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Clinical Issues   |    
Metal-on-Metal Hip Resurfacing with an Uncemented Femoral ComponentA Seven-Year Follow-up Study
Thomas P. Gross, MD1; Fei Liu, PhD1
1 Midlands Orthopaedics, 1910 Blanding Street, Columbia, SC 29201. E-mail address for T.P. Gross: grossortho@yahoo.com
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. 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 (Corin Ltd.). Also, a commercial entity (Corin Ltd.) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated.

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2008 Aug 01;90(Supplement 3):32-37. doi: 10.2106/JBJS.H.00614
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Abstract

Background: Metal-on-metal hip resurfacing with hybrid fixation has been introduced as an alternative to standard total hip arthroplasty, especially for young and active patients. There are few studies in the literature on the midterm results of cementless femoral side resurfacing. The purpose of this study was to present our seven-year clinical results of a series of twenty cementless metal-on-metal hip resurfacing procedures.

Methods: Between 1999 and 2000, eighteen patients (twenty hips) underwent primary metal-on-metal hip resurfacing with uncemented femoral and acetabular components. One patient was lost to follow-up. This left eleven men and six women, who had a mean age of forty-five years at the time of surgery. Clinical and radiographic examinations were performed prospectively, and the results were analyzed.

Results: The mean duration of follow-up was 7.4 years. There were four revisions, none of which was due to aseptic failure of the femoral component. Two were due to loosening of the acetabular component, one was due to a late hematogenous infection, and one was due to persistent pain despite normal radiographic findings. The mean preoperative Harris hip score was 54 points, and it increased to 94 points at the time of the last follow-up. Radiographic examination of the hips for which the procedure was successful revealed no femoral or acetabular radiolucencies, no migration of any implant, and no osteolysis. The radiographs of one patient (two hips) showed substantial narrowing of the femoral necks (a mean of 12%), which stabilized at three years postoperatively. This patient had a Harris hip score of 100 points for both hips at six years.

Conclusions: This study suggests that cementless femoral fixation may be a viable alternative to fixation with cement in metal-on-metal hip resurfacing. Further study of this concept in larger numbers of patients is warranted.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    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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