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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 in the Athlete with - - PowerPoint PPT Presentation
Hip Resurfacing is the Ideal First Choice in the Athlete with - - PowerPoint PPT Presentation
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
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SLIDE 3
Hip Resurfacing is the Ideal First Choice for the Athlete with Arthritis
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Why?
A more normal hip reconstruction
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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
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Y
- ung 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
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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
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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
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Argenson CORR 2012
(UC Ceramic PE THR) based on UCLA score
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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
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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
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Cobb
IO 2013
Mont
JOA 2007
Barrack
CORR 2013
Baker
JBJS Br 2011
Haddad
BJJ 2015
Noble
presented @ IS TA
Resurfacing function is superior
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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
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Y
- ung patients with HRA are much more able to
participate in high level sports than patients with THR Barrack CORR 2013 Noble presented @ IS TA
Resurfacing function is superior
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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
- f pat ient s who ret urned t o t heir most favored
recreat ional act ivit y.
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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
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Its not rocket science
unstable Thigh pain
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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?
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The best option for athletes
19
The XLPE Hip S
- ciety is wrong.