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Journal of Orthopaedic Surgery and Research

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Open Access 01-12-2017 | Research article

Metal-on-metal hip resurfacing in patients younger than 50 years: a retrospective analysis

1285 cases, 12-year survivorship

Authors: Melissa D. Gaillard, Thomas P. Gross

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2017

Abstract

Background

The Nordic registry reports patients under 50 years old with total hip replacements realize only 83% 10-year implant survivorship. These results do not meet the 95% 10-year survivorship guideline posed by the UK’s National Institute for Health and Care Excellence (NICE) in 2014.

Methods

The purpose of this study is threefold: First, we evaluate if metal-on-metal hip resurfacing arthroplasty meets these high standards in younger patients. Next, we compare outcomes between age groups to determine if younger patients are at higher risk for revision or complication. Lastly, we assess how outcomes between sexes changed over time. From January 2001 to August 2013, a single surgeon performed 1285 metal-on-metal hip resurfacings in patients younger than 50 years old. We compared these to an older cohort matched by sex and BMI.

Results

Kaplan-Meier implant survivorship was 96.5% at 10 years and 96.3% at 12 years; this did not differ from implant survivorship for older patients. Implant survivorship at 12 years was 98 and 93% for younger men and women, respectively; survivorship for women improved from 93 to 97% by using exclusively Biomet implants. There were four (0.3%) adverse wear-related failures, with no instances of wear or problematic ion levels since 2009. Activity scores improved from 5.4 ± 2.3 preoperatively to 7.6 ± 1.9 postoperatively (p < 0.0001), with 43% of patients reporting a UCLA activity score of 9 or 10.

Conclusions

Hip resurfacing exceeds the stricter 2014 NICE survivorship criteria independently in men and women even when performed on patients under 50 years old.

Amstutz HC, Beaule PE, Dorey FJ, Le Duff MJ, Campbell PA, Gruen TA. Metal-on-metal hybrid surface arthroplasty: two to six-year follow-up study. J Bone Jt Surg Am. 2004;86–A:28–39. doi:10.2106/JBJS.F.00273.CrossRef

Innmann MM, Weiss S, Andreas F, Merle C, Streit MR. Sports and physical activity after cementless total hip arthroplasty with a minimum follow-up of 10 years. Scand J Med Sci Sports. 2016;26:550–6. doi:10.1111/sms.12482.CrossRefPubMed

Ollivier M, Frey S. Does impact sport activity influence total hip arthroplasty durability? Clin Orthop Relat Res. 2012;470:3060–6. doi:10.1007/s11999-012-2362-z.CrossRefPubMedPubMedCentral

Havelin LI, Robertsson O, Fenstad AM, Overgaard S, Garellick G, Furnes O. A Scandinavian experience of register collaboration: the Nordic Arthroplasty Register Association (NARA). J Bone Jt Surg. 2011;93:13–9. doi:10.2106/JBJS.K.00951.CrossRef

Mäkelä KT, Matilainen M, Pulkkinen P, Fenstad AM, Havelin LI, Engesaeter L, et al. Countrywise results of total hip replacement. An analysis of 438,733 hips based on the Nordic Arthroplasty Register Association database. Acta Orthop. 2014;85:107–16. doi:10.3109/17453674.2014.893498.CrossRefPubMedPubMedCentral

Orthopaedic Data Evaluation Panel. http://www.odep.org.uk. Accessed 22 May 2017.

Charnley J. Arthroplasty of the hip—a new operation. Lancet. 1961;1:1129.CrossRefPubMed

Aldinger PR, Jung AW, Pritsch M, Breusch S, Thomsen M, Ewerbeck V, et al. Uncemented grit-blasted straight tapered titanium stems in patients younger than fifty-five years of age. Fifteen to twenty-year results. J Bone Jt Surg Am. 2009;91:1432–9. doi:10.2106/JBJS.H.00297.CrossRef

De Kam D. Total hip arthroplasties in young patients under 50 years: limited evidence for current trends. A descriptive literature review. Hip Int. 2011;21:518–25.CrossRefPubMed

10.

Baker RP, Pollard TCB, Eastaugh-Waring SJ, Bannister GC. A medium-term comparison of hybrid hip replacement and Birmingham hip resurfacing in active young patients. J Bone Jt Surg [Br]. 2011;93:158–63. doi:10.1302/0301-620X.93B2.CrossRef

11.

Sayeed SA, Johnson AJ, Bs DAS, Gross TP, Mont MA. Hip resurfacing in patients who have osteonecrosis and are 25 years or under. Clin Orthop Relat Res 2011:1582–8. doi:10.1007/s11999-010-1629-5

12.

Torchia ME, Klassen RA, Bianco AJ. Total hip arthroplasty with cement in patients less than twenty years old. J Bone Jt Surg. 1996;78:995–1003.CrossRef

13.

McMinn DJW, Treacy RBC, Lin K, Pynsent PB. Metal on metal surface replacement of the hip: experience of the McMinn prothesis. Clin Orthop Relat Res. 1996;329S:S89–98.CrossRef

14.

Amstutz HC. Treatment of primary osteoarthritis of the hip: a comparison of total joint and surface replacement arthroplasty. J Bone Jt Surg. 1984.

15.

Amstutz HC, Le Duff MJ. Hip resurfacing results for osteonecrosis are as good as for other etiologies at 2 to 12 years. Clin Orthop Relat Res. 2010;468:375–81. doi:10.1007/s11999-009-1077-2.CrossRefPubMed

16.

Beaulé PE. Surface arthroplasty of the hip: a review and current indications. Semin Arthroplasty. 2005;16:70–6. doi:10.1053/j.sart.2004.12.008.CrossRef

17.

Mont M a, Seyler TM, Marker DR, Marulanda G a, Delanois RE. Use of metal-on-metal total hip resurfacing for the treatment of osteonecrosis of the femoral head. J Bone Joint Surg Am 2006;88 Suppl 3:90–7. doi:10.2106/JBJS.F.00543.

18.

Aqil A, Drabu R, Bergmann JH, Masjedi M, Manning V, Andrews B, et al. The gait of patients with one resurfacing and one replacement hip: a single blinded controlled study. n.d. doi:10.1007/s00264-013-1819-3

19.

Mont MA, Seyler TM, Ragland PS, Starr R, Erhart J, Bhave A. Gait analysis of patients with resurfacing hip arthroplasty compared with hip osteoarthritis and standard total hip arthroplasty. n.d. doi:10.1016/j.arth.2006.03.010

20.

Gross TP, Liu F, Webb LA. Clinical outcome of the metal-on-metal hybrid Corin Cormet 2000 hip resurfacing system. An up to 11-year follow-up study. J Arthroplasty 2012;27:533–538.e1. doi:10.1016/j.arth.2011.06.019.

21.

Gross TP, Liu F. Current status of modern fully porous coated metal-on-metal hip resurfacing arthroplasty. J Arthroplast. 2014;29:181–5. doi:10.1016/j.arth.2013.04.010.CrossRef

22.

Howie DW. Metal-on-metal resurfacing versus total hip replacement-the value of a randomized clinical trial. Orthop Clin North Am. 2005;36:195. doi:10.1016/j.ocl.2004.12.001.

23.

Haddad FS, Konan S, Tahmassebi J. A prospective comparative study of cementless total hip arthroplasty and hip resurfacing in patients under the age of 55 years. Bone Jt J 2015;97–B:617–22. doi:10.1302/0301-620X.97B5.

24.

Mont MA, Schmalzried T. Modern metal-on-metal hip resurfacing: important observations from the first ten years. J Bone Jt Surg. 2008;90:3–11. doi:10.2106/JBJS.H.00750.CrossRef

25.

Barrack RL. Metal-on-metal hip resurfacing offers advantages over traditional arthroplasty in selected patients. Orthopedics. 2007;30.

26.

Prosser GH, Yates PJ, Wood DJ, Graves SE, De Steiger RN, Miller LN. Outcome of primary resurfacing hip replacement: evaluation of risk factors for early revision 12,093 replacements from the Australian Joint Registry. Acta Orthop. 2010;81:66–71. doi:10.3109/17453671003685434.CrossRefPubMedPubMedCentral

27.

Smith AJ, Dieppe P, Howard PW, Blom AW. Failure rates of metal-on-metal hip resurfacings: analysis of data from the National Joint Registry for England and Wales. Lancet. 2012;380:1759–66. doi:10.1016/S0140-6736(12)60989-1.CrossRefPubMed

28.

Williams S, Leslie I, Isaac G, Jin Z, Ingham E, Fisher J. Tribology and wear of metal-on-metal hip prostheses: influence of cup angle and head position. JBJSAm. 2008;90:111–7. doi:10.2106/JBJS.H.00485.CrossRef

29.

Malchau H, Herberts P, Eisler T, Gerllick G, Soderman P. The Swedish Total Hip Replacement Register. J Bone Jt Surg. 2004;86.

30.

Gaillard MD, Gross TP. Reducing the failure rate of hip resurfacing in dysplasia patients: a retrospective analysis of 363 cases. BMC Musculoskelet Disord. 2016;17:251. doi:10.1186/s12891-016-1095-7.CrossRefPubMedPubMedCentral

31.

O’Leary R, Gaillard MD, Gross TP. Comparison of cemented and bone ingrowth fixation methods in hip resurfacing for osteonecrosis. J Arthroplasty. 2016. doi:10.1016/j.arth.2016.07.028.

32.

Gross TP, Liu F. Minimally invasive posterior approach for hip resurfacing. Tech Orthop. 2010;25:39–49.CrossRef

33.

Liu F, Gross TP. A safe zone for acetabular component position in metal-on-metal hip resurfacing arthroplasty: winner of the 2012 HAP PAUL award. J Arthroplast. 2013;28:1224–30. doi:10.1016/j.arth.2013.02.033.CrossRef

34.

Langton DJ, Joyce TJ, Mangat N, Lord J, Van Orsouw M, De Smet K, et al. Reducing metal ion release following hip resurfacing arthroplasty. Orthop Clin North Am. 2011;42:169–80. doi:10.1016/j.ocl.2011.01.006. viii.CrossRefPubMed

35.

Smolders JMH, Bisseling P, Hol A, Van Der Straeten C, Schreurs BW, van Susante JLC. Metal ion interpretation in resurfacing versus conventional hip arthroplasty and in whole blood versus serum. How should we interpret metal ion data? Hip Int. 2011;21:587–95. doi:10.5301/HIP.2011.8643.CrossRefPubMed

36.

Van Der Straeten C. Systemic symptoms of metal toxicity in metal-on-metal hip arthroplasty. Palm Beach ISTA Meet. 2013.

37.

Harris W. Endosteal errosion in association with stable uncemented femoral components. J Bone Jt Surg. 1990.

38.

Zahiri CA, Schmalzried TP, Szuszczewicz ES, Amstutz HC. Assessing activity in joint replacement patients. J Arthroplast. 1998;13:890–5. doi:10.1016/S0883-5403(98)90195-4.CrossRef

39.

Scott J. Graphic representation of pain. Pain 1976;2. doi:10.1016/0304-3959(76)90113-5

40.

Gross TP, Liu F. Prevalence of dysplasia as the source of worse outcome in young female patients after hip resurfacing arthroplasty. Int Orthop. 2012;36:27–34. doi:10.1007/s00264-011-1290-y.CrossRefPubMed

41.

Jameson SS, Langton DJ, Natu S, Nargol TVF. The influence of age and sex on early clinical results after hip resurfacing. An independent center analysis. J Arthroplasty. 2008. doi:10.1016/j.arth.2008.03.019.PubMed

42.

Carrothers a D, Gilbert RE, Jaiswal a, Richardson JB. Birmingham hip resurfacing: the prevalence of failure. J Bone Joint Surg Br 2010. doi:10.1302/0301-620X.92B10.23504.

43.

Witzleb WC, Hanisch U, Ziegler J, Guenther K-P. In vivo wear rate of the Birmingham Hip Resurfacing arthroplasty: a review of 10 retrieved components. J Arthroplast. 2009;24:951–6. doi:10.1016/j.arth.2008.06.022.CrossRef

44.

Krantz N, Miletic B, Migaud H, Girard J. Hip resurfacing in patients under thirty years old: an attractive option for young and active patients. Int Orthop. 2012;36:1789–94. doi:10.1007/s00264-012-1555-0.CrossRefPubMedPubMedCentral

45.

Matharu, Uppal HS, Peterson BE, Misfeldt ML, Della Rocca GJ, Volgas DA, et al. The outcome of the Birmingham Hip Resurfacing in patients aged < 50 years up to 14 years post-operatively. Bone Jt J 2013. doi:10.1302/0301-620X.95B9.

46.

Facek M, Tilley S, Walter WK, Zicat B, Walter WL. Ceramic-on-ceramic bearings in young patients. Bone Jt J. 2013;95:1603–9. doi:10.1302/0301-620X.95B12.30917.

47.

Murphy S, Murphy W. Alumina ceramic ceramic THA at 15 years in patients less than 50. New Engl. Baptist Hosp. 2014;98-B(Suppl 3):69.

48.

Nunley RM, Zhu J, Brooks PJ, Engh CAJ, Raterman SJ, Rogerson JS, et al. The learning curve for adopting hip resurfacing among hip specialists. Clin Orthop Relat Res. 2010;468:382–91. doi:10.1007/s11999-009-1106-1.CrossRefPubMed

49.

Amstutz HC, Le Duff MJ. Eleven years of experience with metal-on-metal hybrid hip resurfacing: a review of 1000 conserve plus. J Arthroplasty. 2008;23(6 Suppl 1):36–43.

50.

Wamper KE, Sierevelt IN, Poolman RW, Bhandari M, Haverkamp D. The Harris hip score: do ceiling effects limit its usefulness in orthopedics? Acta Orthop. 2010;81:703–7. doi:10.3109/17453674.2010.537808.CrossRefPubMedPubMedCentral

51.

Jameson SS, Langton DJ, Natu S, Nargol TVF. The influence of age and sex on early clinical results after hip resurfacing. An independent center analysis. J Arthroplasty. 2008;23:50–5. doi:10.1016/j.arth.2008.03.019.CrossRefPubMed

52.

Woon RP, Johnson AJ, Amstutz HC. The results of metal-on-metal hip resurfacing in patients under 30 years of age. J Arthroplasty. 2013;28:1010–4. doi:10.1016/j.arth.2012.07.043.CrossRefPubMed

53.

Amstutz HC, Ball ST, Le Duff MJ, Dorey FJ. Resurfacing THA for patients younger than 50 year: results of 2- to 9-year followup. Clin Orthop Relat Res. 2007;460:159–64.PubMed

54.

Matharu GS, Mcbryde CW, Pynsent WB, Pynsent PB, Treacy RBC, Matharu GS. The outcome of the Birmingham Hip Resurfacing in patients aged < 50 years up to 14 years post-operatively. Bone Jt J. 2013;95:1172–7. doi:10.1302/0301-620X.95B9.CrossRef

55.

Wroblewski BM, Siney PD, Fleming PA. Charnley low-frictional torque arthroplasty in patients under the age of 51 years. J Bone Jt Surg. 2002;84–B:540–3.CrossRef

Title: Metal-on-metal hip resurfacing in patients younger than 50 years: a retrospective analysis
1285 cases, 12-year survivorship
Authors: Melissa D. Gaillard
Thomas P. Gross
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: Journal of Orthopaedic Surgery and Research / Issue 1/2017
Electronic ISSN: 1749-799X
DOI: https://doi.org/10.1186/s13018-017-0579-y

ACC 2024 Congress

Springer Medicine

Metal-on-metal hip resurfacing in patients younger than 50 years: a retrospective analysis

1285 cases, 12-year survivorship

Abstract

Background

Methods

Results

Conclusions

ACC 2024 Congress

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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