratio, 1.857; 95% CI, 1.235-2.793). CONCLUSIONS: The variables we studied can easily be assessed from an AP pelvis radiograph so physicians can predict the occurrence of contralateral OA and the need for future hip arthroplasty in their patients needing unilateral arthroplasty. However, the data available might have led us to underestimate the need for contralateral arthroplasty. Future studies with a prospective design should aim at completing the list of radiographic features associated with the development of OA by adding a review of lateral radiographs. LEVEL OF EVIDENCE: Level IV, prognostic study.

[Bariatric surgery, stomas and other digestive tract reductions: Insufficient data and recommendations to adapt medicines regimens in therapeutic practice]. / Chirurgie bariatrique, stomies et autres réductions du tube digestif : trop peu de données et de recommandations pour l'adaptation des thérapeutiques médicamenteuses.

Surgery modifying digestive tract may alter drugs pharmacokinetics. To maintain concentrations of active substance in their therapeutic ranges, a dosage adjustment or change of drug may be necessary. This is particularly important when no pharmacological or pharmacodynamic parameter reflecting the medication effectiveness is easily measurable. Our objective was to gather the information and documentary tools that can guide prescription in these patients with rearranged digestive tract. We searched information on the documentary portals of French agencies, on gray literature, on MEDLINE and in the summaries product characteristics. No information was found on the website of French agencies, sparse data were identified in gray literature. Some document are discordant, most are imprecise. One hundred and ten studies or case reports referenced on MEDLINE describe 79 medications pharmacokinetics after gastrointestinal surgery. Four are not available in France. Six literature reviews were found. Four summaries of product characteristics provided information related to drug absorption. No documentary tool adapted to clinical routine exists. This unsatisfactory situation is a barrier to optimal patients care. Information is available. It is however necessary to gather under an ergonomic shape adapted to clinical routine, bringing the surgery type, pharmacokinetic changes induced and what to do about the dose adjustment.

Propranolol during pregnancy for large chorioangioma.

Large chorioangiomas are frequently associated with adverse perinatal outcome. Its treatment remains invasive and controversial. Infantile hemangiomas which have numerous similarities with chorioangiomas are now usually treated with propranolol. This drug has been extensively used with a good tolerance during pregnancy in other indications. We report the first use of propranolol with the aim of limiting the increase in chorioangioma volume and avoiding the associated complications. The observed inhibition of the growth of the chorioangioma after introduction of propranolol argues for further evaluation of this treatment in this indication.

Are There Long-term Benefits to Cementing the Metaphyseal Stem in Hip Resurfacing?

BACKGROUND: Cementing the metaphyseal stem during hip resurfacing surgery improves the initial fixation of the femoral component. However, there may be long-term detrimental effects such as stress shielding or an increased risk of thermal necrosis associated with this technique. QUESTIONS/PURPOSES: We compared (1) long-term survivorship free from radiographic femoral failure, (2) validated pain scores, and (3) radiographic evidence of component fixation between hips resurfaced with a cemented metaphyseal stem and hips resurfaced with the metaphyseal stem left uncemented. METHODS: We retrospectively selected all the patients who had undergone bilateral hip resurfacing with an uncemented metaphyseal stem on one side, a cemented metaphyseal stem on the other side, and had both surgeries performed between July 1998 and February 2005. Forty-three patients matched these inclusion criteria. During that period, the indications for cementing the stem evolved in the practice of the senior author (HCA), passing through four phases; initially, only hips with large femoral defects had a cemented stem, then all stems were cemented, then all stems were left uncemented. Finally, stems were cemented for patients receiving small femoral components (< 48 mm) or having large femoral defects (or both). Of the 43 cemented stems, two, 13, 0, and 28 came from each of those four periods. All 43 patients had complete followup at a minimum of 9 years (mean, 143 ± 21 months for the uncemented stems; and 135 ± 22 months for the cemented stems; p = 0.088). Survivorship analyses were performed with Kaplan-Meier and Cox proportional hazards ratios using radiographic failure of the femoral component as the endpoint. Pain was assessed with University of California Los Angeles (UCLA) pain scores, and radiographic femoral failure was defined as complete radiolucency around the metaphyseal stem or gross migration of the femoral component. RESULTS: There were four failures of the femoral component in the press-fit stem group while the cemented stem group had no femoral failures (p = 0.0471). With the numbers available, we found no differences between the two groups regarding pain relief or radiographic appearance other than in patients whose components developed loosening. CONCLUSIONS: Cementing the metaphyseal stem improves long-term implant survival and does not alter long-term pain relief or the radiographic appearance of the proximal femur as had been a concern based on the results of finite element studies. We believe that patients with small component sizes and large femoral head defects have more to gain from the use of this technique which adds surface area for fixation, and there is no clinical downside to cementing the stem in patients with large component sizes. LEVEL OF EVIDENCE: Level III, therapeutic study.

Hip resurfacing: history, current status, and future.

Hip resurfacing arthroplasty (HRA) presents several advantages over conventional total hip arthroplasty (THA), including conservation and preservation of bone, reduced risk of dislocation, easy replication of hip biomechanics and easy revision if needed. It is a particularly appealing procedure for young patients. HRA has been performed for over 40 years following the same technological advances as THA. The bearing material used by most designs is metal-on-metal (MoM), which has the best compromise between strength and wear properties. However, MoM HRA has a specific set of possible complications. Aseptic femoral failures were initially the most prevalent cause for revision but progress in patient selection and surgical technique seem to have resolved this problem. Wear-related failures (high metal ion levels and adverse local tissue reactions) are now the main concern, and are essentially associated with poor acetabular component design and orientation, to which MoM is more sensitive than other bearing materials. The concept of functional coverage is key to understanding how MoM bearings are affected by edge wear. Only a 3-D assessment of cup position (e.g., the contact patch to rim distance) provides the necessary information to determine the role of cup positioning in relationship with abnormal bearing wear.The concept of hip resurfacing is more valid today than ever as the age of the patients in need of hip arthroplasty keeps getting lower. The recent publication of several excellent long-term survivorship results suggests that selection of a well-designed resurfacing system and accuracy in the placement of the cup can achieve long-term durability.

Long-Term Outcomes of Liner Cementation into a Stable Retained Shell: A Concise Follow-up of a Previous Report.

UNLABELLED: Liner cementation into a preexisting stable socket may reduce the morbidity of revision hip arthroplasty and preserve acetabular bone. However, the long-term outcomes of this technique remain unknown. The purpose of this report was to analyze the long-term results of a previously reported cohort of patients. Cementation of thirty-two liners (seventeen polyethylene and fifteen metal liners) into preexisting sockets was performed during revision hip arthroplasty, and the patients were followed for a minimum of two years. A retrospective chart review was performed to investigate the complications and survivorship. The mean duration of follow-up was 12.7 years (range, 2.1 to 19.1 years), with ten hips requiring rerevision at a mean of 6.4 years (range, 1.0 to 15.5 years). Nine patients experienced posterior dislocations, and two hips required rerevision for instability. Liner dissociation from the shell occurred in two patients. Survivorship analysis, with rerevision as the end point, demonstrated ten and fifteen-year survivorship of 77.3% and 68.8%, respectively. Dissociation of the cemented liner from the acetabular shell was an infrequent cause of failure despite long-term follow-up. Given the high rate of dislocations in this study, careful patient selection and surgical technique should be considered. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Aseptic loosening of cobalt chromium monoblock sockets after hip resurfacing.

INTRODUCTION: Acetabular component loosening is a leading cause for revision after metal-on-metal hip resurfacing arthroplasty (MMHRA). We aimed to identify potential risk factors and determine radiographic signs associated with this mode of failure. METHODS: From a series of 1375 hips treated with MMHRA, 21 (20 patients) underwent revision surgery secondary to aseptic loosening of the acetabular component and 6 patients had a radiographically loose acetabular component. A control group of 27 hips (26 patients) was selected among the patients that did not have a revision, and was matched for age, gender, component size and diagnosis. RESULTS: Mean time to revision in the loosening group was 103.0 months and the mean time of follow-up in the control group was 161.4 months. We found greater activity levels, range of motion scores, and cup abduction angles in the loosening group. The centre-edge (CE) angle of Wiberg was 10° lower in the loosening group compared with the control group. In addition, 11 of the hips from the study group presented a sclerotic halo superior to the cup on the last radiograph vs. none in the control group. There was no difference in the prevalence of postoperative reaming gaps or radiographic signs of neck-cup impingement between the 2 groups. DISCUSSION: Risk factors for acetabular loosening included hip dysplasia with low CE angle, and a large cup abduction angle. The patient's level of activity influences the appearance of symptoms and the time to revision. We recommend selecting patients with a sufficient CE angle and properly orienting the cup.

Do clinical and quality of life scores change over time after hip resurfacing?

BACKGROUND: Metal-on-metal hip resurfacing (MOMHR) is an alternative to total hip replacement in young and active patients but little is known about the evolution of clinical outcome scores of hip resurfacing over time.The purpose of this study was 1) to assess the long-term evolution of UCLA hip scores and SF-12 Quality of life evaluations in a group of patients treated with hip resurfacing arthroplasty, 2) to determine whether the age of the patient at surgery influenced these outcome measurements, and 3) whether the changes in SF-12 scores are comparable with those of the general US population. PATIENT AND METHODS: A total of 100 patients with unilateral, unrevised, Charnley class A MOMHR were retrospectively selected for the study. UCLA and SF-12 scores were calculated preoperatively, short-term postoperatively, and beyond 10 years. RESULTS: There was a decrease in the UCLA function and activity scores, and in the SF-12 physical scores between the short-term and the last follow-up at a minimum of 10 years. However, pain, walking, and SF-12 mental scores were maintained through the last follow-up. Furthermore, the SF-12 physical scores at last follow-up were comparable with those of the general US population while the mental scores were greater. There were no significant differences between the two age groups at any of the follow-up intervals for any outcome measurement. CONCLUSIONS: While there is a slight decline in physical function following hip resurfacing over time, pain relief, walking ability, and quality of life are maintained.