Is Mid-head Resection a Durable Conservative Option in the Presence of Poor Femoral Bone Quality and Distorted Anatomy?
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
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.
We therefore assessed (1) implant survivorship of a mid-head resection device during short- and medium-term followup, (2) hip function, (3) adverse radiographic features emphasizing proximal stress shielding, and (4) complications.
We retrospectively reviewed 164 patients (171 hips) who underwent reconstruction with the Birmingham Mid-Head Resection device (Smith and Nephew Orthopaedics Ltd, Warwick, UK) between 2003 and 2008. Patients were reviewed with hip outcome questionnaires, clinical examination, and radiographs. We report findings in 156 of these 171 hips with a minimum followup of 2 years (mean, 3.5 years, range, 2–7.5 years). They include three successive iterations based on the same design rationale.
There were four revisions during this period, including two femoral failures, giving 3.5-year survivorships of 97.4% and 98.7% with revision or reoperation for any reason and femoral failure as the end points, respectively. No patient is currently awaiting revision. Average hip function was 98%, as assessed by Oxford hip score. Five of the 87 intermediate-iteration (V1) stems showed proximal femoral stress shielding, a phenomenon not observed in the other two iterations. Four patients had asymptomatic below-knee deep venous thrombosis and one had nonfatal pulmonary embolism, all of which resolved uneventfully.
The mid-head resection technique can circumvent the need for a more invasive procedure such as standard THA in patients who would benefit from a conservative arthroplasty but do not possess good femoral head bone quality or morphology.
Level of Evidence
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
- Amstutz HC, Beaulé PE, Dorey FJ, Le Duff MJ, Campbell PA, Gruen TA. Metal-on-metal hybrid surface arthroplasty: two to six-year follow-up study. J Bone Joint Surg Am. 2004;86:28–39.
- Daniel J, McBryde C, Pradhan C, Ziaee H. Results of Birmingham Hip Resurfacing in different diagnoses. In: McMinn DJ, ed. Modern Hip Resurfacing. London, UK: Springer; 2009:357–370. CrossRef
- Daniel J, Pradhan A, Pradhan C, Ziaee H, Moss M, Freeman J, McMinn DJ. Multimodal thromboprophylaxis following primary hip arthroplasty: the role of adjuvant intermittent pneumatic calf compression. J Bone Joint Surg Br. 2008;90:562–569. CrossRef
- Daniel J, Pradhan C, Ziaee H. Patient selection and timing of operation. In: McMinn DJ, ed. Modern Hip Resurfacing. London, UK: Springer; 2009:163–167. CrossRef
- Daniel J, Pradhan C, Ziaee H, McMinn DJ. Management of complex anatomy. In: McMinn DJ, ed. Modern Hip Resurfacing. London, UK: Springer; 2009:333–348. CrossRef
- Daniel J, Pynsent PB, McMinn DJ. Metal-on-metal resurfacing of the hip in patients under the age of 55 years with osteoarthritis. J Bone Joint Surg Br. 2004;86:177–184. CrossRef
- Dawson J, Fitzpatrick R, Carr A, Murray D. Questionnaire on the perceptions of patients about total hip replacement. J Bone Joint Surg Br. 1996;78:185–190.
- Ender SA, Machner A, Pap G, Hubbe J, Grashoff H, Neumann HW. Cementless CUT femoral neck prosthesis: increased rate of aseptic loosening after 5 years. Acta Orthop. 2007;78:616–621. CrossRef
- Hayaishi Y, Miki H, Nishii T, Hananouchi T, Yoshikawa H, Sugano N. Proximal femoral bone mineral density after resurfacing total hip arthroplasty and after standard stem-type cementless total hip arthroplasty, both having similar neck preservation and the same articulation type. J Arthroplasty. 2007;22:1208–1213. CrossRef
- Learmonth ID. Conservative stems in total hip replacement. Hip Int. 2009;19:195–200.
- McMinn D, Daniel J. History and modern concepts in surface replacement. Proc Inst Mech Eng H. 2006;220:239–251.
- McMinn DJ. Acetabular preparation and insertion of the standard Birmingham Hip Resurfacing cup. In: McMinn DJ, ed. Modern Hip Resurfacing. London, UK: Springer; 2009:223–264. CrossRef
- McMinn DJ, Daniel J, Pradhan C, Ziaee H. Avascular necrosis in the young patient: a trilogy of arthroplasty options. Orthopedics. 2005;28:945–947.
- McMinn DJ, Daniel J, Pynsent PB, Pradhan C. Mini-incision resurfacing arthroplasty of hip through the posterior approach. Clin Orthop Relat Res. 2005;441:91–98. CrossRef
- McMinn DJ, Daniel J, Ziaee H, Pradhan C. Mid-Head Resection Technique for complex deformity: European experience. Tech Orthop. 2010;25:33–38. CrossRef
- McMinn DJ, Daniel J, Ziaee H, Pradhan C. Posterior surgical approach for hip resurfacing arthroplasty. Tech Orthop. 2010;25:56–66. CrossRef
- McMinn DJ. Daniel J, Ziaee H, Pradhan C. Hip resurfacing. In: Bentley G, ed. European Instructional Lectures. EFORT II. Volume 10. London, UK: Springer; 2010:133–142.
- Mont MA, Schmalzried TP, Zywiel MG, McGrath MS, Seyler TM. Perceptions concerning hip resurfacing from attendees at the Second Annual U.S. Comprehensive Course on Total Hip Resurfacing Arthroplasty. Bull NYU Hosp Jt Dis. 2009;67:102–107.
- Morrey BF, Adams RA, Kessler M. A conservative femoral replacement for total hip arthroplasty: a prospective study. J Bone Joint Surg Br. 2000;82:952–958. CrossRef
- Nunley RM, Della Valle CJ, Barrack RL. Is patient selection important for hip resurfacing? Clin Orthop Relat Res. 2009;467:56–65. CrossRef
- Pradhan C, Daniel J, Ziaee H. Complications and revisions of the Birmingham Hip Resurfacing. In: McMinn DJ, ed. Modern Hip Resurfacing. London, UK: Springer; 2009:371–384. CrossRef
- Schmalzried TP. Total resurfacing for osteonecrosis of the hip. Clin Orthop Relat Res. 2004;429:151–156. CrossRef
- Schmalzried TP, Silva M, de la Rosa MA, Choi ES, Fowble VA. Optimizing patient selection and outcomes with total hip resurfacing. Clin Orthop Relat Res. 2005;441:200–204. CrossRef
- Treacy RB, McBryde CW, Pynsent PB. Birmingham Hip Resurfacing arthroplasty: a minimum follow-up of five years. J Bone Joint Surg Br. 2005;87:167–170. CrossRef
- Is Mid-head Resection a Durable Conservative Option in the Presence of Poor Femoral Bone Quality and Distorted Anatomy?
Clinical Orthopaedics and Related Research®
Volume 469, Issue 6 , pp 1589-1597
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors