|
According to the registries and medical studies, the perfect hip resurfacing
candidate is a male patient under 55 that is active, has good bone density and
has a large femur neck. Of course, I am not a doctor, and am interpreting
what I learned at the 2nd Annual Hip Resurfacing Course in LA on October 24 and
25, 2008. It seems many of the experienced hip resurfacing surgeons at the
conference seemed to agree with this profile.
There are other experienced hip resurfacing surgeons that will also consider
both older women and men as good candidates if they have good bone stock and an appropriate
femur neck. Women seem to have more problems as survivors of hip
resurfacing surgeries. Large boned women that use cups larger than 50 mm have
the same survival rate as men. Smaller women requiring smaller cups have a much
worse survival rate as do smaller men. See information from the 2008 Australian Orthopaedic Registry Below:
| The effect of femoral component head size is evident in both males and
females. There is no significant difference in the risk of revision between
males and females after adjusting for femoral component head size. Males and
females with a femoral component head size greater than 50mm have a similar
seven year cumulative percent revision (2.1% and 2.0% respectively). The
same is seen for males and females with a femoral component head size less than
50mm (seven year cumulative percent revision is 5.5% and 7.3% respectively). The
risk of revision for females with a femoral component head size less than 50mm
is significantly higher than for females with a femoral component head size
greater than 50mm ((age adjusted) HR=3.22; 95% CI (2.47, 4.21) p<0.001). A
similar situation applies to males with a femoral component head size less than
50mm having a significantly higher revision rate compared to males with a
femoral component head size greater than 50mm ((age adjusted) HR=2.69; 95% CI
(1.91, 3.79) p<0.001). http://www.surfacehippy.info/aoanationalreg08.php |
Certain patients, according to Dr. Andrew Shimmin a
faculty presenter at the Resurfacing Course, should also be
avoided:
-
Patients with osteopenic bone should be
avoided, for this reason women over 60 years old should
be considered cautiously
-
Patients with inflammatory arthropathy
or with large femoral head cysts
-
Patients with extensive AVN are
also at higher risk
So most surgeons are very conservative in
their selection of hip resurfacing patients knowing the
results from the 2008 Australian Registry and information
from current medical studies. If a potential
patient is small or has a difficult hip problem, then it
becomes even more important for them to choose a very
experienced surgeon. People seeking hip resurfacing also need to
realize that if one doctor won't do a hip resurfacing for them,
there may still be others that will.
The hip resurfacing doctors are very
conservative and feel they have the patients best outcome in
mind. They don't want to take any chances that could
result in a failed hip resurfacing that would require a
second surgery to a THR.
So we as patients need to understand how
conservative most resurfacing surgeons are. If a
person really feels that they only want a hip resurfacing,
then sometimes they will have to search until they find the
experienced surgeons who will do difficult cases for people
outside the norm for resurfacing. Most surgeons do admit
that they will treat each person as an individual, look
at your x-rays and specific medical situation before making their
recommendation for either a hip resurfacing or total hip
replacement.
A recent medical study and article about the general
guidelines for hip resurfacing by Rush University Medical Center can be read
here:
http://www.surfacehippy.info/hrstudyrush08.php
|
