Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Symposium: Update on Hard-on-Hard Bearings in Hip Arthroplasty 18 articles

Articles

Aspirin Decreases Heterotopic Ossification After Hip Resurfacing

Ryan M. Nunley MD, Jinjun Zhu MD, PhD, John C. Clohisy MD, Robert L. Barrack MD

Heterotopic ossification (HO) is a concern for patients undergoing hip surgery, especially surface replacement arthroplasty (SRA) who tend to be younger, more active, and anticipate good motion. It is unclear, however, whether HO occurs more frequently after SRA than traditional total hip arthroplasty (THA) and whether aspirin influences the risk.

A Squeaky Reputation: The Problem May Be Design-dependent

Javad Parvizi MD, FRCS, Bahar Adeli BA, Justin C. Wong MD, Camilo Restrepo MD, Richard H. Rothman MD, PhD

Squeaking is reportedly a complication in patients having ceramic-on-ceramic total hip implants. The etiology remains unknown and multifactorial with recent studies suggesting a relationship between the audible squeak and implant design. When we evaluated our ceramic-on-ceramic cohort, we noticed squeaking primarily in patients receiving an acetabular system designed with an elevated titanium rim.

Is Mid-head Resection a Durable Conservative Option in the Presence of Poor Femoral Bone Quality and Distorted Anatomy?

Derek J. W. McMinn MD, FRCS, Chandra Pradhan FRCS, MCh(Orth), Hena Ziaee BSc(Hons), Joseph Daniel FRCS, MS(Orth)

High medium-term survivorship of hip resurfacing arthroplasty in young patients has led to its increased usage. To achieve high survival rates, selecting patients with appropriate proximal femoral morphology and bone quality is important. For patients with poor bone quality or abnormal morphology, the mid-head resection technique is an alternative, bone-conserving procedure but whether this technique results in acceptable complications and survival is unknown.

Intraoperative Radiographs for Placing Acetabular Components in Hip Resurfacing Arthroplasty

Thomas P. Gross MD, Fei Liu PhD, Lee Webb NP

Various clinical and biomechanical studies suggest certain acetabular positions may be associated with higher wear and failure rates in modern metal-on-metal hip resurfacing arthroplasties. However, there are no widely available, reliable, and cost-effective surgical techniques that ensure surgeons are able to place an acetabular component within the safe range of inclination angles after hip resurfacing surgeries.

Direct Anterior Approach for Hip Resurfacing: Surgical Technique and Complications

Stefan Kreuzer MD, Kevin Leffers BS, Suneel Kumar MD

The direct anterior approach (DAA) for hip resurfacing arthroplasty is a technically difficult approach but theoretically reduces the soft tissue trauma to the hip because it does not require muscle detachments from the bone. Furthermore, the patient is in the supine position facilitating fluoroscopy to control component placement. However, the complications associated with the learning curve and functional outcome scores are not well defined in the literature.

Early Markers of Nephrotoxicity in Patients With Metal-on-metal Hip Arthroplasty

Massimo Corradi MD, Joseph Daniel FRCS, Hena Ziaee BSc (Hons), Rossella Alinovi BSc, Antonio Mutti MD, Derek J. W. McMinn FRCS

Metal ions released from arthroplasty devices are largely cleared in urine, leading to high exposure in renal tissues. Validated early markers of renal damage are routinely used to monitor workers in heavy metal industries, and renal risk can be quantified in these industries. It is unclear if the ion levels in patients with metal-on-metal hips are sufficient to cause renal damage.

Survival of Hard-on-Hard Bearings in Total Hip Arthroplasty: A Systematic Review

Michael G. Zywiel MD, Siraj A. Sayeed MD, Aaron J. Johnson MD, Thomas P. Schmalzried MD, Michael A. Mont MD

Improvements in prosthetic materials, designs, and implant fixation for THA have led to bearing surface wear being the limitation of this technology. Hard-on-hard bearings promise decreased wear rates and increased survival. However, there may be different survival rates based on bearing materials, manufacturing technologies, and femoral component designs. Additionally, survival rate variability may be based on study design.

Is Resurfacing Arthroplasty Appropriate for Posttraumatic Osteoarthritis?

Aaron J. Johnson MD, Michael G. Zywiel MD, Uma I. Maduekwe MD, Fei Liu PhD, Michael A. Mont MD, Thomas P. Gross MD

High survival has been reported for resurfacing arthroplasty in patients with femoral deformities. Also, hardware removal may not always be necessary with resurfacing arthroplasty and may eliminate some of the difficulties performing total hip arthroplasty (THA) in patients with posttraumatic osteoarthritis.

Surgical Variables Influence Metal Ion Levels After Hip Resurfacing

Nicholas M. Desy MD, Stephane G. Bergeron MD, Alain Petit PhD, Olga L. Huk MD, MSc, John Antoniou MD, PhD

Metal-on-metal bearings in surface arthroplasty are associated with prolonged periods of elevated ion circulation. However, there exists some controversy regarding the effect of different surgical variables on the concentration of metal ions in whole blood of patients after hip resurfacing.

Femoral Head Size Does Not Affect Ion Values in Metal-on-Metal Total Hips

Mitchell Bernstein MD, Alan Walsh MD, Alain Petit PhD, David J. Zukor MD, John Antoniou MD, PhD

Metal-on-metal articulations can release substantial amounts of particles containing cobalt and chromium into the surrounding milieu, causing concern for cellular toxicity and adverse local soft tissue reactions. The diameter of the femoral head has been one of the variables that inversely affects wear of metal-on-metal total hip arthroplasty (THA). The oxidative stress of increased metal ions can be measured with serum markers. It is still controversial if larger femoral head diameters decrease wear rates in patients with metal-on-metal THA and if the increased metal ions alter the body’s antioxidant status.

Hip Resurfacing in Patients Who Have Osteonecrosis and are 25 Years or Under

Siraj A. Sayeed MD, Aaron J. Johnson MD, D. Alex Stroh BS, Thomas P. Gross MD, Michael A. Mont MD

Young patients with osteonecrosis (ON) treated with THA often have suboptimal function and radiographic failure with eventual revision. Resurfacing may be an option because of potentially increased functionality and decreased radiographic failure, although neither has been confirmed in the literature.

Are There Benefits to One- versus Two-stage Procedures in Bilateral Hip Resurfacing?

Harlan C. Amstutz MD, Edwin P. Su MD, Michel J. Duff MA, Vincent A. Fowble MD

Short-term studies report comparable complication rates of one-stage bilateral versus two-stage procedures in hip resurfacing, although the long-term effects of such procedures on survivorship, quality of life, and disease-specific scores are currently unknown.

Does Acetabular Inclination Angle Affect Survivorship of Alumina-ceramic Articulations?

Henning R. Johansson MD, Aaron J. Johnson MD, Michael G. Zywiel MD, Marybeth Naughton BS, Michael A. Mont MD, Peter M. Bonutti MD

Reports in the literature have linked high acetabular inclination angles to increased wear of ceramic-on-ceramic bearings. However, many of these studies were only conducted in vitro and did not address the clinical relevance of such findings.

Avoiding Short-term Femoral Neck Fracture With Imageless Computer Navigation for Hip Resurfacing

Michael Olsen PhD, Emil H. Schemitsch MD, FRCS(C)

Femoral neck fracture in hip resurfacing has been attributed to technical error during femoral head preparation. In the absence of fracture, several radiographic findings have been speculated to increase the risk of femoral component failure.

Does a Plastic Drape Reduce Incidence of Heterotopic Ossification After Hip Resurfacing?

John S. Shields MD, Ali Mofidi MB, BAO, BCh, M Med Sci, FRCS(Orth), William G. Ward MD, Riyaz H. Jinnah MD, FRCS

High rates of heterotopic ossification have been associated with hip resurfacing as compared to THA. Bone debris from femoral head reamings is cited as one of the risk factors linked to increased rates of heterotopic ossification.

Do Large Heads Enhance Stability and Restore Native Anatomy in Primary Total Hip Arthroplasty?

Adolph V. Lombardi MD, FACS, Michael D. Skeels DO, Keith R. Berend MD, Joanne B. Adams BFA, Orlando J. Franchi MD

Dislocation remains a serious complication in hip arthroplasty. Resurfacing proponents tout anatomic femoral head restoration as an advantage over total hip arthroplasty. However, advances in bearings have expanded prosthetic head options from traditional sizes of 22, 26, 28, and 32 mm to diameters as large as 60 mm. Large heads reportedly enhance stability owing to increased range of motion before impingement and increased jump distance to subluxation. Available larger diameter material combinations include metal- or ceramic-on-highly crosslinked polyethylene and metal-on-metal, each with distinct advantages and disadvantages.