Carefully Selected Patients Can Benefit from Total Hip ResurfacingAlthough hip resurfacing has been available for a few decades, the high failure rate caused the procedure to be fall out of favor with many surgeons. However, with new techniques and understanding of the procedure following a meeting of specialists, the procedure is now considered an option for select patients.
The authors of this study wanted to evaluate if these changes improved patient outcomes and reduced complications. To do this, researchers compared the hip resurfacing results of 292 hips before the meeting and 724 after. The outcome of the meeting was a better understanding of the reasons for resurfacing failures, improved techniques, and how to choose the most ideal patients for the procedure.
The patients were evaluated before the surgery and immediately afterwards, between 1 to 6 weeks later. They were assessed again at 6 and 12 months after surgery, and then annually thereafter unless complications required treatment.
The researchers used the Harris hip score to evaluate the status of each hip - a score of 100 is the best score possible. Among the patients who had the surgery before the meeting, the average HHS was 93.1; for those after the meeting, it was 93.4. Breaking this down, among the patients in the before-meeting group, 74.7 percent were rated excellent, 12 percent rated good, 5.5 percent rated fair, and 3.8 percent rated poor. Four percent were not available. Among the after-meeting patients, 74,7 percent were rated excellent, 10.6 percent rated good, 3.9 percent rated Fair, and 3.7 percent rated poor. Just over 7 percent were missing.
The authors noted that patients in the before-meeting group had more revisions than the after-meeting group (13.4 percent vs. 2 percent, respectively). The before-meeting group also experienced more femoral fractures (7.2 percent vs. 0.8 percent), and more loosening (3.4 percent vs. 0.6 percent). This trend continued with pulmonary embolism (clot to the lungs), with the before-meeting group at 1 percent, the after-meeting group at 0.6 percent; the deep vein thrombosis (blood clots in the veins) rate was 2.7 percent in the before-meeting group and 2.2 percent in the after, and with death, 1.4 percent of the patients in the before group died and only 0.6 percent in the after group.
Looking at the results, the authors concluded that, despite the limitation of the short follow-up period, they demonstrated that the metal-on-metal hip resurfacing appears to be promising following the meeting with recommended procedure improvements.
Michael A. Mont, MD, et al. Effect of Changing Indications and Techniques on Total Hip Resurfacing. In Clinical Orthopaedic and Related Research. December 2007. Vol. 465. Pp. 63-70.
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