Causes of early failure in a multicenter clinical trial of hip resurfacing.

The purpose of this study was to evaluate the clinical outcomes and possible causes of early failure in a multicenter trial of metal-on-metal hip resurfacing. Two hundred patients were prospectively enrolled and followed for an average of 31.2 months (range, 12-54 months). Of 200 patients, 14 (7.0%) required revision surgery at a mean time of 19.5 months (range, 3-47 months). Patients with failures were significantly younger and heavier than the nonfailures, and all were male. Patients who were revised did not differ from those who were not revised in terms of radiographic outcomes, but they did report lower functional outcome scores at all preoperative and postoperative testing intervals. Most failures (10/14) were related to early acetabular loosening. The learning curve was likely a factor in these cup failures. This report highlights the importance of patient selection and surgical technique in hip resurfacing arthroplasty. It is anticipated that further surgical experience will lead to a reduction in this high early failure rate.

[1]  H. Amstutz,et al.  Treatment of primary osteoarthritis of the hip. A comparison of total joint and surface replacement arthroplasty. , 1984, The Journal of bone and joint surgery. American volume.

[2]  P B Pynsent,et al.  Metal-on-metal resurfacing of the hip in patients under the age of 55 years with osteoarthritis. , 2004, The Journal of bone and joint surgery. British volume.

[3]  E. Salvati,et al.  Early results and complications of surface replacement of the hip. , 1982, The Journal of bone and joint surgery. American volume.

[4]  S. Vowler,et al.  Hydroxyapatite-coated femoral implant in metal-on-metal resurfacing hip arthroplasty: minimum of two years follow-up. , 2005, The Orthopedic clinics of North America.

[5]  Reinhold Ganz,et al.  Surgical dislocation of the adult hip , 2001 .

[6]  P B Pynsent,et al.  Birmingham hip resurfacing arthroplasty. A minimum follow-up of five years. , 2005, The Journal of bone and joint surgery. British volume.

[7]  M J Dunbar,et al.  The Porous Coated Anatomic Total Hip Replacement: A Ten to Fourteen-Year Follow-up Study of a Cementless Total Hip Arthroplasty , 2001, The Journal of bone and joint surgery. American volume.

[8]  A. Lombardi,et al.  Metal-on-Metal Total Hip Arthroplasty with Large Heads May Prevent Early Dislocation , 2005, Clinical orthopaedics and related research.

[9]  M. L. Le Duff,et al.  Metal-on-metal hip resurfacing for obese patients. , 2007, The Journal of bone and joint surgery. American volume.

[10]  M. L. Le Duff,et al.  Early results of conversion of a failed femoral component in hip resurfacing arthroplasty. , 2007, The Journal of bone and joint surgery. American volume.

[11]  D. Wirtz,et al.  [Durom hip resurfacing arthroplasty: first clinical experiences with a lateral approach]. , 2007, Zeitschrift fur Orthopadie und Unfallchirurgie.

[12]  W. Head,et al.  Wagner surface replacement arthroplasty of the hip. Analysis of fourteen failures in forty-one hips. , 1981, The Journal of bone and joint surgery. American volume.

[13]  K. D. De Smet.  Belgium experience with metal-on-metal surface arthroplasty. , 2005, The Orthopedic clinics of North America.

[14]  D. Wirtz,et al.  Durom™-Hip-Oberflächenersatz am Hüftgelenk: Erste klinische Ergebnisse mit dem lateralen Zugang , 2007 .

[15]  Koen De Smet,et al.  Belgium experience with metal-on-metal surface arthroplasty. , 2005 .

[16]  P. Beaulé,et al.  The value of patient activity level in the outcome of total hip arthroplasty. , 2006, The Journal of arthroplasty.

[17]  P. Campbell,et al.  An unusual lymphocytic perivascular infiltration in tissues around contemporary metal-on-metal joint replacements. , 2005, The Journal of bone and joint surgery. American volume.

[18]  M. Lavigne,et al.  A Prospective Randomized Clinical Trial Comparing Metal-On-Metal Total Hip Arthroplasty and Metal-On-Metal Total Hip Resurfacing in Patients Less than 65 Years Old , 2006, Hip international : the journal of clinical and experimental research on hip pathology and therapy.

[19]  W. Walter,et al.  Hip resurfacing arthroplasty: the Australian experience. , 2007, The Journal of arthroplasty.

[20]  P. Campbell,et al.  Metal-on-metal hybrid surface arthroplasty: two to six-year follow-up study. , 2004, The Journal of bone and joint surgery. American volume.

[21]  P. Beaulé,et al.  Prevention and Treatment of Dislocation after Total Hip Replacement Using Large Diameter Balls , 2004, Clinical orthopaedics and related research.

[22]  V. Goldberg,et al.  Effect of Changing Indications and Techniques on Total Hip Resurfacing , 2007, Clinical orthopaedics and related research.

[23]  A Shimmin,et al.  Early results of primary Birmingham hip resurfacings. An independent prospective study of the first 230 hips. , 2005, The Journal of bone and joint surgery. British volume.

[24]  P. Beaulé,et al.  Risk Factors Affecting Outcome of Metal-on-Metal Surface Arthroplasty of the Hip , 2004, Clinical orthopaedics and related research.

[25]  J Schatzker,et al.  A study of implant failure in the Wagner resurfacing arthroplasty. , 1985, The Journal of bone and joint surgery. American volume.

[26]  W. Harris,et al.  Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. , 1969, The Journal of bone and joint surgery. American volume.

[27]  J. Callaghan,et al.  The porous-coated anatomic total hip prosthesis, inserted without cement. A prospective study with a minimum of ten years of follow-up. , 1999, The Journal of bone and joint surgery. American volume.