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Bone conservi ing hip arthrop plasty

Bone conserving hip arthroplasty

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onserviing hip   

arthropplasty

Apollo Medicine 2012 DecemberVolume 9, Number 4; pp. 290e291 Editorial

Bone conserving hip arthroplasty

Y. Kharbanda

Total hip arthroplasty has been an important surgical opera-tion in orthopaedics in the 20th century. After many trails,major advancement in Total Hip Arthroplasty was made bySir John Charnley in 1962, who introduced low frictionarthroplasty. This consists of a polyethylene cup and22.2 mm head, both components being fixed with methacry-late cement. In the following years there were many changesto this basic principle (model) of total hip arthroplasty.Patient education has become an important factor in improve-ment of function following total hip replacement. Improve-ment in bearing surfaces, introduction of bioactive surfaces,surgical approach and use of navigation have shownimproved results in short to mid-term follow-up.

Various studies have reported excellent to good outcomeof Charnley total hip arthroplasty. Short and mid termfollow-up have shown improved results in total hip arthro-plasty using improved bioactive surfaces for cement lessfixation. Alternate bearing surfaces (metal on metal,ceramic on ceramic) have shown lower wear rates. Intro-duction of highly X-linked polyethylene has overcomethe limitations of conventional polyethylene. Concept offemoral bone conservation1,2 and improvement in biome-chanical restoration of hip joint has led to resurgence ofresurfacing hip arthroplasty. This is particularly attractiveto young and active people.

Resurfacing hip arthroplasty provides near normalmechanics of the hip and allows patient to return back tohigh activity including sports. However, it is mandatory forsuccess of hip resurfacing arthroplasty that femoral head andneck are structurally intact. In cases of femoral osteonecrosis,theremaybeextensive cysts andheadof the femurmaybedefi-cient.When there is abnormal proximal femur anatomy, resur-facing operation may be difficult and there may be increaseincidence of complications. Early complications like fractureneck of femur and avascular necrosis due to damage to theblood supply of femoral head are the main concerns.6

Improved techniques in proper placement of implants andsurgical techniques has lowered incidence of these

Senior Consultant, Orthopedics, Indraprastha Apollo Hospitals, Sarita Viharemail: [email protected] � 2012, Indraprastha Medical Corporation Ltd. All rights reservedhttp://dx.doi.org/10.1016/j.apme.2012.10.005

complications.3,9 Improper seating of the implants remainsan issue where the femoral head is severely compromised.

Mid-head resection is a relatively new technique thatoffers an alternative to resurfacing hip arthroplasty for severedeficiency in femoral head secondary to avascular necrosis offemoral head, developmental disorders such as post slippedcapital femoral epiphysis, post Perthes disease.4,5,7

McMinn DJ et al8 have reported a retrospective reviewedcases of 164 patients (171 hips) who underwent reconstruc-tion with Birmingham Mid-Head Resection device between2003 & 2008. At a mean follow-up of 3.5 years (Range2e7.5 years). They have reported four revisions includingtwo femoral failures, giving 3.5 year survivorship of 97.4%& 98.7% with revision or reoperation for any reason &femoral failure as the end points, respectively. Other workershave also reported short-term follow-up of mid-Head resec-tion with excellent results. Results of resurfacing Hip Arthro-plasty in women is poor and therefore metal on metalresurfacing Arthroplasty is not recommended.9,10,11 Thereis also increase incidence of pseudotumors and thereforelong-term follow-up is required.

Mid-head resection may be useful for patients whoqualify for bone conserving procedure but have severefemoral head deficiency. To achieve appropriate results,patient selection is very important. Patients with severeosteoporosis and extensive damage to head and base ofneck should be excluded and conventional total hip arthro-plasty be considered in them. Concerns about metal ions inblood remains and therefore metal on metal hip arthroplastyis not recommended in females.

CONCLUSION

Short term results of this technique have shown excellentresults. There are no long term results of mid-head resectiontechnique available and its complications and survivalneeds to be ascertained.

, New Delhi 110076, India.

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Bone conserving hip arthroplasty Editorial 291

REFERENCES

1. Bose VC, Baruah BD. Resurfacing arthroplasty of the hip foravascular necrosis of the femoral head: a minimum follow-upof four tears. J Bone Joint Surg Br. 2010;92(7):922e928.

2. Daniel J, Pradhan C, Ziaee H, McMinn DJ. A clinicoradiologicstudy of the Birmingham mid-head resection device. Orthope-dics. 2009;31(12 suppl 2):124e128.

3. Daniel J, Pynsent PB, McMinn DJ. Metal-on-metal resurfac-ing of the hip in patients under the age of 55 years with oste-oarthritis. JBJS (Br). 2004;86:177e184.

4. Rahman Luftfur, Muirhead-Allwood Sarah K. The Birming-ham mid-head resection arthroplasty e minimum two yearclinical and radiological follow-up: an independent singlesurgeon series. Hip Int. 2011;21(03):356e360.

5. McMinn DJ, Daniel J, Ziaee H, Pradhan C. Results of the Bir-mingham hip resurfacing dysplasia component in severeacetabular insufficiency: a six- to 9.6-years follow-up.J Bone Joint Surg Br. 2008;90(6):715e723.

6. Mcminn DJ, Daniel J, Ziae H, Pradhan C. Indications andresults of hip resurfacing. Int Orthop. 2011;35:231e237.

7. McMinn DJ, Daniel J, Pradhan C, Ziaee H. Avascular necrosisin the young patients: a trilogy of arthroplasty options. Ortho-pedics. 2005;28(9):945e947.

8. McMinn DJ. Birmingham mid-head resection technique forcomplex deformity. In: McMinn DJ, ed. Modern Hip Resur-facing. London: Springer; 2009:301e318.

9. McMinn DJ, Pradhan C, Ziaee H, Daniel J. Is mid-head resec-tion a durable conservative option in the presence of poorfemoral bone quality and distorted anatomy? Clin OrthopRelat Res. 2011;469:1589e1597.

10. Murray DW, Grammatopoulos G, Pandit H, Gundle R,Gill HS, McLardy-Smith P. The ten year survival of the Bir-mingham hip resurfacing; an independent series. J Bone JointSurg Br. September 2012;94-B:1180e1186.

11. Sandiford NA, Muirhead-Allwood S, Skinner J, Kabir C.Early results of the Birmingham mid-head resection arthro-plasty. Surg Technol Int. 2009;18:195e200.

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