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Aug 16, 2023 452 likes •734 views

Hip Resurfacing is the Ideal First Choice in the Athlete with Arthritis? Get Real: We Know the Answer, its a Modern Total Hip Replacement Matthew Hepinstall, MD Center for Joint Preservation & Reconstruction Disclosures: Paid

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Center for Joint Preservation & Reconstruction

Hip Resurfacing is the Ideal First Choice in the Athlete with Arthritis?

Get Real: We Know the Answer, it’s a Modern Total Hip Replacement

Matthew Hepinstall, MD

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Center for Joint Preservation & Reconstruction

Disclosures: Paid Consulting: Corin, Stryker Institutional Research Support: Acelity, Stryker Royalties: Corin Speaking: Stryker, Smith & Nephew

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Center for Joint Preservation & Reconstruction

Disclosures: I did a lot of resurfacings in training. They generally did well. There was no epidemic of problems. I enjoy the resurfacing operation. The few I have done in practice have done well. Based on published data, I cannot bring myself to sell a patient on resurfacing.

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Center for Joint Preservation & Reconstruction

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Center for Joint Preservation & Reconstruction

AUSTRALIAN JOINT REGISTRY RESULTS OF METAL-ON-METAL HIP RESURFACING1

1Prosser GH, et al. Acta Orthopaedica 2010:81;66-71.

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Center for Joint Preservation & Reconstruction

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Center for Joint Preservation & Reconstruction

Hip Resurfacing is the Ideal First Choice in the Athlete with Arthritis?

Get Real: We Know the Answer, it’s a Modern Total Hip Replacement

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Center for Joint Preservation & Reconstruction

PROPOSED ADVANTAGES OF HIP RESURFACING

 Better recovery with fewer complications2

 Few dislocations despite no hip precautions

 Improved function3

 Proprioception from femoral neck  Eliminate thigh pain from femoral stem  More anatomic head size, leg length and offset

 Better durability4

 Diminished wear with metal-on-metal

 Easier revision5

 Femoral bone preservation

2Brooks PJ, Bone Joint J 2016 3Szymanski C, Orthop Traumatol Surg Res 2012 4Amstutz HC, et al. Orthop Clin North Am 2011 5Gerhardt DM, et al. Hip Int 2017

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Center for Joint Preservation & Reconstruction

PROPOSED ADVANTAGES OF HIP RESURFACING

 Better recovery with fewer complications  No hip precautions and few dislocations6  Large diameter head7  Are hip precautions required in modern THA?8  Anterior, lateral & superior approaches  Modern posterior soft tissue repairs

6Morse KW, et al. Hip Int 2017 7Cadossi M, et al. Orthopedics 2015 8Kornuijt A, et al. Bone Joint J 2016

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Center for Joint Preservation & Reconstruction

PROPOSED ADVANTAGES OF HIP RESURFACING

 Better recovery with fewer complications  No hip precautions and few dislocations6  Large diameter head7  THA dislocation exceedingly rare in active

young male candidates for resurfacing9

9Barnsley L, et al. Geriatr Orthop Surg Rehabil 2015

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Center for Joint Preservation & Reconstruction

PROPOSED ADVANTAGES OF HIP RESURFACING

 Better recovery with fewer complications  No hip precautions and few hip

dislocations6

 Large diameter head7  THA requires less extreme exposure!10, 11

10Brun Ol, et al. Hip Int 2017 11von Rottkay E, et al. Int Orthop 2017

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Center for Joint Preservation & Reconstruction

PROPOSED ADVANTAGES OF HIP RESURFACING

 Better recovery with fewer complications  No hip precautions and few dislocations6  Large diameter head7  Hard to have a better recovery if you develop

femoral neck fracture after resurfacing12

12Gross TP, et al. J Arthoplasty 2014

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Center for Joint Preservation & Reconstruction

PROPOSED ADVANTAGES OF HIP RESURFACING

 Improved function  Proprioception from femoral neck  REFUTED when normalized against non-operative limb13  Higher activity level  CONTESTED (selection bias, comparisons to 28 mm heads, differing

instructions)14-16

 Eliminate thigh pain from femoral stem with more physiologic stress  CONTESTED15  More anatomic head size, leg length and offset  SUPPORTED17  Hard to alter pathologic anatomy (FAI, LLD)

13Larkin B et al. CORR 2014 14Garbus DS CORR 2010 15Lavigne M CORR 2010 16Penny JO Acta Orthopaedica 2013 17Brown NM, et al. Orthopedics 2013

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Center for Joint Preservation & Reconstruction

HARDER TO ALTER ABNORMAL ANATOMY

Courtesy of Jose Rodriguez

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Center for Joint Preservation & Reconstruction

PROPOSED ADVANTAGES OF HIP RESURFACING

 Better durability18  Diminished volumetric wear w/ metal-on-metal  Fluid-film lubrication (vs boundary vs mixed)  Wear is very dependent on implant position19,20  Contact Patch to Rim (CPR) distance  Correlates with metal ion levels 18Amstutz HC, et al. HSS J 2012 19Amstutz HC, et al. Bone & Joint J 2017

19Amstutz HC, et al. The Bone & Joint Journal 2017.

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Center for Joint Preservation & Reconstruction

PROPOSED ADVANTAGES OF HIP RESURFACING

 Better durability18  Diminished volumetric wear w/ metal-on-metal  Fluid-film lubrication (vs boundary vs mixed)  Biologic response to metal is different19,20  PSEUDOTUMOR!  Volumetric comparisons not meaningful 18Amstutz HC, et al. HSS J 2012 20Gustafson K, et al. Acta Orthop 2014 21Berber R, et al. Acta Orthop 2015 22Wong JML, et al. Clin Orthop Relat Res 2015

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Center for Joint Preservation & Reconstruction

PROPOSED ADVANTAGES OF HIP RESURFACING

 Better durability18  Diminished volumetric wear with metal-on-metal  Fluid-film lubrication (vs boundary vs mixed)  Actual registry revision rates tell a different story1,21

1Prosser GH, et al. Acta Orthopaedica 2010 22Wong JML, et al. Clin Orthop Relat Res 2015

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Center for Joint Preservation & Reconstruction

PROPOSED ADVANTAGES OF HIP RESURFACING

 Easier revision  Femoral bone preservation22  If pseudotumor, definitely not! 23  Poor Survivorship and Frequent Complications at a Median of 10

Years After Metal-on-Metal Hip Resurfacing Revision23

23 Su EP, et al. HSS J 2012 24 Mathary GS, et al. CORR 2017

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Center for Joint Preservation & Reconstruction

HIP RESURFACING IS HARD

 Learning curve24  Narrow indications  Exposure  Cup and femoral position

25Nunley RM, et al. Clin Orthop Relat Res 2010.

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HIP RESURFACING IS UNFORGIVING19

 Femoral implant positioning  Notching and fracture  Recurrent impingement  Cup position  Contact Patch to Rim (CPR)

distance correlates with metal ion levels

19Amstutz HC, et al. The Bone & Joint Journal 2017.

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Center for Joint Preservation & Reconstruction

HIP RESURFACING INDICATIONS ARE NARROW1

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Center for Joint Preservation & Reconstruction

HIP REPLACEMENT IS A MATURE, PROVEN, RELIABLE AND FORGIVING APPROACH FOR THE HIGH DEMAND PATIENT

 Good durability despite less than optimal precision26, 27

27 Stea, et al. JBJS 2014 26Callanan et al. CORR 2011

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Center for Joint Preservation & Reconstruction

HIP RESURFACING IS NOT

 Device recalls  Durom  ASR  Devices no longer distributed in USA  Cormet  Outcomes device and technique specific  BHR  Learning curve  Narrow indications  Technically challenging / unforgiving

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HIP REPLACEMENT vs. HIP RESURFACING

PROVEN SAFETY AND EFFICACY vs. APPEALING CONCEPT WITH MIXED RESULTS

Optimal role for resurfacing (if any) is yet to be elucidated.

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References

1. Prosser GH, et al. Acta Orthopaedica 2010:81;66-71 2. Brooks PJ, Bone Joint J 2016 3. Szymanski C, Orthop Traumatol Surg Res 2012 4. Amstutz HC, et al. Orthop Clin North Am 2011 5. Gerhardt DM, et al. Hip Int 2017 6. Morse KW, et al. Hip Int 2017 7. Cadossi M, et al. Orthopedics 2015 8. Kornuijt A, et al. Bone Joint J 2016 9. Barnsley L, et al. Geriatr Orthop Surg Rehabil 2015

10. Brun Ol, et al. Hip Int 2017
11. von Rottkay E, et al. Int Orthop 2017
12. Gross TP, et al. J Arthoplasty 2014
13. Larkin B et al. CORR 2014
14. Garbus DS CORR 2010
15. Lavigne M CORR 2010
16. Penny JO Acta Orthopaedica 2013
17. Brown NM, et al. Orthopedics 2013
18. Amstutz HC, et al. HSS J 2012
19. Amstutz HC, et al. The Bone & Joint Journal 2017
20. Gustafson K, et al. Acta Orthop 2014
21. Berber R, et al. Acta Orthop 2015
22. Wong JML, et al. Clin Orthop Relat Res 2015
23. Su EP, et al. HSS J 2012
24. Mathary GS, et al. CORR 2017
25. Nunley RM, et al. Clin Orthop Relat Res 2010
26. Callanan et al. CORR 2011
27. Stea, et al. JBJS 214

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Center for Joint Preservation & Reconstruction