Careful selection can help patients regain function and have a satisfactory quality of life.
Better surgical techniques and patient selection will enable total joint surgeons to achieve more reproducible results in the young arthritic patient with hip resurfacing implants, according to Paul E. Beaulé, MD, FRCSC.
By mastering the technique and selecting the right patients for this procedure, they can mitigate the 15% to 30% failure rates seen with some earlier designs of hip resurfacing prostheses, he said.
But, Beaulé, a proponent of resurfacing arthroplasty to treat hip arthritis in appropriate patients, also expects the type and design of fixation to be critical to long-term success with today’s resurfacing components. Deep cement penetration may have contributed to past failures, he said.
Conserve the joint
Modern hip resurfacing dovetails nicely with such clinical goals as joint preservation and keeping open future surgical options. An additional benefit is fewer dislocations. The downside of hip resurfacing is known or suspected problems, like femoral neck fracture and metal ion release, which will require further study, according to Beaulé.
“I think these are exciting times in hip arthroplasty. We are minimizing the time to recovery with improved surgical techniques, better pain management, lower risk of dislocation, and an earlier return to work so patients can have a greater capacity to live their lives to the fullest. Joint preservation should be the first step, more durable implants the second step,” he said…
According to Beaulé, the following patient selection factors can favorably impact modern resurfacing outcomes:
no large femoral head cyst;
younger than 65 years old; and
no prior hip surgery.
“My current ideal indications for hip resurfacing are patients age less than 60 years, risk index less than or equal to 3,” he said.
The risk index — surface arthroplasty risk index (SARI) — is a tool for determining how various factors may interact for a reproducible outcome.
SARI gives two points each for a femoral head cyst >1 cm3 and patient weight <82 kg, and one point each for previous hip surgery and UCLA activity score >6, for a total possible score of 6. The higher the patient’s SARI, the greater his or her risk of implant failure.
Beaulé applied the index in a study he did of 400 patients following resurfacing arthroplasty. The overall series showed a survivorship of 94% at 4 years, which most would consider suboptimal compared to THA.
After grouping patients by SARI, survivorship increased to 97% in those with SARI equal to or less than 3. But it decreased to 89% when the index was equal to or greater than 3…