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Clinical and Radiographic Results of Metal-on-Metal Hip Resurfacing with a Minimum Ten-Year Follow-up
Harlan C. Amstutz, MD1; Michel J. Le Duff, MA1; Patricia A. Campbell, PhD2; Thomas A. Gruen, MS3; Lauren E. Wisk, BS4
1 Joint Replacement Institute, Saint Vincent Medical Center, The S. Mark Taper Building, 2200 West Third Street, Suite 400, Los Angeles, CA 90057. E-mail address for H.C. Amstutz: harlanamstutz@dochs.org
2 J.V. Luck Center, Orthopaedic Hospital, 2400 South Flower Street, Los Angeles, CA 90007
3 31153 Shaker Circle, Wesley Chapel, FL 33543-7895
4 Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, 610 North Walnut Street, WARF Office 558, Madison, WI 53726
View Disclosures and Other Information
Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from Wright Medical Technology. In addition, one or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (Wright Medical Technology).

Investigation performed at the Joint Replacement Institute at Saint Vincent Medical Center, Los Angeles, California

Copyright © 2010 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Nov 17;92(16):2663-2671. doi: 10.2106/JBJS.I.01715
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Abstract

Background: 

There was a need for information about the long-term performance of the modern generation of hip resurfacing implants. A retrospective review of the first 100 hips that had implantation of one resurfacing design and had been followed for a minimum of ten years was performed.

Methods: 

Between 1996 and 1998, 100 CONSERVE PLUS hip resurfacing devices were implanted by a single surgeon in eighty-nine patients. The mean age of the patients was 49.1 years, and fifty-nine patients were male. Primary osteoarthritis was the etiology for sixty-four hips. All patients were assessed clinically and radiographically.

Results: 

The mean duration of follow-up was 11.7 years (range, 10.8 to 12.9 years). Two patients were lost to follow-up, and five patients died of causes unrelated to the surgery. Eleven hips had conversion to total hip arthroplasty because of loosening of the femoral component (eight), a femoral neck fracture (one), recurrent subluxation (one), and late infection (one). The Kaplan-Meier survivorship was 88.5% at ten years. None of the resurfacing arthroplasties failed in the twenty-eight hips that had a femoral component of >46 mm and no femoral head cystic or necrotic defects of >1 cm. Five hips had narrowing of the femoral neck, three had radiolucent zones interpreted as osteolysis, and twenty had signs of neck-socket impingement. Five hips had radiolucencies around the metaphyseal stem (two partial and three complete) that had been stable for 7.8 to 10.2 years. The mean scores on the University of California at Los Angeles (UCLA) system at the time of the latest follow-up were 9.5 points for pain, 9.3 points for walking, 8.9 points for function, and 6.8 points for activity; the mean scores on the physical and mental components of the Short Form-12 (SF-12) were 47.3 and 50.5 points, respectively; and the mean Harris hip score was 90 points.

Conclusions: 

The results of the present series constitute a reference point to which subsequent series should be compared. These ten-year results in a group of young patients are satisfactory, and the low rate of osteolysis is encouraging, but longer follow-up is required for comparison with conventional total hip arthroplasty.

Level of Evidence: 

Therapeutic Level IV. See instructions to authors for a complete description of levels of evidence.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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