Introduction History prior versions of resurfacing failed in the past due to larger femoral head on polyethylene -> increased volumetric wear -> high osteolysis rate modern resurfacing techniques (approved by FDA in 2006) have made the following changes metal-on-metal components larger femoral head very popular 10 years ago particularly in younger patients due to less femoral bone resection Indications Indications (controversial) patients with advanced arthritis and good proximal femoral bone stock best outcomes in younger males with good bone stock patients with proximal femoral deformity making total hip arthroplasty difficult Contraindications absolute bone stock deficiency of the femoral head or neck e.g., cystic degeneration of the femoral head relative coxa vara increased risk for neck fractures significant leg length discrepancies resurfacing does not allow leg length corrections female sex of child bearing age (controversial) due to fact that metal ions can cross placenta renal failure functional kidneys required to excrete metal ions Advantages & Disadvantages Advantages preservation of femoral bone stock better stability compared to standard small head (22- to 32-mm) THA improved restoration of hip biomechanics with lower risk of limb length discrepancy revision may be easier than an intramedullary THA Disadvantages lack of modularity with inability to adjust length or correct offset requires larger exposure than conventional THA Outcomes Variable outcome findings in the literature (79% to 98% success rate) Better results found in patients young, larger males with excellent bone stock treated for osteoarthritis than for dysplasia or osteonecrosis Some case series have shown survival comparable to conventional THA, while others have reported higher rates of early revision some products have been removed from the market due to early failure More recent prospective trials have shown few differences between resurfacing and THA Complications Periprosthetic femoral neck fracture incidence of 0% to 4% (more common than in THA) most common early complication (within first 3 years) and frequent cause for revision in acute post-operative period (<20 weeks) mechanism thought to be related to osteonecrosis fracture pattern vertical fracture line from neck down to lesser trochanter risk factors femoral neck notching prevent by placing implant in slight valgus (rather than slight varus) osteoporotic bone large areas of preexisting AVN femoral neck impingement (from malaligned acetabular component) female sex varus positioning of femoral component presents as groin pain treatment convert to a primary THA place cerclage wire above lesser trochanter to prevent fracture propagation during stem insertion Implant loosening (aseptic) early loosening of the cemented femoral resurfacing component Heterotopic ossification higher incidence of heterotopic ossification compared to THA (from wider exposure) Metallosis may have elevated metal ion levels (cobalt, chromium, and cobalt-chromium ratio) found in blood and urine from metal debris presentation and laboratory values may mimic infection may present with elevated synovial WBC due to metal debris and corrosion most cases related to edge loading of the implant Dislocation risk is <1% (lower than conventional THA) Pseudotumor risk metal-on-metal implants (like resurfacing) young female sex may be asymptomatic symptomatic patients require revision surgery risk metal-on-metal implants (like resurfacing) young female sex may be asymptomatic symptomatic patients require revision surgery risk metal-on-metal implants (like resurfacing) young female sex may be asymptomatic symptomatic patients require revision surgery
QUESTIONS 1 of 15 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Previous Next (OBQ18.92) A 45-year-old male presents with increasing left groin pain. He has a history of bilateral hip avascular necrosis and underwent bilateral hip resurfacing arthroplasties 3 years ago. He is a recreational runner and recently ran a 10-kilometer race several weeks ago. Figure A demonstrates an AP radiograph of his pelvis. Serum testing demonstrated a cobalt level of 10 mcg/L (reference 0.8 - 5.1 mcg/L) and chromium level of 7 mcg/L (reference 0.5 - 2.5 mcg/L). What is the likely cause of the patient's symptoms? QID: 212988 FIGURES: A Type & Select Correct Answer 1 Iliopsoas tendonitis 3% (56/1896) 2 Edge-loading 51% (973/1896) 3 Prosthetic joint infection 0% (5/1896) 4 Increased activity-related wear 26% (501/1896) 5 Femoral neck stress fracture 18% (349/1896) L 4 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (SBQ10HK.86.1) A 40-year-old male presents with chronic severe and progressively worsening right hip pain which has been intractable to conservative management. He has a history of avascular necrosis of the femoral head with subsequent collapse and development of severe osteoarthritis. After discussion of his surgical options, he elects to proceed with the procedure shown in Figure A. He presents to the emergency department 2 months later with severe groin pain and inability to bear weight. Radiographs obtained at this time are shown in Figure B. Each of the following has been shown to increase the risk for development of this complication post-operatively EXCEPT: QID: 9094 FIGURES: A B Type & Select Correct Answer 1 History of avascular necrosis with cystic bone loss 13% (242/1793) 2 Notching of the superior aspect of the femur 9% (164/1793) 3 Varus placement of the femoral component 4% (76/1793) 4 Incomplete seating of the femoral implant 8% (142/1793) 5 Excessive inclination of the acetabular component 64% (1149/1793) L 4 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ09.134) An active 40-year-old male undergoes hip surgery for arthritis. A post-operative radiograph is provided in Figure A. Each of the following are complications associated with this procedure EXCEPT: QID: 2947 FIGURES: A Type & Select Correct Answer 1 Deep vein thrombosis 3% (124/4007) 2 Femoral neck fracture 3% (117/4007) 3 Aseptic loosening 1% (39/4007) 4 Polyethylene debris 85% (3400/4007) 5 Dislocation 8% (305/4007) L 2 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic (SBQ07HK.98.2) Which of the following is the most common reason for reoperation following hip resurfacing in the first 6 months following the operation? QID: 9093 Type & Select Correct Answer 1 Aseptic loosening of the acetabular component 3% (50/1986) 2 Aseptic loosening of the femoral component 9% (177/1986) 3 Fracture of the femoral neck 78% (1550/1986) 4 Fracture of the acetabulum 1% (13/1986) 5 Infection 9% (188/1986) L 4 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (SBQ07HK.98.1) Which of the following complications is the primary reason for early reoperation following the procedure shown in Figure A? QID: 9092 FIGURES: A Type & Select Correct Answer 1 Edge loading leading to rapid polyethylene wear 3% (72/2061) 2 Fracture of the femoral neck 77% (1596/2061) 3 Pseudotumor formation 8% (166/2061) 4 Infection 4% (78/2061) 5 Groin pain from accelerated acetabular erosion 6% (131/2061) L 2 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ07.65) All of the following are absolute or relative contraindication to hip resurfacing arthroplasty EXCEPT? QID: 726 Type & Select Correct Answer 1 1.5 cm femoral head bone cysts 6% (204/3272) 2 Acetabular dysplasia 4% (124/3272) 3 Coxa vara 3% (102/3272) 4 Femoral neck bone stock deficiency 4% (129/3272) 5 Age less than 50-years-old 83% (2701/3272) L 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic (OBQ07.181) When discussing metal on metal hip resurfacing versus metal on polyethylene total hip replacement, the surgeon should inform the patient that all of the following are disadvantages of hip resurfacing EXCEPT? QID: 842 Type & Select Correct Answer 1 Higher dislocation rate 68% (2625/3842) 2 Higher periprosthetic fracture rate 3% (100/3842) 3 Increased serum metal ion levels 3% (120/3842) 4 Higher rates of osteonecrosis 5% (178/3842) 5 Larger incision and surgical dissection 21% (797/3842) L 2 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic (OBQ06.204) Which of the following is the most common cause of early revision surgery (<20 weeks) following a hip resurfacing arthroplasty? QID: 215 Type & Select Correct Answer 1 Periprosthetic fracture 79% (2263/2879) 2 Rupture of abductors 1% (30/2879) 3 Dislocation 14% (397/2879) 4 Heterotopic ossification 3% (96/2879) 5 Post-operative stiffness 2% (71/2879) L 2 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic
All Videos (2) Podcasts (2) Login to View Community Videos Login to View Community Videos Anterior approach for a hip resurfacing - Dr. Stefan Kreuzer Daniel Hatch Recon - Hip Resurfacing B 5/1/2013 2605 views 4.7 (7) Login to View Community Videos Login to View Community Videos Femoral Head Resurfacing - Dr. Vijay Bose Recon - Hip Resurfacing C 2/20/2013 492 views 3.5 (2) Recon | Hip Resurfacing Recon - Hip Resurfacing Listen Now 15:48 min 10/15/2019 330 plays 5.0 (2) Question Session⎪Hip Resurfacing & Adult Isthmic Spondylolisthesis Orthobullets Team Recon - Hip Resurfacing Listen Now 14:19 min 11/8/2019 44 plays 0.0 (0)
2018 HSS Holiday Knee & Hip Course Hip Pain s/p Hip Arthroscopy in 43M (C101108) Doug Padgett Recon - Hip Resurfacing B 10/1/2018 7378 45 8 2017 HSS Holiday Knee & Hip Course Groin Pain s/p Hip Resurfacing in 38M (C2679) Julio Morales Recon - Hip Resurfacing B 9/15/2016 7171 82 22