Abstract
Purpose
Despite the increasing interest and subsequent published literature on hip resurfacing arthroplasty, little is known about the prevalence of its complications and in particular the less common modes of failure. The aim of this study was to identify the prevalence of failure of hip resurfacing arthroplasty and to analyse the reasons for it.
Method
From a multi-surgeon series (141 surgeons) of 5000 Bimingham hip resurfacings we have analysed the modes, prevalence, gender differences and times to failure of any hip requiring revision surgery.
Results
To date 182 hips have been revised (3.6%). The most common cause for revision was a fracture of the neck of the femur (54 hips, prevalence 1.1%), followed by loosening of the acetabular component (32 hips, 0.6%), collapse of the femoral head/avascular necrosis (30 hips, 0.6%), loosening of the femoral component (19 hips, 0.4%), infection (17 hips, 0.3%), pain with aseptic lymphocytic vascular and associated lesions (ALVAL)/metallosis (15 hips, 0.3%), loosening of both components (5 hips, 0.1%) dislocation (5 hips, 0.1%) and malposition of the acetabular component (3 hips, 0.1%). In two cases the cause of failure was unknown.
Comparing men with women, we found the prevalence of revision to be significantly higher in women (women = 5.7%; men = 2.6%. p<0.001). When analysing the individual modes of failure we found women to have significantly more revisions for loosening of the acetabular component, dislocation, infection and pain/ALVAL/metallosis (p<0.001, p=0.004, p=0.008, p=0.01 respectively).
The mean time to failure was 2.9 years (0.003 to 11.0) for all causes, with revisions for fracture of the neck of the femur occurring earlier than other causes (mean 1.5 years, 0.02 to 11.0). There was a significantly shorter time to failure in men (mean 2.1 years, 0.4 to 8.7) compared with women (mean 3.6 years, 0.003 to 11.0) (p<0.001).
Conclusion
Hip resurfacing has its own unique set of complications, including fracture of the neck of the femur. It is important to understand the prevalence of complications as well as the risk factors in order to appropriately select patients and adequately inform them prior to hip resurfacing arthroplasty.
