Examining the "revisability" benefit of hip resurfacing arthroplasty.

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.

Advances in imaging for pre-surgical planning in hip resurfacing arthroplasty.

BACKGROUND: Accurate preoperative templating is essential for the success of hip resurfacing arthroplasty (HRA). While digital radiograph is currently considered the gold standard, stereoradiograph and CT converted 3D methods have shown promising results. However, there is no consensus in the literature regarding the preferred modality for HRA templating, and angular measurements are often overlooked. Thus, this study aimed to: (1) compare the performances of different modality in implant sizing and angle measurements, (2) evaluate the measurement reproducibility, (3) assess the impact of severe osteoarthritis on femoral head sizing, and (4) based on the analysis above, explore the optimal imaging and planning strategy for HRA. HYPOTHESIS: An optimal imaging modality exists for HRA planning regarding implant sizing and angular measurements. MATERIALS AND METHODS: Preoperative imaging data from seventy-seven HRA surgeries were collected. Three raters performed templating using digital radiograph, stereoradiograph, and CT converted 3D models. Measurements for femoral head size, neck-shaft angle, and calcar-shaft angle were obtained. The femoral head sizing was compared to the intraoperative clinical decision. The reproducibility of measurements was assessed using the intraclass correlation coefficient (ICC). Correlations were examined between sizing disagreement and osteoarthritis grade (Tonnis Classification). RESULTS: Digital radiograph, stereoradiograph, and 3D techniques predicted one size off target in 27/77 (35%), 49/70 (70%), and 75/77 (97%) of cases, respectively, corresponding to 1.8±1.6 (0 to 5.67), 0.9±0.7 (0 to 2.67), and 0.4±0.4 (0 to 1.67) sizes off target, indicating statistically significant differences among all three modalities, with p-values all below 0.01. There were no statistically significant differences among the different modalities for angular measurements. Measurements showed moderate to excellent reproducibility (ICC=0.628-0.955). High-grade osteoarthritis did not impact image sizing in any modality (r=0.08-0.22, all p>0.05). DISCUSSION: CT converted 3D models were more accurate for implant sizing in HRA, but did not significantly outperform other modalities in angular measurements. Given the high costs and increased radiation exposure associated with CT, the study recommended using CT scans selectively, particularly for precise femoral head sizing, while alternative imaging methods can be effectively used for angular measurements. LEVEL OF EVIDENCE: III; retrospective comparative diagnostic study.

Comparisons of in-hospital complications between total hip arthroplasty and hip resurfacing arthroplasty.

BACKGROUND: Hip resurfacing arthroplasty (HRA) is a less common but effective alternative method to total hip arthroplasty (THA) for hip reconstruction. In this study, we investigated the incidences of in-hospital complications between patients who had been subjected to THA and HRA. METHODS: The National Inpatient Sample data that had been recorded from 2005 to 2014 was used in this study. Based on the International Classification of Disease, Ninth Revision, Clinical Modification, patients who underwent THA or HRA were included. Data on demographics, preoperative comorbidities, length of hospital stay, total charges, and in-hospital mortality and complications were compared. Multiple logistic regression analysis was used to determine whether different surgical options are independent risk factors for postoperative complications. RESULTS: A total of 537,506 THAs and 9,744 HRAs were obtained from the NIS database. Patients who had been subjected to HRA exhibited less preoperative comorbidity rates, shorter length of stay and extra hospital charges. Moreover, HRA was associated with more in-hospital prosthesis loosening. Notably, patients who underwent HRA were younger and presented less preoperative comorbidities but did not show lower incidences in most complications. CONCLUSIONS: The popularity of HRA gradually reduced from the year 2005 to 2014. Patients who underwent HRA were more likely to be younger, male, have less comorbidities and spend more money on medical costs. The risk of in-hospital prosthesis loosening after HRA was higher. The HRA-associated advantages with regards to most in-hospital complications were not markedly different from those of THA. In-hospital complications of HRA deserve more attention from surgeons.

Hip resurfacing arthroplasty in women: A novel ceramic device enables near normal gait function.

BACKGROUND: Gait function improves after Total Hip Arthroplasty (THA) but is not restored to normal levels. Metal-on-metal Resurfacing Arthroplasty (MoM-HRA) is an alternative to THA and has shown to restore normal levels gait function and physical activity but has been restricted to men owing to problems of metal-ion release. Ceramic HRA (cHRA) removes the cobalt-chrome bearing surfaces, thereby eliminating these specific metal-ion concerns and aiming to be safe for females. RESEARCH QUESTION: Is there a difference in gait function of female cHRA patients compared to female THA using subjective and objective measures? METHODS: Fifteen unilateral cHRA and 15 unilateral THA, age and BMI matched, completed patient reported outcome measures (PROMs) (Oxford Hip Score, EQ5d and MET score) and underwent gait analysis using an instrumented treadmill pre- (2-10 weeks) and post-operatively (52-74 weeks). Maximum walking speed (MWS), Vertical GRF of the stance phase, GRF symmetry index (SI) and spatiotemporal gait measures were recorded. Patients were compared to age, gender and BMI healthy controls (CON). RESULTS: There were no differences in PROMs or gait function between groups pre-operatively. Post- operatively, cHRA had a higher MET score (11.2 vs 7.1, p = 0.02) and a higher MWS (6.2 vs 6.8 km/hr, p = 0.003) compared to THA. cHRA had a similar GRF profile to CON, whereas THA had a reduced push-off force at 70-77 % of the stance phase compared to CON. At faster walking speeds of 6 km/hr walking speed, THA displayed an asymmetric GRF profile (SI<4.4 %) whereas the cHRA patients continued to display a symmetrical gait profile. cHRA was able to increase step length from pre-op levels (63 vs 66 cm, p = 0.02) and produced a larger step length compared to THA (73 vs 79 cm, p = 0.02). SIGNIFICANCE: Female cHRA returned to levels of gait function and activity similar to healthy controls unlike female THA.

Novel Use of an Accelerometer to Assess Load Asymmetry Over Time After Hip Resurfacing Arthroplasty.

BACKGROUND: There is limited knowledge regarding usage of wearable technology to guide return to sport after hip resurfacing arthroplasty (HRA). This study evaluated the use of accelerometers to identify when symmetry is restored between operative and nonoperative limbs. METHODS: A total of 26 primary HRA patients performed 5 validated physical tests before, 3 and 6 months after HRA: broad jump, double-leg vertical jump (DLVJ), hop test, lateral single-leg jump (LSLJ), and vertical single-leg jump. Impact load and average intensity data (g-force units) were collected using accelerometers. Strength data (pounds [lbs.]) for internal and external rotation were collected with a dynamometer. Univariate and correlation analyses analyzed interlimb asymmetries. RESULTS: At preoperation, there were significant impact load asymmetries for DLVJ (P = .008), hop test (P = .021), and LSLJ (P = .003) and intensity asymmetry for DLVJ (P = .010) and LSLJ (P = .003). At 3 months, there was impact load asymmetry for DLVJ (P = .005) and LSLJ (P = .005) and intensity asymmetry for broad jump (P = .020), hop test (P = .042), and LSLJ (P = .005). There were significant strength asymmetries at preoperation and 3 months postoperation for internal (P = .013) and external rotation (P = .037). All significant asymmetries indicated the nonoperative leg had greater output. No significant asymmetries were found for any exercises at 6 months postoperation. An increase in Harris Hip Score was significantly associated with a decrease in impact asymmetry (rs = -0.269, P = .006). CONCLUSION: Impact loads and strength reach interlimb symmetry at 6 months post-HRA. Wearable accelerometers provide useful metrics to distinguish limb asymmetries for recovery monitoring.

A meta-analysis assessing time for return to sport following hip resurfacing.

BACKGROUND: Hip resurfacing arthroplasty (HRA) is associated with excellent functional outcomes and return to pre-disease level of activity. The time for return to sport (RTS) following HRA remains unknown. The aim of this meta-analysis was to establish the time for RTS following HRA. METHODS: A search was performed on PUBMED, MEDLINE, EMBASE, and the Cochrane Library for trials on HRA and RTS, in the English language, published from the inception of the database to October 2020. In addition, a manual search was performed of relevant sports medicine and orthopaedic journals, and the bibliographies reviewed for eligible trials. All clinical trials reporting on time to RTS following HRA were included. Data relating to patient demographics, methodological quality, operation type, RTS, clinical outcomes, and complications were recorded by two independent reviewers. The PRISMA guidelines for reporting meta-analyses was used to undertake this study. RESULTS: The initial literature search identified 1559 studies and nine further studies were found. Of these, 11 studies with a total of 659 patients matched the inclusion criteria. Two studies involving a total of 94 patients demonstrated an overall pooled proportion of 91.8% (95% CI 71.8-100) of patients RTS by three months post-operatively. Four studies including a total of 265 patients determined a pooled proportion of 96.8% (95% CI 91.0-99.7) of patients able to RTS by the 6-month post-operative stage. Pooled proportion analysis from all 11 studies comprising 659 patients showed 90.9% (95% CI 82.2-96.9) of patients were able to RTS by final follow up of 3 years. CONCLUSION: Pooled proportion analysis showed an increasing number of patients were able to RTS after HRA over the first one year after surgery. There remains marked inter and intra-study variations in time for RTS but the pooled analysis shows that over 80% of patients were able to RTS at 6 to 12 months after HRA. The findings of this meta-analysis will enable more informed discussions between patients and healthcare professionals about time for RTS following HRA.

The 50 Most-Cited Articles Regarding Hip Resurfacing.

Background: Hip resurfacing arthroplasty is an accepted treatment option for young patients presenting with osteoarthritis of the hip. The purpose of this review was to evaluate and identify the top 50 most-cited articles pertaining to hip resurfacing, to help clinicians identify influential articles and navigate the literature more effectively. Material and methods: Clarivate Analytics Web of Science was used to identify all articles related to hip resurfacing. The screening was based on the number of citations for each article. The final list of articles was further reviewed, and further data including manuscript title, authors, total citation count, year of publication, journal, country of origin, and level of evidence were extracted. Results: The most-cited publication was "Pseudotumors associated with metal-on-metal hip resurfacings", which was cited 704 times. The average total number of citations per publication was 203. The most prolific publication year was 2008 with 8 publications, and the most recent article was published in 2012. The journals with the most attributable publications were Journal of Bone and Joint Surgery and Clinical and Orthopedic Related Research. Conclusions: This review provides a comprehensive analysis of the most-cited articles pertaining to hip resurfacing. Level of evidence: III.

The metabolic equivalent of task score : a useful metric for comparing high-functioning hip arthroplasty patients.

AIMS: This study investigates the use of the metabolic equivalent of task (MET) score in a young hip arthroplasty population, and its ability to capture additional benefit beyond the ceiling effect of conventional patient-reported outcome measures. METHODS: From our electronic database of 751 hip arthroplasty procedures, 221 patients were included. Patients were excluded if they had revision surgery, an alternative hip procedure, or incomplete data either preoperatively or at one-year follow-up. Included patients had a mean age of 59.4 years (SD 11.3) and 54.3% were male, incorporating 117 primary total hip and 104 hip resurfacing arthroplasty operations. Oxford Hip Score (OHS), EuroQol five-dimension questionnaire (EQ-5D), and the MET were recorded preoperatively and at one-year follow-up. The distribution was examined reporting the presence of ceiling and floor effects. Validity was assessed correlating the MET with the other scores using Spearman's rank correlation coefficient and determining responsiveness. A subgroup of 93 patients scoring 48/48 on the OHS were analyzed by age, sex, BMI, and preoperative MET using the other metrics to determine if differences could be established despite scoring identically on the OHS. RESULTS: Postoperatively the OHS and EQ-5D demonstrate considerable negatively skewed distributions with ceiling effects of 41.6% and 53.8%, respectively. The MET was normally distributed postoperatively with no relevant ceiling effect. Weak-to-moderate significant correlations were found between the MET and the other two metrics. In the 48/48 subgroup, no differences were found comparing groups with the EQ-5D, however significantly higher mean MET scores were demonstrated for patients aged < 60 years (12.7 (SD 4.7) vs 10.6 (SD 2.4), p = 0.008), male patients (12.5 (SD 4.5) vs 10.8 (SD 2.8), p = 0.024), and those with preoperative MET scores > 6 (12.6 (SD 4.2) vs 11.0 (SD 3.3), p = 0.040). CONCLUSION: The MET is normally distributed in patients following hip arthroplasty, recording levels of activity which are undetectable using the OHS. Cite this article: Bone Joint Res 2022;11(5):317-326.

Metal-on-metal hip resurfacing arthroplasty provides excellent long-term survivorship and function in patients with a good-sized femoral head : results of a single, non-designer surgeon's cohort.

AIMS: To establish the survivorship, function, and metal ion levels in an unselected series of metal-on-metal hip resurfacing arthroplasties (HRAs) performed by a non-designer surgeon. METHODS: We reviewed 105 consecutive HRAs in 83 patients, performed by a single surgeon, at a mean follow-up of 14.9 years (9.3 to 19.1). The cohort included 45 male and 38 female patients, with a mean age of 49.5 years (SD 12.5). RESULTS: At the time of review 13 patients with 15 hips had died from causes unrelated to the hip operation, and 14 hips had undergone revision surgery, giving an overall survival rate of rate of 86.7% (95% confidence interval (CI) 84.2 to 89.1). The survival rate in men was 97.7% (95% CI 96.3 to 98.9) and in women was 73.4% (95% CI 70.6 to 75.1). The median head size of the failed group was 42 mm (interquartile range (IQR) 42 to 44), and in the surviving group was 50 mm (IQR 46 to 50). In all, 13 of the 14 revised hips had a femoral component measuring ≤ 46 mm. The mean blood levels of cobalt and chromium ions were 26.6 nmol/l (SD 24.5) and 30.6 nmol/l (SD 15.3), respectively. No metal ion levels exceeded the safe limit. The mean Oxford Hip Score was 41.5 (SD 8.9) and Harris Hip Score was 89.9 (14.8). In the surviving group, four patients had radiolucent lines around the stem of the femoral component, and one had lysis around the acetabular component; eight hips demonstrated heterotopic ossification. CONCLUSION: Our results confirm the existing understanding that HRA provides good long-term survival and function in patients with adequate-sized femoral heads. This is evidenced by a 97.7% survival rate among men (larger heads) in our series at a mean follow-up of 14.9 years. Failure is closely related to head sizes ≤ 46 cm. Cite this article: Bone Jt Open 2022;3(1):68-76.

Hip Resurfacing Arthroplasty after Failure of Tantalum Rod Insertion in Patients with Osteonecrosis of the Femoral Head.

Purpose: The purpose of this study was to examine the clinical outcomes and efficacy of hip resurfacing arthroplasty (HRA) in patients with osteonecrosis of the femoral head after the failure of porous tantalum rod insertion without rod removal. Materials and Methods: Conversion to hip resurfacing arthroplasty was performed in 10 patients (11 hips) with a mean period of 14.9 months after the primary surgery. The mean follow-up period was 73.7 months. Analysis of pre and postoperative range of motion (ROM), University of California at Los Angeles (UCLA) activity score, modified Harris hip score, and visual analog scale (VAS) pain score was performed. Radiographic analysis of component loosening and osteolysis was performed. Results: The postoperative ROM showed significant improvement (P<0.05), excluding flexion contracture. The modified Harris hip score showed improvement from 65.82 to 96.18, the UCLA score showed improvement from 4.18 to 8.00, and the VAS pain score was reduced from 6.09 to 1.80. All scores showed statistically significant improvement (P<0.05). No component loosening or osteolysis was detected by radiographic analysis. Conclusion: Satisfactory results were obtained from conversion hip resurfacing arthroplasty after failure of porous tantalum rod insertion without rod removal. The findings of this study demonstrate the advantages of HRA, including no risk of trochanteric fracture and no bone loss around the tantalum rod. In addition, the remaining porous tantalum rod provided mechanical support, which reduced the potential risk of femoral neck fracture or loosening. This technique can be regarded as a favorable treatment option.

Fixation and Implant Retention of Extracapsular Femoral Neck Periprosthetic Fractures Around Hip Resurfacing Arthroplasty - A Case Series.

BACKGROUND: Extracapsular femoral neck fractures in the presence of a resurfacing hip arthroplasty (RHA) appear to be independent of suboptimal technique during the initial implantation of the RHA and present with a similar etiology as native hip fractures - that is, a fragility fracture related to pathological or age-related osteoporosis, as a consequence of trauma. In the presence of a well-fixed and previously well-functioning RHA, the options for management include revision arthroplasty or open reduction and internal fixation (ORIF). In the absence of loosening through mechanisms of wear, infection, metallosis, or suboptimal prosthesis positioning, many authors have advocated ORIF with implant retention. However, there is often debate regarding the use of total hip arthroplasty in these cases. CASE SERIES: The authors conducted a thorough assessment of the literature followed by a retrospective review of outcomes for three patients treated by ORIF with implant retention for extracapsular femoral neck fractures around a RHA, using a standardized technique. All patients were independently mobile and active with well-fixed and well-functioning RHAs before the date of injury. All patients suffered low-energy trauma resulting in the fracture. There were no intraoperative or perioperative complications. All patients achieved full weight-bearing status and independent mobility. Two patients achieved radiographic union and returned to full range of movement and independent mobilization comparable to their preoperative state. One patient was lost to follow-up. CONCLUSION: The authors believe that fixation of extracapsular proximal femoral fractures distal to a well-fixed, well-functioning RHA is a good management option in an independent and active patient. A higher level of evidence is needed to investigate the surgical management options of these injuries comparing osteosynthesis with revision arthroplasty.

Is the Revision Rate Higher After Hip Arthroplasty in Teenage Patients? A Prospective Study with Long-Term Follow-Up of More Than 10 Years.

BACKGROUND: Total hip arthroplasty (THA) and hip resurfacing arthroplasty (HRA) are already proven good for end-stage arthritis in the older populations but it is challenging in young teenage patients. The primary aim was to assess Hip Disability and Osteoarthritis Outcome Score (HOSS), Harris Hip Score (HHS) and secondary aim for implant survival rate. MATERIALS AND METHODS: The details of 33 teenage patients (forty hips) who underwent HRA (21) and THA (19) at our institution (January 2002 to December 2013) with a mean follow-up period of 11.00 years (range 7.00-18.40) were included. The study group had 25 males and eight females. RESULTS: The overall median HOOSs with interquartile range were 89.00 (87.63-0.00). The median HOOSs at follow-up were as follows: 95.00 (90.00-95.00) for symptoms, 92.00 (90.00-95.00) pain, 87.00 (85.00-90.00) for functions, 81.00 (75.00-85.00) for sports and 94.00 (88.00-95.00) for QOL. HHS improved significantly from 36.88 ± 6.14 to 90.12 ± 6.56 (p < 0.001). The HHS of HRA group improved from 36.29 ± 5.83 to 89.38 ± 5.23 and THA group improved from 37.26 ± 6.22 to 90.94 ± 7.84. The 5-year radiological follow-up X-rays did not show any radiolucent line wider than 2 mm in all three zones of the acetabulum and no progressive subsidence or migration of > 1 mm and divergent radiopaque line in femur. The Implant survival rate for HRA was 100% at 5 years, 100% at 10 years, 92% at 15 years and THA group was 100% at 5 years and 90% at 10 years. CONCLUSION: Our study showed a disability rate of zero with improved HOSS and HHS. The overall implant survival rate was good with 100% at 5 years, 97% at 10 years and 89.9% at 15 years in contrast to the previous studies with the use of modern implants and newer standard surgical techniques. LEVEL OF EVIDENCE: A Level II study http://www.spine.org/Documents/LevelsofEvidenceFinal.pdf.

Hueter Anterior Approach for Metal-on-Metal Hip Resurfacing Arthroplasty: 555 Cases at a Minimum Five-Year Follow-Up.

BACKGROUND: Purpose of this study was to determine implant survivorship and resultant outcomes, including modes of failure, for metal-on-metal hip resurfacing through the Hueter anterior approach (HAA). METHODS: Retrospective review of cases from 2006 to 2015, resulted in 555 metal-on-metal hip resurfacing via HAA, mean age 49.4 ± 6.9 years and mean BMI 28.1 ± 5.3. Kaplan-Meier curves were used to assess implant survivorship. Evaluation of technique was based on radiographic assessment of component position at 6 weeks. Patient-reported outcome measures were assessed using 12-Item Short Form Survey 12, University of California Los Angeles activity, Western Ontario and McMaster Universities Osteoarthritis Index, and hip disability osteoarthritis outcome scores. RESULTS: At a mean follow-up of 9.18 years, survivorship was 95.0% at 5 years (95% CI: 93.2-96.8 years) and 92.5% at 10 years (95% CI: 90.0-95.0 years); men at 96.1% (95% CI: 94.3-97.9) and 93.8% (95% CI: 91.1-96.5), and women at 88.8% (95% CI: 81.9-95.7) and 85.6% (95% CI: 77.6-93.6), 5 and 10 years, respectively (P = .033). There were 37 revisions to total hips (7%) at a mean time of 3.3 years (SD 2.7). Indications for revision were aseptic loosening of acetabular (n = 12) and femoral component (n = 7) and pseudotumor (n = 6). Radiographic parameters were respectable and consistent, median acetabular inclination angle 41.2° and femoral stem shaft angle 137.7°. Patient-reported outcome measure scores significantly improved and remained stable at 2 and 5 years postoperatively. CONCLUSION: Although choice of surgical approach should always be based on surgeon's technical expertise, this study has shown that HAA is safe and effective for hip resurfacing. Mindful attention to long-term metal ion exposure must still be considered.

The hip replacement type choice: presentation of difficulty and responsibility about a case / A csípoprotézis-választás nehézségeinek és felelosségének bemutatása egy eset kapcsán.

Összefoglaló. A felszínpótló, fém a fémen csípoízületi protézisek reneszánszukat élték a 2000-es években. Elsosorban fiatal, aktív betegek esetében javasolták használni a remélt elméleti elonyök, mint a combfej csontállományának megorzése, a csípoízület biomechanikájának fenntartása, a luxatio kockázatának csökkentése, a polietilén törmelékek és kopástermékek hiánya miatt. Bemutatunk egy beteget, akinél 19 éves korában kétszeri vesetranszplantációt követo, hosszan tartó szteroidkezelés következtében kialakult kétoldali combfejnekrózis miatt került sor felszínpótló, fém a fémen csípoprotézis beültetésére. A harmadik posztoperatív évtol mindkét csípot érinto, fokozatosan súlyosbodó fájdalom, pszichés tünetek, valamint ismételt veseelégtelenség alakult ki. A tünetek hátterében kifejezetten magas Co-Cr szérumszintet, a csípoízület környezetében pszeudotumor-kialakulást, kiterjedt acetabularis cystákat, a combnyakak jelentos elvékonyodását találtuk, mely jobb oldalon periprotetikus combnyaktörést okozott. A revíziós mutétek során talált kiterjedt szöveti metallosis eltávolítását követoen a felszínpótló protéziseket cement nélküli kerámia-kerámia totális protézisekre cseréltük. A revíziókat követoen a lokális és pszichés tünetek megszuntek, a szérum Co-Cr szintje normalizálódott, ami lehetové tette a harmadik vesetranszplantáció elvégzését is. Páciensünk csíporevíziókat követo gyors javulása közvetett bizonyítékként szolgál a Co-Cr ionok negatív szerepére mind a helyi, mind a szisztémás szöveti reakciókban, így a transzplantált vese károsodásában. Esetünk tanulságai, hogy szervtranszplantációt követoen kerülni kell a fém a fémen protézisek használatát, valamint hogy nem elég a csípoízületi protézis indikációjának felállítása és a legmodernebbnek tartott protézis használata. Különös gonddal és elmélyülten kell elemezni a beteg járulékos körülményeit, gyógyszerelését, társbetegségeit is ahhoz, hogy a legmegfelelobb típusú protézist tudjuk kiválasztani, ami nem megkerülheto felelossége az ortopéd sebészeknek. Orv Hetil. 2021; 162(20): 800-805. Summary. The surface replacement, metal on metal hip prostheses, experienced a renaissance in the 2000s. It has been recommended for use primarily in young, active patients due to expected theoretical benefits such as preserving femoral bone stock, maintaining hip joint biomechanics, reducing the risk of dislocation, and lacking polyethylene debris abrasion products. We present a patient who had resurfacing prosthesis because of bilateral femoral head necrosis due to long-term steroid treatment following double kidney transplantation at the age of 19. In the third postoperative year, progressive pain in both hips, psychiatric symptoms, and recurrent renal failure developed. We found extremely high serum Co-Cr levels, pseudotumor formation of the hip joint, extensive acetabular cysts, and significant thinning of the femoral neck, followed by a periprosthetic femoral neck fracture on one side. After removing the extensive tissue metallosis found during the revision surgeries, the surface replacement prostheses were replaced with cementless ceramic-ceramic total prostheses. Following the revisions, local and psychiatric symptoms resolved, and serum Co-Cr levels normalized, allowing a third kidney transplant to be performed. The rapid improvement of our patient after prosthesis revisions serves as indirect evidence for the negative role of Co-Cr ions in both local and systemic tissue reactions, including damage to the transplanted kidney. Our case report shows that the use of metal on metal prostheses after organ transplantation should be avoided and simply setting up an indication for hip prosthesis and use the most modern type of prosthesis is inadequate. Depth analysis of the patient's ancillary conditions, medications, co-morbidities are required to select the most appropriate prosthesis type, which is an unavoidable responsibility of orthopedic surgeons. Orv Hetil. 2021; 162(20): 800-805.

Return to Sport After Hip Resurfacing Arthroplasty.

BACKGROUND: Femoroacetabular impingement and degenerative hip osteoarthritis (OA) affect athletes across a wide variety of sports. Hip resurfacing arthroplasty (HRA) has emerged as a surgical treatment for active individuals with end-stage hip OA to provide pain relief and allow return to high-impact activities. Return to professional sports after HRA has not been well characterized. PURPOSE/HYPOTHESIS: The aim of this study was to report on a series of elite athletes in a variety of sports who underwent HRA. We hypothesized that professional and elite-level athletes would be able to return to sports after HRA for end-stage hip OA. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A retrospective case series was conducted on professional athletes who underwent HRA at a single institution between 2007 and 2017. All surgeries were performed by a single surgeon using the posterolateral approach. Athletes' return to play and sport-specific performance statistics were obtained using self-reported and publicly available data sources. Athletes were matched to an age- and performance-based cohort to determine changes in performance-based metrics. RESULTS: Eight professional athletes were identified, including 2 baseball pitchers, 1 ice hockey defenseman, 1 foil fencer, 1 men's doubles tennis player, 1 basketball player, 1 ultramarathoner, and 1 Ironman triathlete. All 8 patients returned to sports; 6 of 8 (75%) patients were able to return for at least 1 full season at a professional level after surgery. There were no significant differences between performance statistics for athletes who returned to play and their preoperative performance measures for the years leading up to surgery or the age- and performance-matched cohort. CONCLUSION: HRA remains a surgical alternative for end-stage hip OA in young, high-impact, active patients. While the primary goals of surgery are pain control and quality of life improvement, it is possible to return to elite-level sporting activity after HRA.

Can hip resurfacing be safely revised with short-stem total hip arthroplasty? A case series of six patients.

BACKGROUND: The usage of short stems in primary total hip arthroplasty (THA) has constantly gained popularity over the last decade, however, to date, short stems are not eligible to be used as revision implants. The aim of this study was to retrospectively evaluate the outcome of revision surgery of failed hip resurfacing arthroplasty (HRA) using short-stem THA. METHODS: In a single center, retrospective analysis, 6 consecutive patients who were treated with a calcar-guided short stem after failure of HRA were evaluated. The mean follow-up was 3.25 years (SD 0.45). Patient reported outcome measurements (PROMs) were recorded using the Harris hip score (HHS) and The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The health status was evaluated by the EQ-5D-5L score. Pain and satisfaction were obtained using the visual analogue scale (VAS). Radiographic analysis was performed by evaluating osteolysis, stress shielding, alignement and signs of aseptic loosening. Complications were documented. RESULTS: At last follow-up, clinical outcome was excellent (HHS ≥ 90) in 5 patients and good (HHS = 87) in 1 patient. The mean WOMAC score was 5.73% (SD 3.66%). The mean EQ-5D-5L index was 0.914 (SD 0.07). Pain and satisfaction on VAS was 1.83 (SD 5.18) and 8.67 (SD 0.94), respectively. Radiologically, no signs of subsidence, aseptic loosening, stress shielding and fracture were obvious. No major complications occurred. To date, no further revision surgery was needed. CONCLUSIONS: The outcomes of the present case series propose that HRA can be safely revised using short-stem THA in a selected patient group. Clinical and radiological results are encouraging. Based on the present data, short stems may be considered as a revision implant for failed HRA for experienced surgeons.

A Comparative Cohort Study With a 20-Year Age Gap: Hip Resurfacing in Patients Aged ≤35 Years and Patients Aged ≥55 Years.

BACKGROUND: This single-center retrospective cohort study aimed to evaluate and compare implant survival and patient-reported outcome measures in 2 distinct age groups separated by 20 years who underwent hip resurfacing arthroplasty (HRA). METHODS: Between 2005 and 2014, 2042 HRAs were performed by a single-surgeon, and 75 and 377 hips from patients aged ≤35 years and ≥55 years, respectively, were included in this study. Implant survival was determined for all available hips. Clinical features and patient-reported outcome measures were collected. RESULTS: Seven hips were revised, 4 for aseptic loosening of one or both components, one for infection, one for accelerated wear and metallosis, and one for femoral neck fracture. There was no difference in all-cause 10-year revision, with 97.1% (95% confidence interval 80.9 to 99.6) and 99.6% (95% confidence interval: 97 to 99.9) survivorship in younger and older patients, respectively (P = .246). Preoperatively, younger patients were less active than older patients on the Lower Extremity Activity Scale (LEAS) or University of California, Los Angeles, activity scale, but at follow-up, younger patients outpaced older ones. CONCLUSION: Original to our study was the isolation and comparison of 2 distinct age groups. With excellent results in disparate age groups, HRA can be applied to a broad patient demographic and is suitable for those patients who want to achieve a high activity level as defined by Lower Extremity Activity Scale or University of California, Los Angeles, scores.

Living with a recalled implant: a qualitative study of patients' experiences with ASR hip resurfacing arthroplasty.

BACKGROUND: Total hip arthroplasty is the traditional treatment for osteoarthritis in the hip joint. Hip resurfacing arthroplasty, with metal on metal bearing, is a modern concept initially developed mainly for young active people. The metal-on-metal hip arthroplasty implant, Articular Surface Replacement (ASR), was implanted in approximately 93,000 patients before it was recalled in 2010 due to a high complication rate. This study aimed to evaluate patients' own experiences living with an implant that they knew had a high complication rate and had been recalled from the market. METHODS: A total of 14 patients, still living with the implant, of a cohort of 34 patients were available for follow-up. Qualitative semi-structured interviews were conducted with 14 patients where a majority actively sought for metal-on-metal hip resurfacing arthroplasty (HRA), and subsequently underwent HRA with an ASR prosthesis between 11/21/2006 and 09/28/2009. The responses were analyzed using content analysis described by Graneheim and Lundman to compress text and identify categories and subcategories. RESULTS: The results showed that most patients had already decided that they wanted a metal-on-metal HRA implant before meeting the surgeon. They expressed that the implant made it possible to live an active life. A majority did not think about the fact that they had a hip implant, because they lacked subjective pain. Most of the patients were positive about the annual exams at the hospital and wanted them to continue. None of them felt that their trust towards the healthcare system had changed after the implant recall. They expressed a belief that they would need new surgery sooner than they first thought. CONCLUSIONS: Despite all the attention when the ASR prosthesis was recalled, patients with ASR-HRA did not report themselves negatively affected by the recall in this group of patients where a majority had actively sought for an HRA procedure. The healthcare system has an obligation to continue the annual exams, even if the implant provider does not continue reimbursement.

Metal on metal hip resurfacing arthroplasty: Where are we now?

Metal on metal hip resurfacing arthroplasty (HRA) was introduced in an attempt to address potential limitations regarding return to sport, return to high functional activity and premature wear in young patients requiring standard total hip replacement (THR). Around 12% patients undergoing hip replacement surgery are under 55 years of age. By more closely mimicking natural anatomy, and having a metal on metal (MoM) bearing, it was hoped that HRA would address the issues. However, concern has emerged about early failure, high revision rates from local adverse reactions to metallic wear debris and potential systemic consequences of metal ion cardiotoxicity. In this article, we discuss the existing literature in the field, the current clinical evidence surrounding HRA, its indications, clinical outcomes, and risk factors for failure and conclude if it still has a role within orthopaedic hip surgery.

Hip resurfacing arthroplasty and total hip arthroplasty in the same patient: which do they prefer?

INTRODUCTION: Hip resurfacing arthroplasty (HRA) is an alternative to conventional total hip arthroplasty (THA) with potential advantages of preserving femoral bone stock and the ability to participate in higher impact activities. This study compares outcomes, satisfaction and preference in patients who underwent HRA in 1 hip and THA on the contralateral side. METHODS: 62 Patients with an HRA in 1 hip and a contralateral THA were retrospectively identified at 3 centres, consisting of 38 males and 24 females with 53 patients (85.5%) undergoing HRA first. A survey regarding satisfaction and preference for each procedure and outcome scores were obtained. RESULTS: Patients were younger (51.5 vs. 56.6 years, p = 0.002) and had longer follow-up on the HRA hip (11.0 vs. 6.0 years, p < 0.001). HRA was associated with larger increase in Harris Hip Score from preoperative to final follow-up (35.8 vs. 30.6, p = 0.035). 18 Patients (29.0%) preferred HRA, 19 (30.6%) preferred THA and 25 (40.3%) had no preference (p = 0.844). When asked what they would choose if they could only have 1 surgery again, 41 (66.1%, p < 0.001) picked HRA. Overall satisfaction (p = 0.504), willingness to live with their HRA versus THA for the rest of their life (p = 0.295) and recommendation to others (p = 0.097) were similar. CONCLUSIONS: Although HRA is associated with risks related to metal-on-metal bearings, it showed greater increase in patient-reported outcomes and a small subjective preference amongst patients who have undergone both conventional and resurfacing arthroplasty.