Hip Resurfacing is the Ideal First Choice in the Athlete with Arthritis I Have 20 Years of Experience: Listen to Only Me – Hip Resurfacing Friday 8AM Thomas Gross, MD 19
Hip Resurfacing is the Ideal First Choice for Anyone with Arthritis
Hip Resurfacing is the Ideal First Choice for the Athlete with Arthritis
Why? A more normal hip reconstruction
Why perform HRA in the young/ athletic ? Durability and function THA works well for the elderly who think that golf and walking on the beach constitute an “ active lifestyle” It is not adequate for younger patients
Y oung age is a surrogate marker for high activity NICE criteria 95 % 10 year implant survivorship S candinavian registry in patients under 50 83% 10-year implant survivorship HRA in 1285 patients under 50 96.5% 10-year implant survivorship JOS R 2016 Gaillard & Gross
Durability of Biomet UC HRA 10 year KM survivorship 99.5 % men, 98.5 % women 4000 consecut ive cases No age rest rict ions No diagnosis rest rict ion gender rest rict ions NO ACTIVITY RES TRICTIONS
Does anything else come close? Ceramic on ceramic UC THR Murphy 220 hips <50 95% 15-year Walt er 120 hips <55 96.5% 10-year
Argenson CORR 2012 (UC Ceramic PE THR) based on UCLA score
Amstutz JBJS 2012 (hybrid MoM HRA) No difference in failures based on UCLA score Impact score > 50 8-year survivorship 89% < 50 “ 96% 70% failures cement loosening
What about function? Numerous studies show superiority of HRA None show superiority of THA When the bar is set low HRA and THA seem equivalent
Resurfacing function is superior Cobb IO 2013 Mont JOA 2007 Barrack CORR 2013 Baker JBJS Br 2011 Haddad BJJ 2015 Noble presented @ IS TA
Resurfacing function is superior THA patients have a shorter stride length and do not fully load the operated hip HRA patients are the same as a normal hip Cobb IO 2013
Resurfacing function is superior Y oung patients with HRA are much more able to participate in high level sports than patients with THR Barrack CORR 2013 Noble presented @ IS TA
Barrack, Ruh, M. Berend, Della Valle, A. Engh, Parvisi, Clohisy, Nunley Results When cont rolled for age, sex, and premorbid act ivit y level, pat ient s wit h S RA had a higher incidence of complet e absence of any limp, lower incidence of t high pain, lower incidence of percept ion of limb lengt h discrepancy, great er abilit y to walk cont inuously for more t han 60 minut es, higher percent age of pat ient s who ran aft er surgery, great er dist ance run, and higher percent age of pat ient s who ret urned t o t heir most favored recreat ional act ivit y.
Why are THA patients limited? Abnormal loading t hrough t he st em 2-5% t high pain wit h ADL limit ing pain wit h impact sport s Inst abilit y difficult y wit h yoga, gymnast ics, mart ial art s, kayaking due t o risk of inst abilit y
Its not rocket science unstable Thigh pain
Interpretation DJD is cart ilage loss Golden rule of ort hopedics: mimic nat ure Replacing t he surfaces is all t hat is required Why amputate the head, load the femoral shaft, and create a mechanically unstable j oint?
The best option for athletes The XLPE Hip S ociety is wrong. Our “ thought leaders” are misleading us. Give patients a more durable and functional hip Allow them to reap the proven benefits of exercise 19
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