Is it Time for Cementless Hip Resurfacing?
- Julien Girard MD, PhD
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Metal-on-metal bearing with cemented femoral component and cementless acetabular fixation is the current standard in surface replacement arthroplasty (RSA) of the hip. Because of concerns about the long-term survivorship of cemented stems in conventional hip arthroplasty, it seems logical to achieve cementless fixation on the femoral side with RSA.
The goals of this review were to evaluate clinical and radiological data reported from previously published cementless RSA series. In addition, we intend to review author’s preliminary experience with Conserve Plus cementless devices specifically assessing the clinical outcomes, the complications rate, the survivorship, and the metallic ions levels measured in follow-up.
A references search was done with PubMed using the key words “cementless hip resurfacing”, “cementless hip resurfacing prosthesis”, and “femoral cementless hip resurfacing”. Additionally, the clinical outcomes, the complications rate, the survivorship, and the metallic ions levels were measured in 94 cementless Conserve Plus© devices in 90 patients (68 males and 22 females) with a mean age of 41.1 years (18–59). Mean follow-up was 13.1 months (8–16).
No revision was performed during the observed follow-up. Neither radiological signs of loosening nor neck narrowing >10% were evident. Chromium and cobalt levels in whole blood samples rose respectively from 0.53 μg/l (0.1–1.7) to 1.7 μg/l (0.6–2.9) and from 0.54 μg/l (0.1–1.4) to 1.98 μg/l (0.1–2.8).
Cementless “fit and fill” femoral-side fixation, which seems to be potentially evolved and design-related, should be considered for future hip-resurfacing device generations.
- Baker R, Whitehouse M, Kilshaw M, Pabbruwe M, Spencer R, Blom A, Bannister G. Maximum temperatures of 89 °C recorded during the mechanical preparation of 35 femoral heads for resurfacing. Acta Orthop. 2011; 82: 669–73 CrossRef
- Chandler HP, Reineck FT, Wixson RL, McCarthy JC. Total hip replacement in patients younger than thirty years old. A five-year follow-up study. J. Bone Joint Surg. Am. 1981; 63: 1426–34
- de Waal Malefijt MC, Huiskes R. A clinical, radiological and biomechanical study of the TARA hip prosthesis. Arch Orthop. Trauma Surg. 1993; 112: 205–20 CrossRef
- Fern ED, Norton MR. Is neck resorption a problem after hip resurfacing? Read at the 2007 Young Arthritic Hip Meeting, October 11–13, 2007, Vienna, Austria
- Girard J, Bocquet D, Autissier G, Fouilleron N, Migaud H. Metal-on-Metal hip arthroplasty in patients thirty years of age or younger. J. Bone Joint Surg. Am. 2010; 92: 2419–26 CrossRef
- Girard J, Glorion C, Bonnomet F, Fron D, Migaud H. Risk factors for revision of hip arthroplasties in patients younger than 30 years. Clin. Orthop. Relat. Res. 2011; 469: 1141–7 CrossRef
- Gross TP, Liu F. Is there added risk in resurfacing a femoral head with cysts? J. Orthop. Surg. Res. 2011; 17: 55–6 CrossRef
- Gross TP, Liu F. The first 100 fully porous-coated femoral components in hip resurfacing. Bull. N.Y.U. Hosp. Jt. Dis. 2011; 69: 30–5
- Gross TP, Liu F. Metal-on-metal hip resurfacing with an uncemented femoral component. A seven-year follow-up study. J. Bone Joint Surg. Am. 2008; 90: S32–7 CrossRef
- Gross TP. Variations and new designs. Uncemented heads. Read at the 4th Hip Resurfacing Course, June 16–19, 2010, Gand, Belgium
- Hing CB, Young DA, Dalziel RE, Bailey M, Back DL, Shimmin AJ. Narrowing of the neck in resurfacing arthroplasty of the hip: a radiological study. J. Bone Joint Surg. Br. 2007; 89: 1019–24
- Hull P, Baxter JA, Lewis C, Kordas G, Foguet P, Prakash U. Metal-on-metal hip resurfacing with uncemented fixation of the femoral component. A minimum 2 year follow up. Hip Int. 2011; 21: 475–8 CrossRef
- Johnson AJ, Zywiel MG, Hooper H, Mont MA. Narrowed indications improve outcomes for hip resurfacing arthroplasty. Bull. N.Y.U. Hosp. Jt. Dis. 2011; 69: 27–9
- Katrana P, Crawford JR, Vowler S, Lilikakis A, Villar RN. Femoral neck resorption after hip resurfacing arthroplasty—a comparison of cemented and uncemented prostheses. J. Bone Joint Surg. Br. 2006; 88: S234 CrossRef
- Lerch M, Olender G, Angrisani N, Rittershaus D, Meyer-Lindenberg A, Thorey F, Windhagen H, Hurschler C. The impact of seating forces from a cementless femoral component in hip resurfacing arthroplasty on the femoral head—a cadaver study using μ-CT analysis. Technol. Health Care 2011; 19: 29–36
- Lilikakis AK, Vowler SL, Villar RN. Hydroxyapatite-coated femoral implant in metal-on-metal resurfacing hip arthroplasty: minimum of two years follow-up. Orthop. Clin. North Am. 2005; 36: 215–22 CrossRef
- Little JP, Gray HA, Murray DW, Beard DJ, Gill HS. Thermal effects of cement mantle thickness for hip resurfacing. J. Arthroplasty 2008; 23: 454–8 CrossRef
- Lord GA, Hardy JR, Kummer FJ. An uncemented total hip replacement: experimental study and review of 300 madreporique arthroplasties. Clin. Orthop. Relat. Res. 1979; 141: 2–16
- Mazzullo S, Paolini M, Verdi C. Numerical simulation of thermal bone necrosis during cementation of femoral prostheses. J. Math. Biol. 1991 29: 475–94 CrossRef
- Migaud H, Putman S, Krantz N, Vasseur L, Girard J. Cementless metal-on-metal versus ceramic-on-polyethylene hip arthroplasty in patients less than 50 years of age: a comparative study at 12- to 14-year follow-up. J. Bone Joint Surg. Am. 2011; 93: 137–42 CrossRef
- Mjöberg B. Loosening of the cemented hip prosthesis. The importance of heat injury. Acta Orthop. Scand. 1986; 221:1–40
- Scheerlinck T, Delport H, Kiewitt T. Influence of the cementing technique on the cement mantle in hip resurfacing: an in vitro computed tomography scan-based analysis. J. Bone Joint Surg. Am. 2010; 92: 375–87 CrossRef
- Spencer RF. Evolution in hip resurfacing design and contemporary experience with an uncemented device. J. Bone Joint Surg. Am. 2011; 93: 84–8 CrossRef
- Spencer RF. Hip resurfacing, UK experience. Eighth Symposium on Joint Preserving and Minimally Invasive Surgery of the Hip, June 10–12, 2010, Ottawa, Canada
- Takamura KM, Yoon J, Ebramzadeh E, Campbell PA, Amstutz HC. Incidence and significance of femoral neck narrowing in the first 500 Conserve® Plus series of hip resurfacing cases: a clinical and histologic study. Orthop. Clin. North Am. 2011; 42: 181–93 CrossRef
- Villar R. BHR versus Cormet hip resurfacing masterclass. Read at the Hip Resurfacing Symposium, July 5–6, 2007, Oswestry, U.K.
- Wagner M, Wagner H. Preliminary results of uncemented metal on metal stemmed and resurfacing hip replacement arthroplasty. Clin. Orthop. Relat. Res.1996; 329: S78–88 CrossRef
- Watanabe Y, Shiba N, Matsuo S, Higuchi F, Tagawa Y, Inoue A. Biomechanical study of the resurfacing hip arthroplasty: finite element analysis of the femoral component. J. Arthroplasty 2000; 15: 505–11 CrossRef
- Is it Time for Cementless Hip Resurfacing?
HSS Journal ®
Volume 8, Issue 3 , pp 245-250
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- hip resurfacing
- cementless device
- bone necrosis
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- Julien Girard MD, PhD (1) (2)
- Author Affiliations
- 1. Department of Orthopaedic Surgery, Roger Salengro Hospital, University of Lille, 2 avenue Oscar Lambret, Lille, France
- 2. Department of Sports Medicine, University of Lille 2, Lille cedex, 59037, France