Total Hip Replacement vs Hip Resurfacing

Video- BIRMINGHAM HIP Resurfacing System vs. Traditional Total Hip Replacement Surgery

 

 

Total hip replacement bearing surfaces

  • Polyethylene (plastic)
    • Classical surface with longest track record
    • Ease of use in THA
    • Very forgiving with regards to implant alignment
    • Inferior RANGE OF MOTION
    • Transfusion rates – 4-46%!
  • Disadvantages
    • Wear and bone resorption
    • Does not allow for large head size because of plastic thickness inside metal shell

 

Potential benefits of HRA over THA in appropriate patients

  • Better ROM, activity, kinematics
  • Lower risk of DVT, PE, early mortality
  • Improved function and return to higher level activities with HRA vs.. THA
  • Lower dislocation rate of HRA vs.. THA
  • Better longevity in young active males
  • Better results of HRA vs.. MOM THA

 

Patient function – BHR vs THA

  • Haddad et. al. 2008 – measures of higher level hip function BHR vs.. THA
  • Prospective – 40 pts BHR – 40 pts in THA
  • Age, BMI matched
  • Patients scored 6 wks, 6 mos, 1 yr and 2 yrs
  • Balance, coordination, speed and directional
  • Balance test – timed single leg stance for 1 minute
  • Improvement by 6 weeks in BHR group; no difference preop to 6 weeks in THA group – quicker rate of improvement in BHR group
  • Balance & higher function test – timed step-ups(forward and lateral) onto 40cm (15″) block
  • Most immediate and sustained improvement in BHR group
  • BHR group improvements by 6 weeks
    BHR group maintained improvements throughout testing from 6 weeks to 2 years
  • Power, balance & coordination test – single leg hop test in meters
  • BHR group made immediate improvement compared to THA group

 

Hip Function: THA Vs HRA

  • Function for HRA system patients
  • 80 patients (40 HRA and 40 THA (OxZr or CoCr on XLPE)
  • Patients were scored at 6 weeks, 6 months, 1 year and 2 years
  • Balance, coordination, speed and directional change, VAS – pain
  • HRA patients made a quicker, more immediate and better sustained improvement than THA group from 6 weeks to 2 years

Total Hip Replacement

 

Prospective randomized trial comparing THR MoM heads and resurfacing in patients less than 65 years old

  • 132 Uncemented stem and cup
  • 103 Resurfacing
  • 3, 6 and 12 months follow up
  • WOMAC, Merle D’Aub, and UCLA
  • More RSA patients returned to heavy or moderate activities at 1 year post op
  • More RSA patients returned to work at one year post op
  • Statistically significant difference with UCLA at one year

 

Comparison patient reported outcomes between resurfacing and THR

  THR n214 HRA n=132
Before operation
Pain 34 39
Stiffness 36 37
Function 33 39
After operation
Pain 88 93
Stiffness 80 83
Function 80 85

 

Conventional hip replacement

 

X-ray of a failed total hip replacement

  • 63 year old male
  • 20 year old hip replacement
  • Plastic is completely worn out
  • Bone of pelvis and femur is “melted” away

 

Comparing the x-ray to the model

 

Putting him back together!

Total Hip Replacement

 

Hip arthritis surgery – hip resurfacing

Hip Arthritis

  • Developed in UK in 1993
  • FDA approved in the U.S. in 2006
  • “Bone conserving” hip replacement

 

Birmingham Hip™ Resurfacing (BHR) System

  • Named for Birmingham UK, where device created
  • Used globally since 1997
  • More than 100,000 implanted
  • Approved by the FDA in May 2006

 

Patient function – BHR vs THA

  • Haddad et. al. 2008 – measures of higher level hip function BHR vs.. THA
  • Prospective – 40 pts BHR – 40 pts in THA
  • Age, BMI matched
  • Patients scored 6 wks, 6 mos, 1 yr and 2 yrs
  • Balance, coordination, speed and directional
  • Balance test – timed single leg stance for 1 minute
  • Improvement by 6 weeks in BHR group; no difference preop to 6 weeks in THA group – quicker rate of improvement in BHR group
  • Balance & higher function test – timed step-ups(forward and lateral) onto 40cm (15″) block
  • Most immediate and sustained improvement in BHR group
  • BHR group improvements by 6 weeks
    BHR group maintained improvements throughout testing from 6 weeks to 2 years
  • Power, balance & coordination test – single leg hop test in meters
  • BHR group made immediate improvement compared to THA group

 

What about hip resurfacing?

  • Many activities discouraged with THA – well tolerated with HRA – Narvani et al
  • Daniel et al – 446 HRA in pts < 55 years; 9 yrs f/u heavy labor patients - .02% revision rate

 

What about hip resurfacing and return to sports?

  • Banerjee 2010 – AJSM
  • 138 consecutive HRA
  • 98% sports pre-op
  • 98% sports post-op!
  • amount of time spent per week in sports increased!

 

Resurfacing and BMD

Increased bone preservation

In two independent studies, femoralbone mineral density (BMD) change was compared in BHR and THA patients. Patients were matched for gender, age and diagnosis in both studies.BMD was measured by dual-energy X-Ray absorptiometry, assesses in Gruen zones 1-7. % change relative to 100% measured at 3 weeks post-op.

  • Both studies showed a significant increase of BMD in the proximal femur in the BHR group compared to the THA group
  • Both studies conclude that the BHR device transfers load to proximal femur in a better physiological manner for preserving bone stock than a long-stemmed device.

 

Hip resurfacing and gait velocity

  • Hip resurfacing patients have 9% higher gait velocity than total hip patients…
  • Usain Bolt won 2008 one hundred meter dash by 0.2 of a second (.2%)
  • Had he won by 9%?

 

Who is the ideal candidate for the hip resurfacing?

  • Younger, more active patients experiencing hip pain due to osteoarthritis with good bone quality
  • Adults under age 65 for whom total hip replacement may not be appropriate due to an increased level of physical activity

 

So why aren’t we doing more hip resurfacing.tradition?

  • Limited US experience – FDA approval 2006
  • More difficult than standard THA
  • Inadequate training of U.S. surgeons
  • Steep learning curve!
  • Best performed by high volume

 

Hip resurfacing bone removal

Hip ResurfacingHip Resurfacing

 

Conventional Total Hip vs Hip Resurfacing Bone Cuts

Total Hip Replacement

 

Hip Resurfacing – Bone conservation!

  • Revision of worn out or failed resurfacing to a primary THA
  • If patients need “revision” surgery, they don’t get a revision implant
  • The follow-up procedure would be the same total hip replacement they would otherwise have received