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Link
http://www.ejbjs.org/cgi/content/abstract/90/Supplement_3/45
August 2008
Michael A. Mont, MD1,Mike S. McGrath, MD1,
Slif D. Ulrich, MD1, Thorsten M. Seyler, MD2,
David R. Marker, BS1 and Ronald E. Delanois, MD1
1 Rubin Institute for Advanced Orthopedics, Sinai
Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215. E-mail
address for M.A. Mont:
mmont@lifebridgehealth.org
2 Department of Orthopaedic Surgery, Wake Forest University School of
Medicine, Medical Center Boulevard, Winston-Salem, NC 27157
Disclosure: In support of
their research for or preparation of this work, one or more of the
authors received, in any one year, outside funding or grants in
excess of $10,000 from Wright Medical Technology. In addition, one or
more of the authors or a member of his or her immediate family
received, in any one year, payments or other benefits in excess of
$10,000 or a commitment or agreement to provide such benefits from a
commercial entity (Wright Medical Technology). Also, a commercial
entity (Wright Medical Technology) paid or directed in any one year,
or agreed to pay or direct, benefits in excess of $10,000 to a
research fund, foundation, division, center, clinical practice, or
other charitable or nonprofit organization with which one or more of
the authors, or a member of his or her immediate family, is
affiliated or associated.
Background: Hip resurfacing has been proposed as an
alternative to total hip replacement in patients who have proximal
femoral deformities or retained hardware in the proximal aspect of
the femur. In these situations, placement of a conventional stemmed
hip prosthesis would be difficult or impossible, possibly necessitating
a complex osteotomy or a custom prosthesis. The purpose of this
study was to evaluate a series of patients who had extra-articular
deformities of the proximal aspect of the femur and/or retained
hardware and who were managed with a resurfacing hip prosthesis.
Methods: Fifteen patients (seventeen hips) who underwent
metal-on-metal resurfacing hip replacements were studied. Ten
patients (twelve hips) had bowing or other deformities of the femur
secondary to trauma, multiple epiphyseal dysplasia, renal
osteodystrophy, or proximal femoral focal deficiency. Five patients
(five hips) had retained hardware. Twelve of the patients (thirteen
hips) had previously been told by orthopaedic surgeons that, due to
the deformity or retained hardware, they could not undergo conventional
total hip arthroplasty without also undergoing ancillary surgical
procedures. We evaluated perioperative factors (operative time
and estimated blood loss), Harris hip scores, complications, and
failure rates.
Results: At a mean follow-up time of three years (range, two
to five years), fourteen patients (sixteen hips) were doing
well clinically and radiographically. Assessment of the intraoperative
records revealed minimal difficulty, with a mean operative time
of 104 minutes and a mean blood loss of 621 mL. The mean Harris hip
score was 92 points. One patient, a fifty-nine-year-old woman,
underwent two subsequent revisions—one for the treatment of a femoral
neck fracture, and one for the treatment of acetabular component
loosening.
Conclusions: Resurfacing hip arthroplasty offers an option for
patients when placement of a conventional total hip prosthesis
is difficult or impossible because of the presence of proximal
femoral deformities or retained hardware in or on the proximal aspect
of the femur.
Level of Evidence: Therapeutic Level IV. See Instructions to
Authors for a complete description of levels of evidence.
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