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Survival and functional outcome of the Birmingham Hip Resurfacing system in patients aged 65 and older at up to ten years of follow-up

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Abstract

Purpose

Limited evidence exists regarding the outcomes of hip resurfacing in elderly patients. The primary study aims were to determine the survival and functional outcome following Birmingham Hip Resurfacing (BHR) in patients ≥65 years at up to ten years of follow-up. Secondary aims were to explore factors affecting survival and functional outcome.

Methods

Between 1997 and 2012, data were prospectively collected on 180 BHR (162 patients; mean age 69.2 years; 62 % male) implanted by one designing surgeon. Mean follow-up was six (range one to 14.4) years with no loss to follow-up. Outcomes of interest were implant survival, functional outcome [Oxford Hip Score (OHS)] and radiological evidence of implant failure.

Results

Three hips were revised, giving an overall cumulative survival of 96.4 % [95 % confidence interval (CI) 90.3–100] at ten years. Survival of 111 male BHR was 98.9 % (95 % CI 94.8–100) at ten years (one revision) compared with 91.9 % (95 % CI 77.0–100) in 69 female BHR (two revisions). Survival was affected by age (p = 0.014) and femoral head size (p = 0.024) but not by gender (p = 0.079). Median pre-operative OHS was 50.0 % [interquartile range (IQR) 37.5–68.8], improving to 4.4 % (IQR 0–10.4) postoperatively. Men had significantly better postoperative OHSs compared with women (median male OHS 2.1 % versus 6.3 % female OHS; p = 0.021).

Conclusions

Good survival and functional outcomes were achieved with the BHR at ten years in men and women ≥65 years. Despite registry findings to the contrary, age alone should not be a contraindication for hip resurfacing in centres with expertise in this procedure.

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References

  1. Treacy RB, McBryde CW, Shears E, Pynsent PB (2011) Birmingham hip resurfacing: a minimum follow-up of ten years. J Bone Joint Surg [Br] 93-B:27–33

    Article  Google Scholar 

  2. McMinn DJ, Daniel J, Ziaee H, Pradhan C (2011) Indications and results of hip resurfacing. Int Orthop 35:231–237

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Amstutz HC, Le Duff MJ, Campbell PA, Gruen TA, Wisk LE (2010) Clinical and radiographic results of metal-on-metal hip resurfacing with a minimum ten-year follow-up. J Bone Joint Surg Am 92-A:2663–2671

    Article  Google Scholar 

  4. Coulter G, Young DA, Dalziel RE, Shimmin AJ (2012) Birmingham hip resurfacing at a mean of ten years: results from an independent centre. J Bone Joint Surg [Br] 94-B:315–321

    Article  Google Scholar 

  5. Holland JP, Langton DJ, Hashmi M (2012) Ten-year clinical, radiological and metal ion analysis of the Birmingham Hip Resurfacing: from a single, non-designer surgeon. J Bone Joint Surg [Br] 94-B:471–476

    Article  Google Scholar 

  6. Murray DW, Grammatopoulos G, Pandit H, Gundle R, Gill HS, McLardy-Smith P (2012) The ten-year survival of the Birmingham hip resurfacing: an independent series. J Bone Joint Surg [Br] 94-B:1180–1186

    Article  Google Scholar 

  7. Myers GJ, Morgan D, McBryde CW, O’Dwyer K (2009) Does surgical approach influence component positioning with Birmingham Hip Resurfacing? Int Orthop 33:59–63

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Ollivere B, Duckett S, August A, Porteous M (2010) The Birmingham Hip Resurfacing: 5-year clinical and radiographic results from a District General Hospital. Int Orthop 34:631–634

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Reito A, Puolakka T, Pajamäki J (2011) Birmingham hip resurfacing: five to eight year results. Int Orthop 35:1119–1124

    Article  PubMed Central  PubMed  Google Scholar 

  10. Malek IA, Hashmi M, Holland JP (2011) Socio-economic impact of Birmingham hip resurfacing on patient employment after ten years. Int Orthop 35:1467–1470

    Article  PubMed Central  PubMed  Google Scholar 

  11. Schuh R, Neumann D, Rauf R, Hofstaetter J, Boehler N, Labek G (2012) Revision rate of Birmingham Hip Resurfacing arthroplasty: comparison of published literature and arthroplasty register data. Int Orthop 36:1349–1354

    Article  PubMed Central  PubMed  Google Scholar 

  12. Hing C, Back D, Shimmin A (2007) Hip resurfacing: indications, results, and conclusions. Instr Course Lect 56:171–178

    PubMed  Google Scholar 

  13. Nunley RM, Valle Della CJ, Barrack RL (2009) Is patient selection important for hip resurfacing? Clin Orthop Relat Res 467:56–65

    Article  PubMed Central  PubMed  Google Scholar 

  14. No authors listed (2012) National Joint Registry for England and Wales. 9th Annual Report.http://www.njrcentre.org.uk/NjrCentre/Portals/0/Documents/England/Reports/9th_annual_report/NJR%209th%20Annual%20Report%202012.pdf (date last accessed 12 November 2013)

  15. Garellick G, Kärrholm J, Rogmark C, Herberts P (2010) Swedish Hip Arthroplasty Register. Annual Report 2010. http://www.shpr.se/Libraries/Documents/AnnualReport-2010-2-eng.sflb.ashx (date last accessed 12 November 2013)

  16. Mont MA, Seyler TM, Ulrich SD et al (2007) Effect of changing indications and techniques on total hip resurfacing. Clin Orthop Relat Res 465:63–70

    PubMed  Google Scholar 

  17. Gross TP, Liu F (2012) Risk factor analysis for early femoral failure in metal-on-metal hip resurfacing arthroplasty: the effect of bone density and body mass index. J Orthop Surg Res 7:1

    Article  PubMed Central  PubMed  Google Scholar 

  18. Prosser GH, Yates PJ, Wood DJ, Graves SE, de Steiger RN, Miller LN (2010) Outcome of primary resurfacing hip replacement: evaluation of risk factors for early revision. Acta Orthop 81:66–71

    Article  PubMed Central  PubMed  Google Scholar 

  19. McGrath MS, Desser DR, Ulrich SD, Seyler TM, Marker DR, Mont MA (2008) Total hip resurfacing in patients who are sixty years of age or older. J Bone Joint Surg Am 90-A:27–31

    Article  Google Scholar 

  20. Carrothers AD, Gilbert RE, Richardson JB (2011) Birmingham hip resurfacing in patients who are seventy years of age or older. Hip Int 21:217–224

    Article  PubMed  Google Scholar 

  21. Le Duff MJ, Takamura KB, Amstutz HC (2012) Metal-on-metal hip resurfacing in patients aged 65 or older. Hip Int 22:648–654

    Article  PubMed  Google Scholar 

  22. Treacy RB, McBryde CW, Pynsent PB (2005) Birmingham hip resurfacing arthroplasty: a minimum follow-up of five years. J Bone Joint Surg [Br] 87-B:167–170

    Article  Google Scholar 

  23. Dawson J, Fitzpatrick R, Carr A, Murray D (1996) Questionnaire on the perceptions of patients about total hip replacement. J Bone Joint Surg [Br] 78-B:185–190

    Google Scholar 

  24. Pynsent PB, Adams DJ, Disney SP (2005) The Oxford hip and knee outcome questionnaires for arthroplasty. J Bone Joint Surg [Br] 87-B:241–248

    Article  Google Scholar 

  25. McBryde CW, Theivendran K, Thomas AM, Treacy RB, Pynsent PB (2010) The influence of head size and sex on the outcome of Birmingham hip resurfacing. J Bone Joint Surg Am 92-A:105–112

    Article  Google Scholar 

  26. Amstutz HC, Beaule PE, Dorey FJ, Le Duff MJ, Campbell PA, Gruen TA (2004) Metal-on-metal hybrid surface arthroplasty: two to six-year follow-up study. J Bone Joint Surg Am 86-A:28–39

    PubMed  Google Scholar 

  27. DeLee JG, Charnley J (1976) Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res 121:20–32

    PubMed  Google Scholar 

  28. Hing CB, Back DL, Bailey M et al (2007) Narrowing of the neck in resurfacing arthroplasty of the hip: a radiological study. J Bone Joint Surg [Br] 89-B:1019–1024

    Article  Google Scholar 

  29. Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr (1973) Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am 55-A:1629–1632

    Google Scholar 

  30. Gruen TA, Le Duff MJ, Wisk LE, Amstutz HC (2011) Prevalence and clinical relevance of radiographic signs of impingement in metal-on-metal hybrid hip resurfacing. J Bone Joint Surg Am 93-A:1519–1526

    Google Scholar 

  31. R Core Team (2013) R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna

    Google Scholar 

  32. No authors listed (2012) Medical and Healthcare products Regulatory Agency (MHRA). Medical Device Alert: All metal-on-metal (MoM) hip replacements. MDA/2012/036. http://www.mhra.gov.uk (date last accessed 12 November 2013)

  33. No authors listed (2003) Guidance in the selection of prostheses for primary total hip replacement. Technology appraisal guidance – No.2. National Institute for Health and Clinical Excellence. 6th January 2003. http://www.nice.org.uk (date last accessed 12 November 2013)

  34. Beaul’e PE, Dorey FJ, LeDuff M, Gruen T, Amstutz HC (2004) Risk factors affecting outcome of metal-on-metal surface arthroplasty of the hip. Clin Orthop Relat Res 418:87–93

    Article  Google Scholar 

  35. Marker DR, Seyler TM, Jinnah RH, Delanois RE, Ulrich SD, Mont MA (2007) Femoral neck fractures after metal-on-metal total hip resurfacing: a prospective cohort study. J Arthroplasty 22:66–71

    Article  PubMed  Google Scholar 

  36. Matharu GS, McBryde CW, Pynsent WB, Pynsent PB, Treacy RB (2013) The outcome of the Birmingham Hip Resurfacing in patients aged < 50 years up to 14 years post-operatively. Bone Joint J 95-B:1172–1177

    Article  CAS  PubMed  Google Scholar 

  37. McBryde CW, Shears E, O’Hara JN, Pynsent PB (2008) Metal-on-metal hip resurfacing in developmental dysplasia: a case–control study. J Bone Joint Surg [Br] 90-B:708–714

    Article  Google Scholar 

  38. Glyn-Jones S, Pandit H, Kwon YM, Doll H, Gill HS, Murray DW (2009) Risk factors for inflammatory pseudotumour formation following hip resurfacing. J Bone Joint Surg [Br] 91-B:1566–1574

    Article  Google Scholar 

  39. Nunley RM, Zhu J, Brooks PJ et al (2010) The learning curve for adopting hip resurfacing among hip specialists. Clin Orthop 468:382–391

    Article  PubMed Central  PubMed  Google Scholar 

  40. McMinn DJ, Snell KI, Daniel J, Treacy RB, Pynsent PB, Riley RD (2012) Mortality and implant revision rates of hip arthroplasty in patients with osteoarthritis: registry based cohort study. BMJ 344:e3319

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  41. Kendal AR, Prieto-Alhambra D, Arden NK, Carr A, Judge A (2013) Mortality rates at 10 years after metal-on-metal hip resurfacing compared with total hip replacement in England: retrospective cohort analysis of hospital episode statistics. BMJ 347:f6549

  42. Crowninshield RD, Rosenberg AG, Sporer SM (2006) Changing demographics of patients with total joint replacement. Clin Orthop Relat Res 443:266–272

    Article  PubMed  Google Scholar 

  43. Wylde V, Blom A, Dieppe P, Hewlett S, Learmonth I (2008) Return to sport after joint replacement. J Bone Joint Surg [Br] 90-B:920–923

    Article  Google Scholar 

  44. Jourdan C, Poiraudeau S, Descamps S et al (2012) Comparison of patient and surgeon expectations of total hip arthroplasty. PLoS ONE 7:e30195

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  45. Naal FD, Maffiuletti NA, Munzinger U, Hersche O (2007) Sports after hip resurfacing arthroplasty. Am J Sports Med 35:705–711

    Article  PubMed  Google Scholar 

  46. Langton DJ, Joyce TJ, Jameson SS et al (2011) Adverse reaction to metal debris following hip resurfacing: the influence of component type, orientation and volumetric wear. J Bone Joint Surg [Br] 93-B:164–171

    Article  Google Scholar 

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Acknowledgments

All work presented was carried out by the five listed authors.

Conflict of interest

The author or one or more of the authors have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this article. In addition, benefits have been or will be directed to a research fund, foundation, educational institution or other nonprofit organisation with which one or more of the authors are associated.

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Authors and Affiliations

  1. The Royal Orthopaedic Hospital, Birmingham, UK, B31 2AP

    Regis Pailhe, Gulraj S. Matharu, Akash Sharma, Paul B. Pynsent & Ronan B. Treacy

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  1. Regis Pailhe
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  2. Gulraj S. Matharu
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  3. Akash Sharma
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  4. Paul B. Pynsent
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  5. Ronan B. Treacy
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Correspondence to Gulraj S. Matharu.

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Pailhe, R., Matharu, G.S., Sharma, A. et al. Survival and functional outcome of the Birmingham Hip Resurfacing system in patients aged 65 and older at up to ten years of follow-up. International Orthopaedics (SICOT) 38, 1139–1145 (2014). https://doi.org/10.1007/s00264-013-2240-7

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