Mid-term Clinical and Radiographic Outcome of Metal-on-metal Hip Resurfacing Through an Anterolateral Approach

Overview

Journal Musculoskelet Surg

Date 2023 Jun 7

PMID 37285004

Authors

D Regis

G Lugani

A Valentini

A Sandri

C Ambrosini

F Bagnis

A Dorigotti

S Negri

B Magnan

Affiliations

Soon will be listed here.

Abstract

Purpose: The aim of this retrospective study was to evaluate the medium-term clinical and radiographic results of current generation metal-on-metal resurfacing prostheses performed through anterolateral approach.

Materials And Methods: Fifty-seven hips in 52 patients underwent resurfacing arthroplasty. Two patients died from unrelated causes, leaving 55 hips in 35 males (3 bilateral) and 15 females (2 bilateral), with a mean age at surgery of 56.2 years (range, 27-70 years). Clinical and radiographic assessment was carried out preoperatively and at follow-up in all the survived cases. The cumulative survival rate was determined according to the method of Kaplan-Meier.

Results: At a mean follow-up of 5.2 years (range, 1.8-9.1 years), 2 HRs of the same female patient were revised because of early loosening of the acetabular component. Deep venous thrombosis and transient femoral nerve palsy occurred both in 1 case. No specific complications of HR were observed. Average Harris hip score improved significantly from 59.8 points (range, 30.4-90.6) preoperatively to 93.7 points (range, 53-100) at the latest examination. Neck narrowing showed an average of 3.27%, but it never exceeded 10%. Nonprogressive acetabular radiolucencies and osteolysis were detected both in 2 hips. A high rate of patients (32, 60.4%) developed heterotopic ossifications, although low-grade in most cases (27, 84.4%). The cumulative survival rate at 9.1 years with revision for any reason as the end point was 93.0%.

Conclusions: The early clinical and radiographic results of modern metal-on-metal hip resurfacing performed through an anterolateral approach are promising, but longer-term follow-up studies are necessary.

Citing Articles

Anterior Minimally Invasive Approach (AMIS) for Total Hip Arthroplasty: Analysis of the First 1000 Consecutive Patients Operated at a High Volume Center.

Faldini C, Rossomando V, Brunello M, DAgostino C, Ruta F, Pilla F J Clin Med. 2024; 13(9).

PMID: 38731146 PMC: 11084447. DOI: 10.3390/jcm13092617.

References

Mont M, Schmalzried T . Modern metal-on-metal hip resurfacing: important observations from the first ten years. J Bone Joint Surg Am. 2008; 90 Suppl 3:3-11. DOI: 10.2106/JBJS.H.00750. View

Langton D, Jameson S, Joyce T, Hallab N, Natu S, Nargol A . Early failure of metal-on-metal bearings in hip resurfacing and large-diameter total hip replacement: A consequence of excess wear. J Bone Joint Surg Br. 2010; 92(1):38-46. DOI: 10.1302/0301-620X.92B1.22770. View

Clough E, Clough T . Metal on metal hip resurfacing arthroplasty: Where are we now?. J Orthop. 2021; 23:123-127. PMC: 7809170. DOI: 10.1016/j.jor.2020.12.036. View

de Steiger R, Hang J, Miller L, Graves S, Davidson D . Five-year results of the ASR XL Acetabular System and the ASR Hip Resurfacing System: an analysis from the Australian Orthopaedic Association National Joint Replacement Registry. J Bone Joint Surg Am. 2012; 93(24):2287-93. DOI: 10.2106/JBJS.J.01727. View

Naal F, Pilz R, Munzinger U, Hersche O, Leunig M . High revision rate at 5 years after hip resurfacing with the Durom implant. Clin Orthop Relat Res. 2011; 469(9):2598-604. PMC: 3148364. DOI: 10.1007/s11999-011-1792-3. View

Daniel J, Pradhan C, Ziaee H, Pynsent P, McMinn D . Results of Birmingham hip resurfacing at 12 to 15 years: a single-surgeon series. Bone Joint J. 2014; 96-B(10):1298-306. DOI: 10.1302/0301-620X.96B10.33695. View

Amstutz H, Le Duff M . Long-term results of metal-on-metal hip resurfacing in patients 65 years of age or older. Hip Int. 2020; 32(1):113-117. DOI: 10.1177/1120700020924642. View

Daniel J, Pynsent P, McMinn D . Metal-on-metal resurfacing of the hip in patients under the age of 55 years with osteoarthritis. J Bone Joint Surg Br. 2004; 86(2):177-84. DOI: 10.1302/0301-620x.86b2.14600. View

Matharu G, McBryde C, Pynsent W, Pynsent P, Treacy R . 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):1172-7. DOI: 10.1302/0301-620X.95B9.31711. View

10.

Woon R, Johnson A, Amstutz H . The results of metal-on-metal hip resurfacing in patients under 30 years of age. J Arthroplasty. 2013; 28(6):1010-4. DOI: 10.1016/j.arth.2012.07.043. View

11.

Steffen R, Smith S, Urban J, McLardy-Smith P, Beard D, Gill H . The effect of hip resurfacing on oxygen concentration in the femoral head. J Bone Joint Surg Br. 2005; 87(11):1468-74. DOI: 10.1302/0301-620X.87B11.16780. View

12.

Beaule P, Campbell P, Shim P . Femoral head blood flow during hip resurfacing. Clin Orthop Relat Res. 2006; 456:148-52. DOI: 10.1097/01.blo.0000238865.77109.af. View

13.

Khan A, Yates P, Lovering A, Bannister G, Spencer R . The effect of surgical approach on blood flow to the femoral head during resurfacing. J Bone Joint Surg Br. 2007; 89(1):21-5. DOI: 10.1302/0301-620X.89B1.18330. View

14.

Steffen R, ORourke K, Gill H, Murray D . The anterolateral approach leads to less disruption of the femoral head-neck blood supply than the posterior approach during hip resurfacing. J Bone Joint Surg Br. 2007; 89(10):1293-8. DOI: 10.1302/0301-620X.89B10.18974. View

15.

Amarasekera H, Costa M, Foguet P, Krikler S, Prakash U, Griffin D . The blood flow to the femoral head/neck junction during resurfacing arthroplasty: a comparison of two approaches using Laser Doppler flowmetry. J Bone Joint Surg Br. 2008; 90(4):442-5. DOI: 10.1302/0301-620X.90B4.20050. View

16.

Jacobs M, Goytia R, Bhargava T . Hip resurfacing through an anterolateral approach. Surgical description and early review. J Bone Joint Surg Am. 2008; 90 Suppl 3:38-44. DOI: 10.2106/JBJS.H.00684. View

17.

Benoit B, Gofton W, Beaule P . Hueter anterior approach for hip resurfacing: assessment of the learning curve. Orthop Clin North Am. 2009; 40(3):357-63. DOI: 10.1016/j.ocl.2009.02.002. View

18.

Steffen R, De Smet K, Murray D, Gill H . A modified posterior approach preserves femoral head oxgenation during hip resurfacing. J Arthroplasty. 2010; 26(3):404-8. DOI: 10.1016/j.arth.2009.12.018. View

19.

Amarasekera H, Campbell P, Parsons N, Achten J, Masters J, Griffin D . The effect of surgical approach on the histologyof the femoral head following resurfacing of the hip: Analysis of retrieval specimens. Bone Joint Res. 2013; 2(9):200-5. PMC: 3780557. DOI: 10.1302/2046-3758.29.2000179. View

20.

Sandri A, Regis D, Magnan B, Luminari E, Bartolozzi P . Hip resurfacing using the anterolateral Watson-Jones approach in the supine position. Orthopedics. 2009; 32(6):406. DOI: 10.3928/01477447-20090511-09. View