Hip resurfacing

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Hip resurfacing
Hipoptions.jpg
BHR compared with THR
ICD-9-CM 00.85-00.86

Hip resurfacing has been developed as a surgical alternative to total hip replacement (THR). The procedure consists of placing a cap (usually made of cobalt-chrome metal), which is hollow and shaped like a mushroom, over the head of the femur while a matching metal cup (similar to what is used with a THR) is placed in the acetabulum (pelvis socket), replacing the articulating surfaces of the person's hip joint and removing very little bone compared to a THR. When the person moves the hip, the movement of the joint induces synovial fluid to flow between the hard metal bearing surfaces lubricating them when the components are placed in the correct position. The surgeon's level of experience with hip resurfacing is most important; therefore, the selection of the right surgeon is crucial for a successful outcome. Health-related quality of life measures are markedly improved and the person's satisfaction is favorable after hip resurfacing arthroplasty. [1]

Contents

Uses

A person's suitability for hip resurfacing is decided by the person's anatomy and the surgeon. Hip resurfacing is generally more suitable for younger people who are not morbidly obese, are clinically qualified for a hip replacement (determined by the doctor), have been diagnosed with noninflammatory degenerative joint disease, do not have an infection, and are not allergic to the metals used in the implant. [2]

The potential advantages of hip resurfacing compared to THR include less bone removal (bone preservation), a reduced chance of hip dislocation due to a relatively larger femoral head size (given that the person has an anatomically correct femoral head size), and easier revision surgery for any subsequent revision to a THR device because a surgeon will have more original bone stock available. [3] Hip resurfacing has the potential of being a solution for life, allows a normal ROM (range of movement) and minimizes the amount of "stress shielding", compared with THR. Since the femoral neck is retained and the femoral cavity with its marrow not opened up two other advantages exist, namely no risk of blood clots by fatty marrow that can enter the blood stream with the THR procedure and no risk of introducing bacteria in the opened femoral canal resulting in a deep infection as can happen with the THR procedure. The potential disadvantages of hip resurfacing are femoral neck fractures (rate of 0–4%), aseptic loosening, and metal wear. [3] Due to the retention of the person's complete femoral neck other advantages exist: Surgeon induced discrepancies in leg length (as could happen with THR) are now minimized. Also, the toe-in or toe-out faults that could occur interoperatively with THR are now over because the femoral neck that determines foot direction is left undisturbed with hip resurfacing.

On February 10, 2011, the U.S. FDA issued a patient advisory on metal-metal hip implants, stating it was continuing to gather and review all available information about metal-on-metal hip systems. [4] On June 27–28, 2012, an advisory panel met to decide whether to impose new standards. [5] [6] [7] No new standards, such as routine checking of blood metal ion levels, were set, but guidance was updated. [8]

According to the Australian Orthopaedic Associate National Joint Replacement Registry (AOANJRR) 2018 Annual Report, hip (total) resurfacing is overwhelmingly used for males (98% of total resurfacing hip replacement were males), and has declined in popularity since the mid-2000s (the number of total resurfacing procedures in 2017 was 78.7% less than 2005). [9]

In 2006, the United States FDA approved hip resurfacing using the Birmingham Hip Resurfacing (BHR) system, [10] designed by British Orthopaedic surgeon Derek McMinn. All other FDA approved devices have been removed from the US Market. The BHR is no longer suggested for use in women. There are several other manufacturers of hip resurfacing systems, mainly in Europe.

Contra-indications

Hip resurfacing should not be used on people who have severe bone loss in their femoral head, those with large femoral neck cysts present (typically found at surgery) or cysts that are close to the head neck junction, or people who have poor bone stock or osteoporosis. [3] Caution should be used for people who have rheumatoid arthritis, are tall, thin, or small boned, [11] those with osteonecrosis (poor blood supply) to the femoral head, or those with femoral head cysts > 1 cm on an x-ray taken before surgery. [3]

Metal-on-metal resurfacing systems are generally unsuitable for women of child-bearing age due to unknown effects of metal ion release on the fetus. [7] There are hip resurfacing components that have a ceramic coating on metal femoral head component and cross linked polyethylene plastic as a liner for the socket or cup area making it not metal on metal. The plastic sleeve can be replaced if needed without removing the main components.[ citation needed ]

Technique

The hip resurfacing devices are metal-on-metal articulating devices which differ from total hip replacement devices because they are more bone conserving and retain the natural geometry (so-called large ball THR devices share this trait). A THR requires that the upper portion of the femur bone be cut off to accept the stem portion of a THR device. The femur cap of the hip resurfacing devices does not require the femur bone be cut off; instead the top of the femoral head is shaped to closely fit the underside of the cap. Both hip resurfacing and hip replacement require that a cup is placed in the acetabulum of the hip socket. The main advantage of the hip resurfacing surgery is that when a revision is required, there is still an intact femur bone left for a THR stem. When a THR stem requires a revision, the metal stem in the femur has to be removed and often more bone is lost in the process of removal and replacement with a larger diameter stem. Having a hip resurfacing at a younger age means that a revision will likely be easier to perform when required. [12]

Recent studies have shown that the outcome of a hip resurfacing is dependent on surgeon experience [13] and that proper positioning of hip resurfacing components is crucial. [14] [15] Therefore, in addition to ensuring that a proven device is used, care should be taken in selecting a surgeon with experience and a good track record.[ citation needed ]

Although formal labeling restrictions exist in some countries, including the United States, hip resurfacing may allow younger, active people to return to many activities they enjoyed prior to their hip problems, [16] [17] which is an advantage over a traditional hip arthroplasty. [18] The large size cap and cup of the hip resurfacing devices are the same size as a person's original ball and socket and thus are less prone to dislocation.

An often forgotten but very important advantage of hip resurfacing and thereby the retention of the femoral neck is the fact that hip resurfacing has the least measurable amount of "stress shielding" when compared to any type of THR. This means that with hip resurfacing the femur's upper portion fully retains its natural mechanical characteristics under load, also ensuring less disturbance of the processes that take place inside bone that is alive.[ citation needed ]

History

Hip Resurfacing has a long history paralleling the advances of THR. Similar designs appear to have begun in the 1940s, with the first prostheses and procedures (called double-cup arthroplasty) using congruent femoral and acetabular components emerging in the 1970s. These early designs used metal-on-polyethylene bearings, and had poor results compared to THR at the time. It has since been observed that these poor results were strongly tied with polyethylene wear debris associated with the use of air-sterilised ultra high molecular weight polyethylene (UHMWPE) at the time. [19]

A more modern style of Hip Resurfacing emerged in the 1990s, using cobalt-chrome bearings. Clinical results using these material choice were good, prompting the popularity of resurfacing procedures to rise into the early 2000s. [19]

Starting around 2008, a body of research was conducted around metal-on-metal bearings in general and questioning their value, finding (for instance) failures associated with metal ions due to fretting and corrosion. In 2010, the ASR device (produced by DePuy, also a metal-on-metal resurfacing implant) was recalled, and resulted in many cases of litigation. [19]

It has been suggested that research in the area at the time focused on metal-on-metal bearings “as a class” and insufficiently distinguished the role of prosthesis design and surgical technique. Therefore, the current state of hip-resurfacing is an ongoing debate over material choice, implant design and surgical technique. [19]

See also

Related Research Articles

<span class="mw-page-title-main">Orthopedic surgery</span> Branch of surgery concerned with the musculoskeletal and bones system

Orthopedic surgery or orthopedics is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors, and congenital disorders.

<span class="mw-page-title-main">Hip replacement</span> Surgery replacing hip joint with prosthetic implant

Hip replacement is a surgical procedure in which the hip joint is replaced by a prosthetic implant, that is, a hip prosthesis. Hip replacement surgery can be performed as a total replacement or a hemi (half) replacement. Such joint replacement orthopaedic surgery is generally conducted to relieve arthritis pain or in some hip fractures. A total hip replacement consists of replacing both the acetabulum and the femoral head while hemiarthroplasty generally only replaces the femoral head. Hip replacement is one of the most common orthopaedic operations, though patient satisfaction varies widely. Approximately 58% of total hip replacements are estimated to last 25 years. The average cost of a total hip replacement in 2012 was $40,364 in the United States, and about $7,700 to $12,000 in most European countries.

Arthroplasty is an orthopedic surgical procedure where the articular surface of a musculoskeletal joint is replaced, remodeled, or realigned by osteotomy or some other procedure. It is an elective procedure that is done to relieve pain and restore function to the joint after damage by arthritis or some other type of trauma.

<span class="mw-page-title-main">Knee replacement</span> Surgical procedure

Knee replacement, also known as knee arthroplasty, is a surgical procedure to replace the weight-bearing surfaces of the knee joint to relieve pain and disability, most commonly offered when joint pain is not diminished by conservative sources. It may also be performed for other knee diseases, such as rheumatoid arthritis. In patients with severe deformity from advanced rheumatoid arthritis, trauma, or long-standing osteoarthritis, the surgery may be more complicated and carry higher risk. Osteoporosis does not typically cause knee pain, deformity, or inflammation, and is not a reason to perform knee replacement.

<span class="mw-page-title-main">Computer-assisted orthopedic surgery</span>

Computer-assisted orthopedic surgery or computer-assisted orthopaedic surgery is a discipline where computer technology is applied pre-, intra- and/or post-operatively to improve the outcome of orthopedic surgical procedures. Although records show that it has been implemented since the 1990s, CAOS is still an active research discipline which brings together orthopedic practitioners with traditionally technical disciplines, such as engineering, computer science and robotics.

<span class="mw-page-title-main">Joint replacement</span> Orthopedic surgery to replace a joint

Replacement arthroplasty, or joint replacement surgery, is a procedure of orthopedic surgery in which an arthritic or dysfunctional joint surface is replaced with an orthopedic prosthesis. Joint replacement is considered as a treatment when severe joint pain or dysfunction is not alleviated by less-invasive therapies. It is a form of arthroplasty, and is often indicated from various joint diseases, including osteoarthritis and rheumatoid arthritis.

<span class="mw-page-title-main">Femoral head ostectomy</span> Surgical removal of the head and neck of the femur

A femoral head ostectomy is a surgical operation to remove the head and neck from the femur. It is performed to alleviate pain, and is a salvage procedure, reserved for condition where pain can not be alleviated in any other way. It is common in veterinary surgery. Other names are excision arthroplasty of the femoral head and neck, Girdlestone's operation, Girdlestone procedure, and femoral head and neck ostectomy.

<span class="mw-page-title-main">Femoral neck</span>

The femoral neck is a flattened pyramidal process of bone, connecting the femoral head with the femoral shaft, and forming with the latter a wide angle opening medialward.

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<span class="mw-page-title-main">Unicompartmental knee arthroplasty</span>

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Minimally invasive hip resurfacing (MIS) is a total or partial hip surgery that can be carried out through an incision of less than 10 cm without imparting great forces on the anatomy or compromising component positioning.

Femoral neck targeting is the process of calculating the centre of the femoral neck during hip resurfacing surgery. This can be done by hand or using electronic aides.

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"Professor" Derek McMinn is a British orthopaedic surgeon and inventor who practised in Birmingham, United Kingdom at the BMI Edgbaston Hospital. McMinn developed one of the successful modern metal-on-metal hip resurfacing and the instrumentation and surgical technique to implant it. Hip resurfacing is a bone-conserving, less invasive alternative to total hip replacement (THR) for young patients, markedly improves the health-related quality of life measures and currently makes up around a twentieth of all hip arthroplasty procedures performed in the United Kingdom. McMinn is also the inventor of several other prostheses for the hip and knee.

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<span class="mw-page-title-main">William H. Harris (orthopaedic surgeon)</span> American orthopaedic surgeon

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References

  1. ↑ Koutras C, Antoniou SA, Talias MA, Heep H (19 May 2015). "Impact of Total Hip Resurfacing Arthroplasty on Health-Related Quality of Life Measures: A Systematic Review and Meta-Analysis". J Arthroplasty. 30 (11): 1938–52. doi:10.1016/j.arth.2015.05.014. PMID   26067708.
  2. ↑ Mont MA, Seyler TM, Ulrich SD, et al. (December 2007). "Effect of changing indications and techniques on total hip resurfacing". Clin. Orthop. Relat. Res. 465: 63–70. doi: 10.1097/BLO.0b013e318159dd60 . PMID   17891034. S2CID   30254202.
  3. 1 2 3 4 Mont MA, Ragland PS, Etienne G, Seyler TM, Schmalzried TP (August 2006). "Hip resurfacing arthroplasty". J Am Acad Orthop Surg. 14 (8): 454–63. doi:10.5435/00124635-200608000-00003. PMID   16885477. S2CID   12775356.
  4. ↑ "Metal-on-Metal Hip Implants". Food and Drug Administration. February 10, 2011. Retrieved January 4, 2012.
  5. ↑ "FDA seeks more advice on metal hip implants". Reuters. 29 March 2012. Retrieved 20 May 2012.
  6. ↑ "Orthopaedic and Rehabilitation Devices Panel of the Medical Devices Advisory Committee Meeting Announcement". Food and Drug Administration. 27 March 2012. FDA-2012-N-0293. Retrieved 20 May 2012.
  7. 1 2 FDA Executive Summary Memorandum - Metal-on-Metal Hip Implant System (PDF) (Report). Food and Drug Administration. 27 June 2012. Retrieved 15 March 2013.
  8. ↑ "Concerns about Metal-on-Metal Hip Implants". Food and Drug Administration. 17 January 2013. Retrieved 15 March 2013.
  9. ↑ 2018 Annual Report (Report). Australian Orthopaedic Associate National Joint Replacement Registry. 2018.
  10. ↑ Tavares S (November 2005). "Controversial topics in orthopaedics: the best bearing couple for hip arthroplasty". Ann R Coll Surg Engl. 87 (6): 411–418. doi:10.1308/003588405X71090. PMC   1964129 . PMID   16263007.
  11. ↑ De Haan R, Pattyn C, Gill HS, Murray DW, Campbell PA, De Smet K (October 2008). "Correlation between inclination of the acetabular component and metal ion levels in metal-on-metal hip resurfacing replacement". J Bone Joint Surg Br. 90 (10): 1291–7. doi: 10.1302/0301-620X.90B10.20533 . PMID   18827237.
  12. ↑ Resurfaced hips converted to THA show similar clinical results to primary total hips
  13. ↑ Outcome of Hip Resurfacing May be dependent on experience
  14. ↑ Metal-on-Metal Hip Resurfacing: The Effect of Component Position Archived 2011-07-07 at the Wayback Machine
  15. ↑ De Haan R, Campbell PA, Su EP, De Smet KA (September 2008). "Revision of metal-on-metal resurfacing arthroplasty of the hip: the influence of malpositioning of the components". J Bone Joint Surg Br. 90 (9): 1158–63. doi: 10.1302/0301-620X.90B9.19891 . PMID   18757954.
  16. ↑ "Results of Hip Resurfacing in patients under 55 years with osteoarthritis". Archived from the original on 2011-07-07. Retrieved 2010-09-04.
  17. ↑ Naal FD, Maffiuletti NA, Munzinger U, Hersche O (May 2007). "Sports after hip resurfacing arthroplasty". Am J Sports Med. 35 (5): 705–11. doi:10.1177/0363546506296606. PMID   17218652. S2CID   27937148.
  18. ↑ Barrack RL (September 2007). "Metal-metal hip resurfacing offers advantages over traditional arthroplasty in selected patients". Orthopedics. 30 (9): 725–6. doi:10.3928/01477447-20070901-16. PMID   17899914.
  19. 1 2 3 4 Amstutz HC, Le Duff MJ (July 2015). "Hip resurfacing: history, current status, and future". Hip Int. 25 (4): 330–338. doi:10.5301/hipint.5000268. PMID   26109156. S2CID   46689989.
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