OBSERVATION OF EFFECTIVENESS OF HIP RESURFACING ARTHROPLASTY IN TREATMENT OF OSTEONECROSIS OF FEMORAL HEAD IN YOUNG AND MIDDLE-AGED PATIENTS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YUYinxian ¹ , YIChengqing ¹ , MAJinzhong ¹ ,  WANGQiugen ²

1. Department of Orthopaedic Surgery, Shanghai General Hospital of Nanjing Medical University, Shanghai, 200080, P. R. China;
2. Trauma Center, Shanghai General Hospital of Nanjing Medical University, Shanghai, 200080, P. R. China;

Corresponding author：

WANGQiugen, Email: wangqiugen@163.com

Keywords：

Hip; Osteonecrosis of the femoral head; Hip resurfacing arthroplasty; Metal-on-metal

DOI：

10.7507/1002-1892.20160027

Video：

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Objective To evaluate the clinical and radiographic outcomes of hip resurfacing arthroplasty (HRA) for treating osteonecrosis of the femoral head (ONFH) in young and middle-aged patients. Methods Between January 2008 and April 2009, 34 patients with ONFH underwent HRA. There were 19 males and 15 females with an average age of 54 years (range, 33-59 years). Of 34 cases, 16 left hips and 18 right hips were involved, including 9 cases of alcoholinduced ONFH, 8 cases of steroid-induced ONFH, 7 cases of traumatic ONFH, and 10 cases of unexplained ONFH. According to modified Ficat classification system, 26 hips were rated as stage III, and 8 hips as stage IV. The Harris hip score (HHS) and modified University of California, Los Angeles (UCLA) activity score were used to evaluate the clinical results. Migration of prosthesis was assessed on the anteroposterior radiographs. The abduction angle was measured on the acetabular side. On the femoral side, varus-valgus shift was determined by measurement of stem-shaft angle. The axial collapse of femoral component was assessed with the component-lateral cortex ratio. Results Healing of incision by first intention was achieved in all patients without complications of infection and thrombosis of deep vein of lower extremities. Thirty-two patients were followed up 78 months on average (range, 70-84 months). No implant loosening, infection, femoral neck fracture, dislocation, and inflammatory pseudotumor were observed. At last follow-up, the HHS score was significantly increased to 95.22±1.47 from preoperative 50.10±2.27 (t=1.510, P=0.008). Modified UCLA activity score was significantly increased to 7.70±1.13 from preoperative 3.90±0.90 (t=0.830, P=0.003). The abduction angle, stemshaft angle, and compotent-lateral cortex ratio showed no significant difference between at 3 days after operation and last follow-up (P>0.05). Conclusion If the indication of operation is mastered strictly, HRA may be effective in treatment for ONFH at Ficat stage III or IV in young and middle-aged patients.

Citation： YUYinxian, YIChengqing, MAJinzhong, WANGQiugen. OBSERVATION OF EFFECTIVENESS OF HIP RESURFACING ARTHROPLASTY IN TREATMENT OF OSTEONECROSIS OF FEMORAL HEAD IN YOUNG AND MIDDLE-AGED PATIENTS. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(2): 133-137. doi: 10.7507/1002-1892.20160027 Copy

1.	Azam MQ, McMahon S, Hawdon G, et al. Survivorship and clinical outcome of Birmingham hip resurfacing:a minimum ten years' follow-up. Int Orthop, 2015.[Epub ahead of print].
2.	Imbuldeniya A, Munir S, Chow J, et al. Factors affecting squeaking in metal on metal hip resurfacings. Hip Int, 2014, 24(4):340-346.
3.	Savarino L, Cadossi M, Chiarello E, et al. How do metal ion levels change over time in hip resurfacing patients? A cohort study. ScientificWorldJournal, 2014, 2014:291925.
4.	Reito A, Puolakka T, Elo P, et al. Outcome of Birmingham hip resurfacing at ten years:role of routine whole blood metal ion measurements in screening for pseudotumours. Int Orthop, 2014, 38(11):2251-2257.
5.	Bisschop R, Boomsma MF, Van Raay JJ, et al. High prevalence of pseudotumors in patients with a Birmingham Hip Resurfacing prosthesis:a prospective cohort study of one hundred and twenty-nine patients. J Bone Joint Surg (Am), 2013, 95(17):1554-1560.
6.	Sandiford NA, Ahmed S, Doctor C, et al. Patient satisfaction and clinical results at a mean eight years following BHR arthroplasty:results from a district general hospital. Hip Int, 2014, 24(3):249-255.
7.	Pailhe R, Matharu GS, Sharma A, et al. Survival and functional outcome of the Birmingham Hip Resurfacing system in patients aged 65 and older at up to ten years of follow-up. Int Orthop, 2014, 38(6):1139-1145.
8.	Daniel J, Pradhan C, Ziaee H, et al. Results of Birmingham hip resurfacing at 12 to 15 years:a single-surgeon series. Bone Joint J, 2014, 96-B(10):1298-1306.
9.	毛远青, 徐嘉炜, 张经纬, 等. 髋关节表面置换术治疗髋关节发育不良的临床疗效. 中华骨科杂志, 2014, 34(12):1198-1204.
10.	Krantz N, Miletic B, Migaud H, 等. 全髋关节表面置换在30岁以下病人中的应用:对于年轻而活跃的病人是非常有吸引力的治疗方案. 中国矫形外科杂志, 2013, 21(3):298.
11.	Matharu GS, McBryde CW, Pynsent WB, et al. The outcome of the Birmingham Hip Resurfacing in patients aged < 50 years up to 14 years post-operatively. Bone Joint J, 2013, 95-B(9):1172-1177.
12.	Yoo MC, Cho YJ, Kim KI, et al. Resurfacing arthroplasty in osteonecrosis of the femoral head-minimum 3 years follow-up. J Bone Joint Surg (Br), 2010, 92-B(Suppl I):145.
13.	Revell MP, McBryde CW, Bhatnagar S, et al. Metal-on-metal hip resurfacing in osteonecrosis of the femoral head. J Bone Joint Surg (Am), 2006, 88 Suppl 3:98-103.
14.	Chun YS, Yoo MC, Cho YJ, et al. Hip resurfacing arthroplasty for osteonecrosis of the femoral head-lessons after 5 to 11-years of experience. J Bone Joint Surg (Br), 2012, 94-B(Suppl VIII):38.
15.	Daniel J, Pradhan C, Ziaee H, et al. Survival of Birmingham hip resurfacing in patients with femoral head osteonecrosis. J Bone Joint Surg (Br), 2012, 94-B(Suppl IV):7.
16.	Bose VC, Baruah BD. Resurfacing arthroplasty of the hip for avascular necrosis of the femoral head:a minimum follow-up of four years. J Bone Joint Surg (Br), 2010, 92(7):922-928.
17.	Kohan L, Field C, Kerr D, et al. Femoral neck remodelling after hip resurfacing surgery:a radiological study. ANZ J Surg, 2014, 84(9):639-642.
18.	Wang W, Geller JA, Hasija R, et al. Longitudinal evaluation of time related femoral neck narrowing after metal-on-metal hip resurfacing. World J Orthop, 2013, 4(2):75-79.
19.	Robinson PG, Wilkinson AJ, Meek RM. Metal ion levels and revision rates in metal-on-metal hip resurfacing arthroplasty:a comparative study. Hip Int, 2014, 24(2):123-128.
20.	Junnila M, Seppänen M, Mokka J, et al. Adverse reaction to metal debris after Birmingham hip resurfacing arthroplasty. Acta Orthop, 2015, 86(3):345-350.
21.	Langton DJ, Sidaqinamale RP, Joyce TH, et al. The clinical implications of elevated blood metal ion concentrations in asymptomatic patients with MoM hip resurfacings:a cohort study. BMJ Open, 2013, 3(3):pii:e001541.
22.	Van Der Straeten C, Van Quickenborne D, De Roest B, et al. Metal ion levels from well-functioning Birmingham Hip Resurfacings decline significantly at ten years. Bone Joint J, 2013, 95-B(10):1332-1338.
23.	Seppänen M, Mäkelä K, Virolainen P, et al. Hip resurfacing arthroplasty:short-term survivorship of 4,401 hips from the Finnish Arthroplasty Register. Acta Orthop, 2012, 83(3):207-213.
24.	Matharu GS, Berryman F, Brash L, et al. Influence of implant design on blood metal ion concentrations in metal-on-metal total hip replacement patients. Int Orthop, 2015, 39(9):1803-1811.
25.	王聪, 马金忠. 全髋关节表面置换术术前评估及患者选择的重要性. 中华关节外科杂志(电子版), 2010, 4(2):272-276.

1. Azam MQ, McMahon S, Hawdon G, et al. Survivorship and clinical outcome of Birmingham hip resurfacing:a minimum ten years' follow-up. Int Orthop, 2015.[Epub ahead of print].
2. Imbuldeniya A, Munir S, Chow J, et al. Factors affecting squeaking in metal on metal hip resurfacings. Hip Int, 2014, 24(4):340-346.
3. Savarino L, Cadossi M, Chiarello E, et al. How do metal ion levels change over time in hip resurfacing patients? A cohort study. ScientificWorldJournal, 2014, 2014:291925.
4. Reito A, Puolakka T, Elo P, et al. Outcome of Birmingham hip resurfacing at ten years:role of routine whole blood metal ion measurements in screening for pseudotumours. Int Orthop, 2014, 38(11):2251-2257.
5. Bisschop R, Boomsma MF, Van Raay JJ, et al. High prevalence of pseudotumors in patients with a Birmingham Hip Resurfacing prosthesis:a prospective cohort study of one hundred and twenty-nine patients. J Bone Joint Surg (Am), 2013, 95(17):1554-1560.
6. Sandiford NA, Ahmed S, Doctor C, et al. Patient satisfaction and clinical results at a mean eight years following BHR arthroplasty:results from a district general hospital. Hip Int, 2014, 24(3):249-255.
7. Pailhe R, Matharu GS, Sharma A, et al. Survival and functional outcome of the Birmingham Hip Resurfacing system in patients aged 65 and older at up to ten years of follow-up. Int Orthop, 2014, 38(6):1139-1145.
8. Daniel J, Pradhan C, Ziaee H, et al. Results of Birmingham hip resurfacing at 12 to 15 years:a single-surgeon series. Bone Joint J, 2014, 96-B(10):1298-1306.
9. 毛远青, 徐嘉炜, 张经纬, 等. 髋关节表面置换术治疗髋关节发育不良的临床疗效. 中华骨科杂志, 2014, 34(12):1198-1204.
10. Krantz N, Miletic B, Migaud H, 等. 全髋关节表面置换在30岁以下病人中的应用:对于年轻而活跃的病人是非常有吸引力的治疗方案. 中国矫形外科杂志, 2013, 21(3):298.
11. Matharu GS, McBryde CW, Pynsent WB, et al. The outcome of the Birmingham Hip Resurfacing in patients aged < 50 years up to 14 years post-operatively. Bone Joint J, 2013, 95-B(9):1172-1177.
12. Yoo MC, Cho YJ, Kim KI, et al. Resurfacing arthroplasty in osteonecrosis of the femoral head-minimum 3 years follow-up. J Bone Joint Surg (Br), 2010, 92-B(Suppl I):145.
13. Revell MP, McBryde CW, Bhatnagar S, et al. Metal-on-metal hip resurfacing in osteonecrosis of the femoral head. J Bone Joint Surg (Am), 2006, 88 Suppl 3:98-103.
14. Chun YS, Yoo MC, Cho YJ, et al. Hip resurfacing arthroplasty for osteonecrosis of the femoral head-lessons after 5 to 11-years of experience. J Bone Joint Surg (Br), 2012, 94-B(Suppl VIII):38.
15. Daniel J, Pradhan C, Ziaee H, et al. Survival of Birmingham hip resurfacing in patients with femoral head osteonecrosis. J Bone Joint Surg (Br), 2012, 94-B(Suppl IV):7.
16. Bose VC, Baruah BD. Resurfacing arthroplasty of the hip for avascular necrosis of the femoral head:a minimum follow-up of four years. J Bone Joint Surg (Br), 2010, 92(7):922-928.
17. Kohan L, Field C, Kerr D, et al. Femoral neck remodelling after hip resurfacing surgery:a radiological study. ANZ J Surg, 2014, 84(9):639-642.
18. Wang W, Geller JA, Hasija R, et al. Longitudinal evaluation of time related femoral neck narrowing after metal-on-metal hip resurfacing. World J Orthop, 2013, 4(2):75-79.
19. Robinson PG, Wilkinson AJ, Meek RM. Metal ion levels and revision rates in metal-on-metal hip resurfacing arthroplasty:a comparative study. Hip Int, 2014, 24(2):123-128.
20. Junnila M, Seppänen M, Mokka J, et al. Adverse reaction to metal debris after Birmingham hip resurfacing arthroplasty. Acta Orthop, 2015, 86(3):345-350.
21. Langton DJ, Sidaqinamale RP, Joyce TH, et al. The clinical implications of elevated blood metal ion concentrations in asymptomatic patients with MoM hip resurfacings:a cohort study. BMJ Open, 2013, 3(3):pii:e001541.
22. Van Der Straeten C, Van Quickenborne D, De Roest B, et al. Metal ion levels from well-functioning Birmingham Hip Resurfacings decline significantly at ten years. Bone Joint J, 2013, 95-B(10):1332-1338.
23. Seppänen M, Mäkelä K, Virolainen P, et al. Hip resurfacing arthroplasty:short-term survivorship of 4,401 hips from the Finnish Arthroplasty Register. Acta Orthop, 2012, 83(3):207-213.
24. Matharu GS, Berryman F, Brash L, et al. Influence of implant design on blood metal ion concentrations in metal-on-metal total hip replacement patients. Int Orthop, 2015, 39(9):1803-1811.
25. 王聪, 马金忠. 全髋关节表面置换术术前评估及患者选择的重要性. 中华关节外科杂志(电子版), 2010, 4(2):272-276.

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Chinese Journal of Reparative and Reconstructive Surgery

OBSERVATION OF EFFECTIVENESS OF HIP RESURFACING ARTHROPLASTY IN TREATMENT OF OSTEONECROSIS OF FEMORAL HEAD IN YOUNG AND MIDDLE-AGED PATIENTS

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