Background
Conservative /tip arthroplasty with resurfacing of the acetabulum and femoral head is an attractive concept particularly in young and active patients. The natural anatomy, joint biomechanics and stability are all preserved. Non -violation ofthe proximal femur, retention of the upper femoral bone stock and avoidance of stress shielding in the proximal femur are unique advantages. Unique disadvantages are tlU! potential for failure from femoral neck fracture and collapsed femoral heads from avascular necrosis or osteolysis.
Patients and Methods
From Ju(v 2005 to April 2010, 38 Birmingham hip resurfacings were done in 32 patients; 20 males and 12 females (6 cases with bilateral affection) with a mean age 43.4 years (range 25 56). Patients were clinically scored with the Harris Hip Score, hip range of movements and activity level. The mean pre-operative HHS was 37 (range 25-50). The follow -up period ranged from 6 months up to 5 years (range 2.5 years). All radiographs were evaluated pre-and postoperatively and at regular follow -up visits for osteo(vsis, reactive and radiolucent lines, bone remodeling, bone resorption or component migration.
Results
At the most recent follow-up, 84.2% had no pain. The HHS averaged 91.8 (range 75-98). Seventy four percent of patients performed strenuous activities. Hip flexion averaged 120° (range 80° -142°). The final clinical results were excellent in 68.4% of patients, good in 21.1%, fair in 10.5% with no poor cases. Regarding the radiological results, a slight valgus placement of the head component is aimed for. The mean pre-operative angle of the femoral neck was 133.5° which improved to 136.9° post-operatively. In the full series, loosening, osteolysis, reactive lines or migration of the component was not seen in any of cases. There were infrequent complications mainly superficial wound infection ill 3 cases and heterotopic ossification in 2 cases.
Conclusion
Hip resurfacing is not a panacea for all hip artAritis. It works well in yOWlg patients with good quality femoral head bone and a reasonable proximal femoral anatomy. The Binningham Hip Resurfacing, when performed well in properly selected patients, continue to demonstrate excellent outcomes. |
