Role of Hip Resurfacing for the older patients Pascal A. Vendittoli, MD MSc FRSC Montréal, Canada.

Role of Hip Resurfacing for the older patients

Pascal A. Vendittoli, MD MSc FRSC

Montréal, Canada

2M pa

6.4M pa

Evolving patients- more active

Literature Review

• 35 patients (40 hips): >65 years of age vs 130 patient (153 hips): <65 years• F/U: 36 months• Results: Harris Hip Scores and SF12 were similar• No difference in the rate of complications/femoral neck

fracture

Literature Review

• 57 patients: >65 years of age52 males / 5 females

• F/U: 33 months

• No fracture

AAOS 2010 posterHip Resurfacing in the Older PopulationMark Mullins et al. United Kingdom

Literature Review

295 Patients<55 years (range 14-49 years) vs281 patients>55 years (range 50-78 years)

UCLA scores and SF 12 scores were similar in both groups. No difference in survival between young and old patients

Australian joint replacement Registry

Hip resurfacing has fewer complications when performed on men<65 years and women<55 years

Australian Joint Replacement Registry Annual Report, 2007

The 7-year cumulative revision rate for patients <55 years = 4.7% >55 to 74 years = 5.6% Australin Joint Replacement Registry Annual Report, 2009

Pascal-A Vendittoli, MD

• Improved Clinical function• Better patient satisfaction• No Leg length discrepancy• Better Range of motion• No Dislocation • No Tight pain• Less Bone stock loss • Easier Revision

Why should we do HR vs THA?

Hip Resurfacing vs28 mm Total Hip Arthoplasty

• Slightly higher clinical scores (WOMAC)• Femoral bone conservation-easy revisability• Better implant stability- reduced rate of dislocation• More precise Biomechanical reconstruction

vs

HR vs LDH THA

No Functional Benefit

Pascal-A Vendittoli, MD

VS

Hip Resurfacing Real Benefits vs THA

• • • • • • • • Femoral bone preservation for future revision, if needed

Is there some downsides ?

HR and Femoral Neck Fractures

Rate of fracture is higher in • women • patients with osteoporosis

Aseptic loosening of femoral component

• Femoral head necrosis

• Overpenetration of cement Campbell P et al CORR 2006

2 - 6 %Hip Int 2010

Simple Equation

Femoral stem survival Versus

Patient life expectancy

Most current femoral implant designsCemented or Uncemented > 15 years survivorship

Indications for resurfacing in subjects over 50 years old

• Deformity of proximal femur• Presence of implants, which are difficult to remove• Post Septic Arthritis• Old femoral diaphysal osteomylitis

Post traumatic deformity of the Femur

68 years old male

Post traumatic femoral deformation

Post Septic Arthritis

63 years old male

Haematogenous septic arthritis

1 y post infection

One example of infected HR

Old osteomylitis of the diaphysis

Old osteomylitis of the diaphysis

Significant Hardware

67 years old

Discussion

• There is no clear consensus on upper age limit for HR• Litterature only reports short term data

Great results of THA femoral stemsNo clear benefit HR vs THA except femoral bone preservationIncreased failure risk with HR (neck fx and femoral loosening)

RecommandationHR for the subject over 50 y old where femoral

stem implantation would be challenging

When needed… in the olderNow available: Extended metaphyseal fixation