The Journal of Bone & Joint Surgery

The Journal of Bone & Joint Surgery, Volume 94, Issue 10

Scientific Articles | May 16, 2012

The Relationship of Sporting Activity and Implant Survivorship After Hip Resurfacing

Michel J. Le Duff, MA¹; Harlan C. Amstutz, MD¹

¹ Joint Replacement Institute, 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

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

J Bone Joint Surg Am, 2012 May 16;94(10):911-918. doi: 10.2106/JBJS.K.00100

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Abstract

Background:

The effect of sports on the durability of the prosthesis after hip resurfacing has not been studied, to our knowledge. The purpose of this study was to correlate sporting activity levels calculated as Impact and Cycle Scores with the survivorship of the hip resurfacing implants.

Methods:

Four hundred and forty-five patients were surveyed from one to five years after surgery. The mean age of the patients was 48.7 years, and 74% were men. The Impact and Cycle Score included two scores: an Impact Score and a Hip Cycle Score. All patients were also evaluated with the University of California at Los Angeles activity score. Twenty-three patients (twenty-seven hips) underwent revision surgery after they had completed the survey.

Results:

The mean duration of follow-up at the time of survey data collection was 1.9 years (range, 1.0 to 4.9 years), and the mean follow-up period was 10.2 years (range, 6.1 to 13.7 years). The mean Impact Score was 28.1 (range, 0 to 128), and the mean Hip Cycle Score was 33 (range, 0 to 144). Positive correlations were found between the University of California Los Angeles activity score and the Impact Score (r = 0.535) or Hip Cycle Score (r = 0.497). After adjustment for femoral component size, body mass index, and femoral defect size, a 10-point increment in Impact Score corresponded to a 37% increase (hazard ratio, 1.37; 95% confidence interval, 1.18 to 1.59) in the risk of revision arthroplasty, while a 10-point increment in the Hip Cycle Score increased the risk of revision by 22% (hazard ratio, 1.22; 95% confidence interval, 1.06 to 1.41).Patients with an Impact Score of <50 had a risk of revision 3.8 times lower (hazard ratio, 3.8; 95% confidence interval, 1.6 to 8.9) than that of the patients with an Impact Score of ≥50, with a survivorship rate at eight years of 96.4% (95% confidence interval, 93.6% to 98.0%) compared with 88.8% (95% confidence interval, 74.7% to 95.3%). We found no association between the University of California at Los Angeles activity score and the survivorship of the implants.

Conclusions:

High levels of sporting activities can be detrimental to the long-term success of hip resurfacing devices, independently from other risk factors. Patients seeking hip resurfacing are usually young and should limit their involvement in sports to levels that the implant construct will be able to tolerate.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Figures in this Article

Introduction

Introduction | Materials and Methods | Results | Discussion | Appendix

The ability to return to recreational activities is a major reason for patients with end-stage osteoarthritis to undergo total hip arthroplasty¹. For young patients, sporting activities constitute an important part of the overall physical activity², and the return to so-called high-demand exercise activities is one of the main reasons why surgeons and patients select hip resurfacing arthroplasty as the treatment of choice. The success of metal-on-metal hip resurfacing devices, which are now commonly implanted in young and active patients^3-7, may depend on the type and quantity of sporting activity the patients engage in postoperatively. Descriptive reports on the participation in sports at short-term follow-up after hip resurfacing have been published, showing a high rate of return to sporting activities^8-11. Also, in a randomized clinical trial, a difference in overall activity score has been found in favor of hip resurfacing one year after surgery compared with conventional total hip arthroplasty¹².

To our knowledge, participation in sporting activities has not been associated with any reduction in survivorship for metal-on-metal resurfacing implants, most likely because the studies describing patient activity patterns were conducted at a short-term follow-up but also possibly because there was a so-called ceiling effect of the outcome instruments used for the measurement of activity.

The purpose of the present study was to correlate the Impact and Cycle Scores, calculated from a postoperative sporting activity survey, with the survivorship of the procedure in a large series of patients with a minimum follow-up of six years.

Materials and Methods

Introduction | Materials and Methods | Results | Discussion | Appendix

Instruments

The survey used in the present study and the Impact and Cycle Score scoring algorithms have been described in a previous publication¹³. The patients reported the frequency of participation and the duration of typical sessions for up to three sporting activities chosen out of an extensive list. The survey was filled out with a minimum follow-up of one year and a maximum of five years.

The calculation of the Impact and Cycle Score included two scores: (1) The patient's Impact Score (IS): activities were rated on the basis of the predominant type of displacement involved, then multiplied by frequency and duration scores as shown in the following formula: Patient IS = Σ (Activity IS × F × D), where Activity IS is the Impact Score associated with an activity, F is the frequency score, and D is the duration score. (2) The Hip Cycle Score (HCS): activities were rated on the basis of the number of hip cycles per unit of time characterizing the activity, then multiplied by frequency and duration scores as shown in the following formula: Patient HCS = Σ (Activity HCS × F × D), where Activity HCS is the Hip Cycle Score associated with an activity, F is the frequency score, and D is the duration score. The details of the scoring algorithm are presented in tables in the Appendix.

The University of California at Los Angeles (UCLA) activity scores¹⁴ were also recorded at the time of data collection of the sports activity survey. Radiographic follow-up was performed during the patient visits, and the presence of radiolucencies around the components was noted. The position of the acetabular component was assessed with use of Ein-Bild-Röentgen-Analyse (EBRA) cup software^15,16 (Department of Engineering Mathematics, Geometry and Computer Science, University of Innsbruck, Innsbruck, Austria).

Subjects

From 1996 to 2003, 547 patients (636 hips) had metal-on-metal surface arthroplasties (Conserve Plus; Wright Medical Technology, Arlington, Tennessee), and were asked to complete the sports activity survey at least one year postoperatively and then yearly thereafter. Four hundred and forty-five patients (81.4%) who completed at least one survey between one and five years after surgery constituted our study group. Of these 445 patients (116 with bilateral hip resurfacing prostheses), twenty-three (5.2%; twenty-seven hips) underwent revision after the first survey was completed. The revisions were performed because of femoral component loosening (nineteen hips in sixteen patients), acetabular component loosening (three hips in three patients), excessive wear of the component (four hips in three patients), and infection (one hip in one patient). The average age of the patients at the time of the index arthroplasty for the study group was 48.7 years (range, fifteen to seventy-seven years), and 331 (74.4%) were male. The average patient weight was 83.2 kg (range, 42 to 164 kg), and the average body mass index (BMI) was 26.9 (range, 18 to 46). Diagnoses included osteoarthritis (66%), developmental dysplasia of the hip (11%), osteonecrosis (7%), trauma (8%), and others (8%), including Legg-Calvé-Perthes disease, slipped capital femoral epiphysis, epiphyseal dysplasia, inflammatory joint disease, melorheostosis, and pigmented villonodular synovitis. Thirty-three patients (7%) had previous surgical procedures on the involved hip. One hundred and sixteen patients (26%) had bilateral hip resurfacing, and 4% had various types of conventional total hip arthroplasties on the contralateral hip.

Implants and Surgical Technique

The prosthesis used in the present study was the Conserve Plus (Wright Medical Technology). A posterior approach was used in all but one hip, in which a transtrochanteric approach was chosen to facilitate the exposure as the patient had undergone multiple previous osteotomies. The femoral component was cemented with an approximately 1-mm-thick cement mantle and was inserted after manual application of bone cement in a doughy stage. The surgical technique used for implantation of the devices was previously described¹⁷. The patients were instructed that returning to sporting activity might negatively affect the durability of the procedure. Low-impact activities were usually allowed four months after surgery, and high-impact sports were never recommended for patients with femoral head defects of >1 cm in size¹⁷.

Statistics

Pearson correlation coefficients were calculated between sports survey scores (Impact Score and Hip Cycle Score) and the other outcome scores (Short Form-12 [SF-12] and UCLA activity score). The Cox proportional hazard ratio was used to determine the effect of sporting activity scores (Impact Score and Hip Cycle Score) on the survivorship of the procedure. A multivariate model, which included four independent variables previously shown in series reported by the senior author (H.C.A.) to affect the survivorship of metal-on-metal hip resurfacing procedures (femoral component size¹⁸, BMI¹⁹, femoral defect size¹⁸, and surgical technique generation²⁰), was calculated. Kaplan-Meier survivorship estimates were calculated in a study of Impact Scores and Hip Cycle Scores of ≥50 compared with scores of <50. The ceiling effect of the activity scores was calculated as the number of maximum possible scores recorded over the total number of scores for the cohort and was expressed as a percent as described by Naal et al.²¹.

Source of Funding

Funding for this study was provided by Saint Vincent Medical Center, Los Angeles, California, and Wright Medical Technology, Inc. Neither of these institutions played any role in the selection of the research question, design of the study, or the way the investigation was performed.

Results

Introduction | Materials and Methods | Results | Discussion | Appendix

The data collection for the sports activity survey was performed at a mean of 1.9 years (range, one to five years) after surgery. The mean follow-up period was 10.2 years (range, 6.9 to 13.8 years) for this group of patients. At the time of the last follow-up, the mean UCLA hip scores of the study group were 9.4, 9.6, 9.5, and 7.6 for pain, walking, function, and activity, respectively. The mean SF-12 scores were 50.7 for the physical component summary and 53.4 for the mental component summary. At the time of the latest follow-up, eleven hips from these series had radiolucencies (three around the acetabular cup and eight around the metaphyseal stem), which had been visible on radiographs for a mean of 8.5 years (range, 1.9 to 12.0 years). However, none of these patients had revision surgery pending, and all were asymptomatic. The orientation of the acetabular component was comparable between the hips requiring revision and the hips that survived in this series: the mean abduction angles were 43.2° versus 43.3° (p = 0.927) and the mean anteversion angles were 16.7° versus 17.5° (p = 0.668), respectively.

The mean Impact Score from the sports activity survey was 28.1 (range, 0 to 128), and the mean Hip Cycle Score was 33 (range, 0 to 144). A positive correlation was found between the UCLA hip score at the time the survey was performed and both the Impact Score (r = 0.535, p < 0.001) and the Hip Cycle Score (r = 0.497, p < 0.001). However, the spread of scores on the sports activity survey corresponding to the highest stage of the UCLA hip score (a score of 10) was quite large, ranging from 12 to 128 for Impact Scores and 9 to 144 for Hip Cycle Scores (Figs. 1-A and 1-B). The mean UCLA activity score at the time of data collection of the sports activity survey was 7.6 (range, 2 to 10) and showed a so-called ceiling effect of 14.4% (a score of 10 recorded for sixty-four of 445 patients), while the sports activity survey had no ceiling effect (the ratio between the number of maximum scores recorded over the total number of scores). We found no association between the sports activity survey scores and the other disease-specific or quality-of-life scores at the time of the last follow-up.

Scattergram plots showing the relationship between the UCLA activity score and the two components of the Impact and Cycle Score.

Fig. 1-A

Scattergram plot showing the correlation between the UCLA activity score and the Impact Score.

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Fig. 1-B

Scattergram plot showing the correlation between the UCLA activity score and the Hip Cycle Score. The spread of both Impact and Hip Cycle Scores in the higher values of the UCLA activity score denotes the need to account for frequency and duration of sessions when sporting activity is quantified.

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Survivorship Studies

For a greater ease of interpretation, we calculated the Cox proportional hazard ratio for the sports activity survey scores on a minimal increment of 10 points. The bivariate Cox model yielded hazard ratios of 1.25 (95% confidence interval [95% CI], 1.09 to 1.43) for the Impact Score, 1.18 (95% CI, 1.03 to 1.35) for the Hip Cycle Score, 0.82 (95% CI, 0.74 to 0.91) for component size, 0.78 (95% CI, 0.69 to 0.89) for BMI, and 1.93 (95% CI, 0.81 to 4.57) for femoral head defects. After adjustment for femoral component size, BMI, and femoral defect size, a 10-point increment in the Impact Score corresponded to a 37% increase in the risk of revision (hazard ratio, 1.37; 95% CI, 1.18 to 1.59; p = 0.0001), while a 10-point increment in the Hip Cycle Score increased the risk of revision by 22% (hazard ratio, 1.22; 95% CI, 1.06 to 1.41; p = 0.005). The results of the multivariate analysis are presented in Tables I and II.

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TABLE I Cox Proportional Hazard Ratios of the Impact Score, Femoral Component Size, Body Mass Index, and Femoral Defect Size Calculated in a Multivariate Model

	Hazard Ratio*	P Value	95% Confidence Interval
Impact Score	1.374898	0.000	1.182199 to 1.599007
Femoral head size	0.808882	0.001	0.717149 to 0.912346
Body mass index	0.841923	0.018	0.730106 to 0.970865
Femoral head defects of >1 cm	2.093749	0.108	0.850715 to 5.151587
Second-generation surgical technique	0.19529	0.004	0.064076 to 0.595209

*The ratios correspond to a 10-point increment for Impact Score, a 1-mm increment in head size, a 1-point increment of body mass index, femoral defects of <1 cm versus ≥1 cm in size, and first versus second-generation surgical technique.

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TABLE I Cox Proportional Hazard Ratios of the Impact Score, Femoral Component Size, Body Mass Index, and Femoral Defect Size Calculated in a Multivariate Model

	Hazard Ratio*	P Value	95% Confidence Interval
Impact Score	1.374898	0.000	1.182199 to 1.599007
Femoral head size	0.808882	0.001	0.717149 to 0.912346
Body mass index	0.841923	0.018	0.730106 to 0.970865
Femoral head defects of >1 cm	2.093749	0.108	0.850715 to 5.151587
Second-generation surgical technique	0.19529	0.004	0.064076 to 0.595209

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TABLE II Cox Proportional Hazard Ratios of the Hip Cycle Score, Femoral Component Size, Body Mass Index, and Femoral Defect Size Calculated in a Multivariate Model

	Hazard Ratio*	P Value	95% Confidence Interval
Hip Cycle Score	1.222054	0.005	1.061912 to 1.406346
Femoral head size	0.836751	0.002	0.746139 to 0.938367
Body mass index	0.836668	0.013	0.727396 to 0.962356
Femoral head defects of >1 cm	1.948708	0.135	0.812769 to 4.672257
Second-generation surgical technique	0.213807	0.007	0.069820 to 0.654734

*The ratios correspond to a 10-point increment for Hip Cycle Score, a 1-mm increment in head size, a 1-point increment of body mass index, femoral defects of <1 cm versus ≥1 cm in size, and first versus second-generation surgical technique.

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TABLE II Cox Proportional Hazard Ratios of the Hip Cycle Score, Femoral Component Size, Body Mass Index, and Femoral Defect Size Calculated in a Multivariate Model

	Hazard Ratio*	P Value	95% Confidence Interval
Hip Cycle Score	1.222054	0.005	1.061912 to 1.406346
Femoral head size	0.836751	0.002	0.746139 to 0.938367
Body mass index	0.836668	0.013	0.727396 to 0.962356
Femoral head defects of >1 cm	1.948708	0.135	0.812769 to 4.672257
Second-generation surgical technique	0.213807	0.007	0.069820 to 0.654734

A comparative analysis of high and low Impact Scores was also performed, with use of a cutoff point of 50. Patients with an Impact Score of <50 had a risk of revision 3.8 times lower (hazard ratio, 3.8, 95% CI, 1.6 to 8.9) than the patients with an Impact Score of ≥50 (p = 0.003), with a survivorship rate at eight years of 96.4% (95% CI, 93.6% to 98.0%) compared with 88.8% (95% CI, 74.7% to 95.3%). The difference between the two survivorship curves was significant (log-rank test, p = 0.001), as shown in Figure 2-A. Similarly, we compared the effect of Hip Cycle Scores of ≥50 and scores of <50. Patients with a Hip Cycle Score of <50 had a survivorship rate of 97.1% at eight years and a risk of revision 2.6 times lower than the patients with a Hip Cycle Score of ≥50 (p = 0.024). The difference between the two survivorship curves was significant (log-rank test, p = 0.018), as shown in Figure 2-B.

Kaplan-Meier survivorship curves (and 95% confidence intervals) showing the effect of high Impact Scores (IS) and Hip Cycle Scores (HCS) on the durability of metal-on metal hip resurfacing prosthesis.

Fig. 2-A

Kaplan-Meier survivorship curves showing the effect of high Impact Scores (≥50) on the durability of the prosthesis. The number of patients followed (remaining at risk) is indicated along the curves.

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Fig. 2-B

Kaplan-Meier survivorship curves showing the effect of high Hip Cycle Scores (≥50) on the durability of the prosthesis. The number of patients followed (remaining at risk) is indicated along the curves.

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We found no association between the UCLA activity score recorded at the time of the survey and survivorship of the procedure (p = 0.127). Also, bilateral status was not a risk factor for the revision procedure (p = 0.872).

Discussion

Introduction | Materials and Methods | Results | Discussion | Appendix

In this study, we quantified sporting activity levels after hip resurfacing on the basis of the type of activity and the duration and frequency of typical sessions, calculating two scores, one to reflect the amount of loading and the other to reflect the number of cycles the prosthesis endures during these physical activities. The scope of the Impact and Cycle Score is limited to the sporting activity of the patient and does not evaluate the overall patient activity, as a pedometer study would. We aimed to correlate these scores with the midterm to long-term survivorship of the procedure, but a direct quantification of the daily activity of the patients would certainly have been a useful complement of information. Among the limitations of this study is that participation of the patients in our survey was voluntary. However, our study group included 81% (445) of the 547 patients eligible for the study, and the mean UCLA activity score was comparable with that of the entire series²². Also, sporting activity was only measured between one and five years after surgery, and this measurement did not account for possible changes in the patient activity levels, which are known to slightly decline over time¹³. Another possible limitation was that the date of revision surgery was chosen as the end point for the survivorship analyses instead of the date at which the joint became symptomatic or a date of failure of the components on radiographs. This may have somewhat affected the results of our study because the time between actual failure and the moment of revision may vary on the basis of the activity level and desire of the patient to resume promptly his or her previous lifestyle. However, the time to revision is an objective way to assess failure rates and information that is consistently available for all patients.

To our knowledge, this study is the first to show that excessive participation in sporting activities negatively affects the durability of the implant. This result had not been demonstrated so far in any of the studies investigating sporting activity after modern metal-on-metal hip resurfacing arthroplasty, most likely because these studies had insufficient follow-up time^8-10, and the negative effect of excessive repetitive loading on the prosthetic construct can only be observed after a sufficient delay.

The UCLA activity score, designed in the early 1980s, is at best a qualitative measure, not specific to sporting activities, but is generally recognized as the best activity scale available and has shown only a 4% ceiling effect in patients with a conventional total hip replacement²¹. However, in the present study, with patients who had reconstruction with a hip resurfacing device, the ceiling effect of the UCLA hip activity score was 14.4%, while the sports activity survey scores showed no ceiling effect. The increased ceiling effect, combined with the absence of quantitative assessment in the UCLA activity score, may explain why the UCLA activity score failed to show an association between activity and survivorship, while such an association was demonstrated by the calculation of the sport-specific survey in the present study.

The relative strength of the association between the Impact Score or Hip Cycle Score with the survivorship of the prosthesis suggests that, at the current level of follow-up, high-impact activities may be more detrimental than activities requiring a large number of hip cycles per unit of time. In other words, in choosing activities in which the cardiovascular system is challenged, cycling or backpacking might be more reasonable choices than distance running or singles tennis (Figs. 3-A and 3-B). This current trend is in alignment with the previous findings in the study by Kilgus et al. who demonstrated a clear association between impact activity and a higher failure rate with metal-on-polyethylene all-cemented hip resurfacing devices²³. In addition, these results are consistent with the usual agreement among surgeons that high-impact sports should not be recommended after a hip arthroplasty^24,25. However, the Hip Cycle Score also showed an association with the survivorship of the implants. The wear of metal-on-metal components, although much reduced compared with polyethylene bearings²⁶, is still likely to be affected by a large number of hip cycles. These results could intuitively be expected, given the experience with prior forms of total stem-type arthroplasty²⁷. The advantage of metal-on-metal hip resurfacing resides in the fact that conversion to total hip arthroplasty, if needed, is relatively simple and has been shown to be much like a primary arthroplasty with comparable results^28-33. However, Grammatopolous et al. found that hip resurfacing arthroplasties revised to total hip replacement because of a pseudotumor had poor outcomes³⁴, and de Steiger et al. reported a high risk of rerevision in hips that had undergone a revision of the acetabular component only³⁵. For the patients whose preference is to continue vigorous sporting activities, we believe it is the surgeon's responsibility to optimize techniques to maximize prosthetic durability. On the basis of the results in our study, both patients and surgeons should be aware of the fact that high-demand activities performed frequently are associated with reduced survivorship over time, and patients should be properly counseled with respect to high levels of sporting activity on the basis of the presence of additional risk factors.

A sixty-six-year-old marathon runner who received a hip resurfacing arthroplasty for a diagnosis of severe osteoarthritis of the right hip.

Fig. 3-A

Anteroposterior pelvic radiograph, made five years after the right hip was resurfaced with use of first-generation femoral preparation techniques (insert), demonstrating multiple defects in the right femoral head. One year after surgery, the patient had resumed running competitively and training over twelve times per month. At that time, his Impact Score and Hip Cycle Scores were 60 and 64, respectively, and his UCLA score was 10. The left hip was resurfaced four years after the right, with second-generation surgical technique (insert).

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Fig. 3-B

Anteroposterior radiograph, made eight years after the resurfacing of the right hip, showing the revision of the right hip to a metal-on metal conventional total hip replacement. The revision had been done five years after the resurfacing. Six years after the revision of the right hip, the patient had stopped running and was engaging regularly in cycling.

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The diversity in the physical activities available to the patient after hip surgery and the wide range in the levels of involvement make it challenging for the researcher to establish a quantified relationship between activity and a successful clinical outcome after a hip replacement. For the clinician, an assessment that is simple and quick to perform is important for practical reasons but does not always provide enough information to capture the essence of these activities. We believe that the sports activity survey and scoring algorithm used in the present study provide the information necessary to determine what levels of sporting activity are acceptable to ensure the longevity of hip replacements. Further use of the sports activity survey and scoring algorithms described in the present study and their application in other large series with sufficient follow-up are needed to confirm their validity.

Appendix

Introduction | Materials and Methods | Results | Discussion | Appendix

Tables showing the details of the scoring algorithm are available with the online version of this article as a data supplement at jbjs.org.

Wright JG; Rudicel S; Feinstein AR. Ask patients what they want. Evaluation of individual complaints before total hip replacement. J Bone Joint Surg Br. 1994;76:229-34.

Sequeira MM; Rickenbach M; Wietlisbach V; Tullen B; Schutz Y. Physical activity assessment using a pedometer and its comparison with a questionnaire in a large population survey. Am J Epidemiol. 1995;142:989-99.

Back DL; Dalziel R; Young D; Shimmin A. Early results of primary Birmingham hip resurfacings. An independent prospective study of the first 230 hips. J Bone Joint Surg Br. 2005;87:324-9.

Daniel J; Pynsent PB; McMinn DJ. Metal-on-metal resurfacing of the hip in patients under the age of 55 years with osteoarthritis. J Bone Joint Surg Br. 2004;86:177-88.

De Smet KA. Belgium experience with metal-on-metal surface arthroplasty. Orthop Clin North Am. 2005;36:203-13, ix.

Siebel T; Maubach S; Morlock MM. Lessons learned from early clinical experience and results of 300 ASR hip resurfacing implantations. Proc Inst Mech Eng H. 2006;220:345-53.

Treacy RB; McBryde CW; Pynsent PB. Birmingham hip resurfacing arthroplasty. A minimum follow-up of five years. J Bone Joint Surg Br. 2005;87:167-70.

Banerjee M; Bouillon B; Banerjee C; Bäthis H; Lefering R; Nardini M; Schmidt J. Sports activity after total hip resurfacing. Am J Sports Med. 2010;38:1229-36.

Naal FD; Maffiuletti NA; Munzinger U; Hersche O. Sports after hip resurfacing arthroplasty. Am J Sports Med. 2007;35:705-11.

Narvani AA; Tsiridis E; Nwaboku HC; Bajekal RA. Sporting activity following Birmingham hip resurfacing. Int J Sports Med. 2006;27:505-7.

Fisher NE; Killampalli VV; Kundra RK; Jagodzinski NA; Mathur K; Reading AD. Sporting and physical activity following hip resurfacing. Int Orthop. 2011;35:977-80.

Lavigne M; Masse V; Girard J; Roy AG; Vendittoli PA. [Return to sport after hip resurfacing or total hip arthroplasty: a randomized study]. Rev Chir Orthop Reparatrice Appar Mot. 2008;94:361-7. French.

Le Duff MJ; Amstutz HC. Sporting activity after hip resurfacing: changes over time. Orthop Clin North Am. 2011;42:161-7, vii-viii.

Amstutz HC; Thomas BJ; Jinnah R; Kim W; Grogan T; Yale C. Treatment of primary osteoarthritis of the hip. A comparison of total joint and surface replacement arthroplasty. J Bone Joint Surg Am. 1984;66:228-41.

Biedermann R; Tonin A; Krismer M; Rachbauer F; Eibl G; Stöckl B. Reducing the risk of dislocation after total hip arthroplasty: the effect of orientation of the acetabular component. J Bone Joint Surg Br. 2005;87:762-9.

Langton DJ; Sprowson AP; Mahadeva D; Bhatnagar S; Holland JP; Nargol AV. Cup anteversion in hip resurfacing: validation of EBRA and the presentation of a simple clinical grading system. J Arthroplasty. 2009;25:607-13.

Amstutz HC; Beaulé PE; Dorey FJ; Le Duff MJ; Campbell PA; Gruen TA. Metal-on-metal hybrid surface arthroplasty. Surgical technique. J Bone Joint Surg Am. 2006;88 Suppl 1 Pt 2:234-49.

Amstutz HC; Beaulé PE; Dorey FJ; Le Duff MJ; Campbell PA; Gruen TA. Metal-on-metal hybrid surface arthroplasty: two to six-year follow-up study. J Bone Joint Surg Am. 2004;86:28-39.

Le Duff MJ; Amstutz HC; Dorey FJ. Metal-on-metal hip resurfacing for obese patients. J Bone Joint Surg Am. 2007;89:2705-11.

Amstutz HC; Le Duff MJ; Campbell PA; Dorey FJ. The effects of technique changes on aseptic loosening of the femoral component in hip resurfacing. Results of 600 Conserve Plus with a 3 to 9 year follow-up. J Arthroplasty. 2007;22:481-9.

Naal FD; Impellizzeri FM; Leunig M. Which is the best activity rating scale for patients undergoing total joint arthroplasty?Clin Orthop Relat Res. 2009;467:958-65.

Amstutz HC; Le Duff MJ. Eleven years of experience with metal-on-metal hybrid hip resurfacing: a review of 1000 conserve plus. J Arthroplasty. 2008;23( 6 Suppl 1):36-43.

Kilgus DJ; Dorey FJ; Finerman GA; Amstutz HC. Patient activity, sports participation, and impact loading on the durability of cemented total hip replacements. Clin Orthop Relat Res. 1991;269:25-31.

McGrory BJ; Stuart MJ; Sim FH. Participation in sports after hip and knee arthroplasty: review of literature and survey of surgeon preferences. Mayo Clin Proc. 1995;70:342-8.

Kuster MS. Exercise recommendations after total joint replacement: a review of the current literature and proposal of scientifically based guidelines. Sports Med. 2002;32:433-45.

Schmalzried TP; Shepherd EF; Dorey FJ; Jackson WO; dela Rosa M; Fa'vae F; McKellop HA; McClung CD; Martell J; Moreland JR; Amstutz HC. The John Charnley Award. Wear is a function of use, not time. Clin Orthop Relat Res. 2000;381:36-46.

Golant A; Christoforou DC; Slover JD; Zuckerman JD. Athletic participation after hip and knee arthroplasty. Bull NYU Hosp Jt Dis. 2010;68:76-83.

Ball ST; Le Duff MJ; Amstutz HC. Early results of conversion of a failed femoral component in hip resurfacing arthroplasty. J Bone Joint Surg Am. 2007;89:735-41.

Eswaramoorthy VK; Biant LC; Field RE. Clinical and radiological outcome of stemmed hip replacement after revision from metal-on-metal resurfacing. J Bone Joint Surg Br. 2009;91:1454-8.

McGrath MS; Marker DR; Seyler TM; Ulrich SD; Mont MA. Surface replacement is comparable to primary total hip arthroplasty. Clin Orthop Relat Res. 2009;467:94-100.

Wera GD; Gillespie RJ; Petty C; Petersilge WJ; Kraay MJ; Goldberg VM. Revision of hip resurfacing arthroplasty. Am J Orthop (Belle Mead NJ). 2010;39:E78-83.

Garrett SJ; Bolland BJ; Yates PJ; Gardner EM; Latham JM. Femoral revision in hip resurfacing compared with large-bearing metal-on-metal hip arthroplasty. J Arthroplasty. 2011;26:1214-8.

Sandiford NA; Muirhead-Allwood SK; Skinner JA. Revision of failed hip resurfacing to total hip arthroplasty rapidly relieves pain and improves function in the early post operative period. J Orthop Surg Res. 2010;5:88.

Grammatopolous G; Pandit H; Kwon YM; Gundle R; McLardy-Smith P; Beard DJ; Murray DW; Gill HS. Hip resurfacings revised for inflammatory pseudotumour have a poor outcome. J Bone Joint Surg Br. 2009;91:1019-24.

de Steiger RN; Miller LN; Prosser GH; Graves SE; Davidson DC; Stanford TE. Poor outcome of revised resurfacing hip arthroplasty. Acta Orthop. 2010;81:72-6.

Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Topics

hip joint ; prosthesis failure ; sports ; hip resurfacing arthroplasty

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Michel J. Le Duff, Harlan C. Amstutz; The Relationship of Sporting Activity and Implant Survivorship After Hip Resurfacing. The Journal of Bone & Joint Surgery. 2012 May;94(10):911-918.

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