Hip - Clinical Data
Publications
Partial hemi-resurfacing of the hip joint--a new approach to treat local osteochondral defects?
Jäger M, Begg MJ, Krauspe R.
Biomed Tech (Berl). 2006 Dec;51(5-6):371-6.
Department of Orthopaedics, Heinrich-Heine University Hospital Düsseldorf, Düsseldorf, Germany.
jaeger@med.uni-duesseldorf.de
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Abstract
There is currently renewed interest in articular resurfacing for the treatment of damaged hip-joint cartilage. In contrast to these implants, which involve endoprosthetic replacement of both articulating surfaces, we present a new joint-preserving technique that allows treatment of local osteochondral defects of the femoral head by partial hemi-resurfacing. In this study we describe the operative and technical aspects and problems for partial hemi-resurfacing of the hip joint and critically discuss indication temp
s for this procedure in one case. To guarantee an adequate view of the situs, we recommend a surgical approach involving trochanter flip osteotomy, followed by surgical dislocation of the hip joint. Besides partial hemi-resurfacing of the osteochondral defect, this approach allows treatment of associated labral tears and cartilage defects of the hip joint at the same time. For adequate implant fixation, good bone quality is required. Furthermore, osteochondral defects of limited extent and excellent patient compliance are essential for clinical success. In particular, prominence of the implant has to be avoided, which can lead to an irregular joint surface and may induce further cartilage destruction. Long-term studies on statistical populations will show if partial articular hemi-resurfacing is a bone-preserving and useful therapeutic alternative to hemi-resurfacing caps in the treatment of osteochondral hip-joint defects, especially in young patients.
Partial resurfacing with varus osteotomy for an osteochondral defect of the femoral head
Renee A. Van Stralen, Daniel Haverkamp, Christiaan J.A. Van Bergen, Henk Eijer
Hip Int 2009; 19(1): 67 - 70
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Pubmed Abstract:
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Abstract
Osteochondral defects of the femoral head represent a major challenge and various modern treatment options exist. We report a 16-year-old male with a large (3 x 3cm) osteochondral defect of the femoral head that was treated with a partial resurfacing prosthesis combined with a high varus osteotomy, performed by surgical dislocation of the hip. Two years after surgery the patient was progressing well without complications.
Restoration of hip joint congruency after Perthes disease with partial arthroplasty: a new technique
A. Bucknill and R. De Steiger
Journal of Bone and Joint Surgery - British Volume, Vol 92-B, Issue SUPP_IV, 512. 2010
EFORT Central Office, Technoparkstrasse 1, CH – 8005 Zürich, Switzerland
office@efort.org
Publisher Abstract: http://proceedings.jbjs.org.uk/cgi/content/abstract/92-B/SUPP_IV/512:
Abstract
Perthes disease often leaves young adults with hip joint incongruency due to femoral head asphericity, (an extra-articular extrusion and a superior flattening). This causes femoroacetabular impingement, a reduced range of movement and early degenerative change. We report a novel method for restoration of femoral head sphericity and femoroacetabular congruency. 2 males (21 & 22 years) presented with groin pain and severe hip stiffness after childhood Perthes disease. Imaging confirmed characteristic saddle shaped deformities of the femoral head, with central depression and overlying cartilage loss. A new method of treatment was proposed. Both cases were treated in the same manner. Using a surgical dislocation with the trochanteric flip osteotomy it was possible to remove the extra-articular bump to reduce femoroacetabular impingement. We found that the sphericity of the femoral head could be restored using a HemiCAP partial resurfacing (Arthrosurface, MA, USA). The radius of the implant was selected to match that of the acetabulum. Restoration of the height of the flattened portion of the weight-bearing surface of the femoral head reduces abnormal loading of the acetabular articular cartilage by improving congruency of the joint. At a minimum of 3 year follow up both patients had sustained improved range of movement, pain and Oxford hip score. Repeated imaging shows no evidence of joint space narrowing or loosening at this stage. We conclude that this novel treatment functions well in the short term. Further studies are needed to confirm that after Perthes disease this treatment results in improved long term durability of the natural hip joint.
Mid-term results of partial hip resurfacing
A. Tzaveas; and R. Villar
The Richard Villar Practice, Wellington Hospital
Journal of Bone and Joint Surgery - British Volume, Vol 93-B, Issue SUPP_III, 353. 2011
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Abstract
Isolated osteochondral defects (OCD) of the femoral head remain a challenging issue for the surgeons when trying to balance between a less invasive procedure and the maximum benefit for the patient. We present our experience of the HemiCAP partial hip resurfacing system in 12 patients. In ten patients the defects were identified arthroscopically. Seven of them had concurrent early degeneration of cartilage (OA, Grade I). Three patients had OCD surrounded by normal cartilage and two patients had avascular necrosis. The mean patient age was 41 years (30 to 63) and mean follow-up 27 months (range 9 to 48).
Five patients required a hip resurfacing arthroplasty or total hip replacement at a mean interval of 17 months (12 to 24) due to persistent pain. Three patients required further hip arthroscopy at a mean interval of 36 months (range, 24 to 48). Four patients did not require secondary surgery with mean follow-up 32.7 months (range, 9 to 43). In all hips with revision surgery the components were found to be stable and secure.
Partial resurfacing arthroplasty seems to have a tendency towards early failure, especially in OA patients, but more favorable results in AVN patients and the surgeons should have a cautious approach to this type of arthroplasty.
