Comparison of functional results of hip resurfacing and total hip replacement: a review of the literature

Total hip arthroplasty (THA) results in good outcomes in function and risk for revision in older patients. However, in young, active patients, it results in an increased rate of revision and poorer outcomes. Modern metal-on-metal hip resurfacing arthroplasty (HRA) is described as an appropriate treatment of hip osteoarthritis in young, active patients. The selection of an appropriate prosthesis is critical for this patient demographic. This review compares the functional results of THA and HRA and focuses on range of motion, activity level, groin pain, patient satisfaction, restoration of normal hip anatomy, and gait.     

Bipolar versus total hip arthroplasty for hip osteonecrosis in the same patient

The authors studied 28 patients with bilateral avascular necrosis of the femoral head who were treated with a cementless bipolar endoprosthesis in one hip and cementless total hip arthroplasty in the other. All the hips selected for bipolar endoprostheses were classified as having avascular necrosis of the femoral head Ficat Stage III, and all the hips selected for total hip arthroplasty were classified as having Ficat Stage IV avascular necrosis. After a midterm followup of an average of 6.4 years (range, 4-12 years), 24 of 28 hips that received bipolar endoprostheses were considered satisfactory, whereas 23 of 28 hips in which an arthroplasty was done were considered satisfactory. After a followup of more than 6 years, the cartilaginous space of the acetabulum could be preserved in 25 hips (89.3%) that received a bipolar endoprosthesis. There were no statistical differences in both groups in terms of clinical result, thigh pain, groin pain, osteolysis, dislocation, and revision rate. Total hip arthroplasty is not the preferred treatment for all patients with hip osteonecrosis. In young patients with Ficat Stage III osteonecrosis with Grade 0 or Grade I cartilage, the use of a cementless bipolar endoprosthesis with a bone ingrowth stem may be considered as an alternative to total hip arthroplasty.     

Survival analysis of T-28 hip arthroplasty with clinical implications

Seventeen years after its introduction, the T-28 and its successor (the TR-28) have proved to be a successful arthroplasty system, with very low long-term socket and femoral loosening rates, especially in older patients. The 10-year revision rate for aseptic loosening of the socket is only 2 per cent. This form of conventional cemented total hip replacement has provided pain relief and improved function in many individuals who have exhausted nonoperative treatment alternatives. Although there are still unsolved long-term problems for the young active patients, cemented hip arthroplasty continues to play an important role in joint replacement, and remains the treatment of choice in older and relatively inactive patients.     

Hip arthrodesis: a procedure for the new millennium?

Advanced hip arthrosis in the young patient represents a difficult problem. Using currently available techniques, total hip arthroplasty (THA) in this patient population likely would result in multiple revision surgeries, usually at the expense of bone in the proximal femur and acetabulum. For noninflammatory, monoarticular hip arthritis, arthrodesis remains an excellent reconstruction option. Arthrodesis can provide pain relief and return to function in the majority of patients indicated for the procedure. Current techniques provide acceptable fusion rates. If possible, techniques that protect the abductor mechanism and limit deformity of the pelvis should be used. Patient education is an important part of the treatment process. The position of the limb is important to early satisfaction and durability of the fusion. Long-term difficulties after hip fusion are related to pain in contiguous joints. Conversion arthroplasty, if necessary, can result in favorable outcomes. Familiarity with the techniques and outcomes of hip arthrodesis are important for the hip surgeon to understand.     

Management of Ficat stage III and IV osteonecrosis of the hip

Management of Ficat stage III and IV osteonecrosis of the hip remains controversial. Because patients usually require a surgical intervention in their mid 30s, the initial procedure is often the first step in a lifelong treatment plan. Long-term results of total hip arthroplasty in these young, active patients have been disappointing. New alternative bearing surfaces (metal-on-metal, ceramic-on-ceramic, and highly cross-linked polyethylene) and improved methods of fixation may lead to better long-term results. Nevertheless, bone- and joint-preserving procedures, such as free-vascularized fibular graft, trapdoor grafting, redirectional osteotomy, or hemiresurfacing hip arthroplasty, should be considered. The choice of option depends on patient age, the cause of osteonecrosis, the extent of femoral head involvement, and the condition of the acetabular articular cartilage. The goals of treatment are to relieve pain, improve function, minimize morbidity, and maintain options for secondary procedures.     

Metal on metal hip resurfacing versus uncemented custom total hip replacement - early results

Introduction  

There is no current consensus on the most appropriate prosthesis for treating symptomatic osteoarthritis (OA) of the hip in young, active patients. Modern metal on metal hip resurfacing arthroplasty (HR) has gained popularity as it is theoretically more stable, bone conserving and easier to revise than total hip arthroplasty. Early results of metal on metal resurfacing have been encouraging. We have compared two well matched cohorts of patients with regard to function, pain relief and patient satisfaction.     

Bipolar hip arthroplasty in ankylosing spondylitis

Nineteen severely affected hips in 12 young patients with ankylosing spondylitis were treated with bipolar hip arthroplasty followed by a comprehensive postoperative rehabilitation programme. Additional operative procedures of adductor tenotomy, knee flexion release, supracondylar femoral osteotomy for genu valgum and tendo Achillis lengthening for equinus contracture were required in 13 limbs. After a mean follow-up of 45.8 months, results were good in all cases with respect to relief from pain, and there was significant improvement in posture and function. All the patients resumed employment. The average gain in sum total range of hip movements was 194 deg, and the mean preoperative Harris hip score of 27.8 improved to 82.6 after bipolar arthroplasty. Ectopic ossification did not develop in any case. Bipolar hip arthroplasty appears to be ideally suited for young patients with ankylosing spondylitis.     

Isolated varus intertrochanteric osteotomy for hip dysplasia in 52 patients: long-term results

Great strides have been made in the field of total hip arthroplasty, but the issue of wear and osteolysis continue to be a problem, mostly for young adults. For this population varus rotational osteotomy still remains a viable alternative to total hip arthroplasty. The purpose of this prospective study was to describe the indications, the technique and the functional outcome of an isolated varus femoral osteotomy in 52 patients with hip dysplasia. We obtained very good results with a significant improvement of hip function and pain relief. We conclude that with appropriate selection of the patient the procedure may prevent or postpone the development of secondary osteoarthritis.     

Oberflächenersatz bei Hüftkopfnekrose

Osteonecrosis of the femoral head is a disease of the young patient which eventually destroys the hip joint. In the early stage of the disease, treatment options are aimed at preserving the femoral head. Unfortunately, many patients present with late-stage disease (Ficat III and IV).In late-stage disease the treatment of choice is total hip arthroplasty. The high failure rate of total hip arthroplasty in young patients with osteonecrosis of the femoral head, however, made it an unfavourable treatment option. The results of hemiresurfacing (femoral resurfacing) in this patient population have been very disappointing due to high revision rates and insufficient pain relief. More recently, promising short- and mid-term results were reported with the use of total resurfacing with a survivorship of 90-93% after 3.4-10 years. Our own results in 60 patients show an overall survivorship of 92% after a mean follow-up of 4.8 years (1.6-6.5 years). Total hip resurfacing is a valuable treatment option for late-stage osteonecrosis based on recent study results.     

全髋和半髋置换治疗老年股骨颈骨折的比较研究

目的比较半髋关节置换与全髋关节置换治疗老年移位股骨颈骨折的安全性及有效性差异。方法1999年2月至2007年1月在我院行髋关节置换的老年移位股骨颈骨折（GardenⅢ、Ⅳ型）患者共133例,其中全髋关节置换78例,半髋关节置换55例。收集病例资料并进行随访,随访内容包括安全性评估指标及有效性评估指标,具体为术后并发症、术后疼痛率、翻修率及术后髋关节功能评分,统计学分析两种术式的安全性及有效性有无差异。结果8例失访,7例在随访过程中死亡,118例完成随访,随访时间2～10年,平均5．1年。全髋置换组术后并发症发生率高于半髋置换组,翻修率低于半髋置换组,但均无统计学差异;全髋置换组术后疼痛率低于半髋置换组,有统计学差异;术后髋关节功能评分高于半髋置换组,有显著统计学差异。结论全髋关节置换术的安全性和有效性均高于半髋关节置换术,应为首选措施。     

Septic arthritis of the hip after percutaneous femoral artery catheterization

Infection of the hip joint can cause severe articular damage. Standard treatment of septic arthritis includes surgical débridement and intravenous antibiotics. Options for definitive management in the presence of joint destruction include excision arthroplasty, arthrodesis, and total hip arthroplasty. Two cases of septic arthritis of the hip as a complication of femoral artery cannulation are presented. These cases highlight a potential complication that may not be readily appreciated by clinicians who routinely perform femoral vascular cannulation. After all evidence of ongoing infection had disappeared, both cases ultimately were treated with total hip arthroplasty. Both patients have improved function and pain at 2.5 and 5 years of follow-up. Given the frequency with which femoral intravascular catheters are used in numerous procedures, methods of avoiding infection of the hip joint must be implemented. These 2 cases emphasize the potential risks of these procedures and show management with total hip arthroplasty.     

Comparison between bipolar hemiarthroplasty and THA for osteonecrosis of the femoral head

It is controversial whether bipolar hemiarthroplasty or total hip arthroplasty should be done for Ficat Stage III osteonecrosis of the femoral head. A prospective comparative study was done using the same cementless femoral components for both procedures. Forty cementless bipolar hemiarthroplasties and 31 cementless total hip arthroplasties were done in 54 patients with Ficat Stage III osteonecrosis of the femoral head. Age, gender, and followup were matched between patients having bipolar hemiarthroplasty and total hip arthroplasty. Treatment with total hip arthroplasty increased the total hip score more than treatment with bipolar hemiarthroplasty. The final pain score especially showed a significant difference between patients who had a bipolar hemiarthroplasty (5.5) and patients who had a total hip arthroplasty (5.9). Thigh pain occurred in four patients (four hips) from the bipolar hemiarthroplasty group and in six patients (six hips) from the total hip arthroplasty group. In the bipolar hemiarthroplasty group, gluteal pain occurred in six patients (six hips, 15%) and groin pain occurred in eight patients (eight hips, 20%). Dislocation occurred in two hips (two patients) in each group. The outer head migrated superiorly in nine hips (nine patients) (23%) from the bipolar hemiarthroplasty group. Because of the incidence of gluteal and groin pain and migration, total hip arthroplasty is a better procedure than bipolar hemiarthroplasty for patients with Ficat Stage III osteonecrosis of the femoral head.     

Conversion of a fused hip to total hip arthroplasty

BACKGROUND: Arthrodesis of the hip remains a viable treatment for severe unilateral arthritis after traumatic injury or infection in a young but otherwise healthy individual. The goal of the present study was to review the long-term clinical and radiographic results after conversion of a fused hip to a total hip arthroplasty and to identify the risk factors that would lead to a higher rate of failure. METHODS: We performed a retrospective review of the charts and radiographs of 187 patients (208 hips) who had conversion of a fused hip to a total hip arthroplasty. The mean duration of follow-up after the conversion to total hip arthroplasty was 9.2 years (range, two to twenty-six years). RESULTS: The mean age at time of the arthroplasty was fifty-one years. The mean time-interval between the arthrodesis and the conversion to a total hip arthroplasty was twenty-seven years. According to the information in the charts, at a mean duration of follow-up of 9.2 years after the total hip arthroplasty, 79% of hips were either pain-free or had minimal pain, 83% had good-to-excellent function, and 79% had good-to-excellent range of motion. Complications, which included fifteen nerve palsies, occurred in twenty-four hips. Twenty-eight hips had heterotopic ossification, but it was not associated with a recurrence of ankylosis or a marked reduction of motion. Revision arthroplasty was performed in twelve hips. The probability of survival of the implant was 96.1% (95% confidence interval, 91.5% to 98.2%) at ten years, 89.9% (95% confidence interval, 85.3% to 96.1%) at fifteen years, and 72.8% (95% confidence interval, 36% to 90.6%) at twenty-six years. CONCLUSIONS: Conversion of a fused hip to a total hip arthroplasty has a favorable outcome. However, the technically demanding nature of the procedure should not be underestimated. Patients should be cautioned with regard to the possibility of a higher rate of complications than that seen with primary total hip arthroplasty.     

Functional outcome of hip fusion in the young patient. Follow-up study of 10 patients

In the young patient, an osteoarthritic or osteonecrotic hip presents a challenging therapeutic problem. Until the long-term results of noncemented total hip arthroplasty are known, hip fusion provides an option to cemented total hip arthroplasty in the young patient with hip disease. The authors describe the outcome of hip fusion in 10 patients with an average follow-up period of 8.5 years. Seventy percent of the patients had a good or very good result with pain relief, and 90% or more had a good or excellent functional result with support aids, ambulation, and climbing stairs. All 10 patients were subjectively satisfied with their hip fusion. A lower incidence of pain in the contralateral hip, ipsilateral knee, and lower back was noted at 8.5 years than that reported at long-term follow-up evaluation and was associated with a satisfactory anatomic position of hip arthrodesis.     

Results of total hip and total knee arthroplasties in patients with synovial chondromatosis

This retrospective analysis examines the outcome of total joint arthroplasty for severe arthritis in patients with synovial chondromatosis. All 11 patients treated with total hip arthroplasty (n = 7) or total knee arthroplasty (n = 4) returned for follow-up at a mean of 10.8 years after surgery. Pain and functional scores improved significantly in all patients. Knee range of motion improved in all patients. Synovial chondromatosis recurred in 1 knee (25%) and 1 hip (14%). Total joint arthroplasty is a valuable treatment option for these patients with predictable improvement in pain and function. Knee range of motion is likely to improve but may be less than expected for primary total knee arthroplasty. Patients remain at risk for recurrence.     

Chiari pelvic osteotomy for advanced osteoarthritis in patients with hip dysplasia

BACKGROUND: It is not clear whether a Chiari pelvic osteotomy performed for the treatment of advanced osteoarthritis can delay the need for total hip arthroplasty. We present the mid-term results of the Chiari pelvic osteotomy performed for the treatment of T?nnis grade-3 osteoarthritis (large cysts, severe narrowing of the joint space, or severe deformity or necrosis of the head with extensive osteophyte formation), with a particular focus on whether this procedure can delay the need for total hip arthroplasty. METHODS: We followed thirty-two hips in thirty-one patients with T?nnis grade-3 osteoarthritis who had refused total hip arthroplasty and had been treated with a Chiari pelvic osteotomy. The mean age at the time of surgery was 35.2 years. The mean duration of follow-up was 11.2 years, at which time clinical evaluation with the Harris hip score and radiographic evaluation were performed. RESULTS: The average Harris hip score improved from 52 points preoperatively to 77 points at the time of follow-up; the average pain score improved from 20 to 31 points. Three hips with a hip score of <70 points required total hip arthroplasty. With a hip score of <70 points as the end point, the cumulative rate of survival at ten years was 72%. The clinical outcome was significantly influenced by the preoperative center-edge angle (p = 0.004), the preoperative acetabular head index (p = 0.039), achievement of the appropriate osteotomy level (p = 0.011), and superior migration (p = 0.009) and lateral migration (p = 0.026) of the femoral head. CONCLUSIONS: Although the clinical results were inferior to those of total hip arthroplasty, Chiari pelvic osteotomy may be an option for young patients with advanced osteoarthritis who prefer a joint-conserving procedure to total hip arthroplasty and accept a clinical outcome that is predicted to be less optimal than that of total hip arthroplasty. Moderate dysplasia and moderate subluxation without complete obliteration of the joint space and a preoperative center-edge angle of at least -10 degrees are desirable selection criteria.     

Cortical strut grafting for enigmatic thigh pain following total hip arthroplasty

Enigmatic thigh pain remains a difficult problem to treat after total hip arthroplasty. This article reports on the use of strut cortical allografting for the treatment of recalcitrant enigmatic thigh pain following total hip arthroplasty in patients with a well-fixed cemented or cementless femoral component.     

Coxarthrosis after traumatic hip dislocation in the adult

Sixteen percent of patients with uncomplicated hip dislocations have posttraumatic arthritis develop. Incidences as high as 88% are reported for patients with dislocations associated with severe acetabular fractures. The surgical treatment of patients with posttraumatic arthritis includes arthroscopy, arthrodesis, osteotomy, and arthroplasty. Although arthroplasty offers the best solution for the painful arthritic hip in the older or inactive patient, the treatment of an active patient in the prime of life with severe osteoarthritis of the hip is problematic. In the younger, active patient, it may be prudent to consider alternative treatment in an attempt to avoid, or delay, total hip arthroplasty. Although improving the longevity of primary arthroplasty is desirable, measures to prevent or delay the onset of the osteoarthritis seem more appropriate. Arthroscopic lavage, debridement and chondral abrasion, and osteochondral fragment removal after dislocation may have a role in the treatment of young patients with the early stages of coxarthrosis. Any patient with isolated posttraumatic arthritis of the hip who has a life expectancy greater than 30 years may be a candidate for hip arthrodesis. The ideal candidates for hip arthrodesis are only laborers younger than 35 years of age. Osteotomy of the hip for posttraumatic arthritis remains an appealing alternative for many patients because of the long-term failures of total hip arthroplasty. The clinical results of osteotomy are variable and do not match the results of a total hip arthroplasty. However, primary arthroplasty may fail, and revision arthroplasty is routinely more difficult and shorter lived than the primary operation.     

Total hip arthroplasty in chronic unreduced hip fracture-dislocation

We treated 15 patients with chronic unreduced hip fracture-dislocations at our hospital; all patients sustained the fracture-dislocations in motor vehicle accidents. All presented to our institution more than 6 months after initial treatment at their local hospitals with uncontained femoral heads; all underwent 1-stage total hip arthroplasty with bone grafting. These patients were monitored for a mean of 71.5 months (range, 36-96 months). All patients had significantly decreased pain, increased function, and increased range-of-motion scores using the Merle d'Aubigné scoring system. All grafts showed radiographic evidence of union. There were 2 dislocations, 1 transient peroneal nerve palsy, and 1 superficial infection. Total hip arthroplasty is effective for relieving pain and restoring function in chronic unreduced hip fracture-dislocations.     

Treatment of displaced intracapsular hip fractures with total hip arthroplasty: comparison of primary arthroplasty with early salvage arthroplasty after failed internal fixation

BACKGROUND: Closed reduction and internal fixation is the preferred initial treatment for young active patients who sustain a displaced intracapsular hip fracture. However, there is a paucity of information on the outcome in patients in whom this procedure fails and who subsequently require revision to a total hip arthroplasty. The purpose of this study was to compare a group of patients with a displaced intracapsular fracture who required early salvage total hip arthroplasty following failure of internal fixation within the first year after fracture with a group treated with primary total joint replacement for treatment of the same type of fracture. METHODS: With use of a matched-pairs case-control design, a group of 107 patients, between the ages of sixty and eighty years, who required an early salvage total hip arthroplasty with cement following failed reduction and internal fixation of a displaced intracapsular hip fracture (Group I) was compared with an age and gender-matched group of patients who had undergone total hip arthroplasty with cement as the primary procedure for the treatment of such a fracture (Group II). RESULTS: During the first year after the arthroplasty, there were fifty-two early complications in thirty-nine patients in Group I and twenty-two complications in fourteen patients in Group II (p < 0.05). There were significantly more superficial infections and dislocations in Group I (p < 0.05). The rate of revision beyond one year was greater and the overall prosthetic survival rate at both five and ten years postoperatively was significantly worse in Group I (log-rank test, p < 0.05). The functional outcomes at one year and at the time of final follow-up were also significantly worse in Group I. CONCLUSIONS: Reduction and internal fixation will continue to be used as the primary treatment of displaced intracapsular fractures in many younger patients because of the benefits of preservation of the normal hip joint. However, patients should be counseled that if this method of treatment is unsuccessful and requires revision to a total hip arthroplasty with cement, the risk of early complications is higher and hip function may be poorer than if the arthroplasty had been performed as a primary procedure.