Modern Hip Resurfacing (eBook)

Over the past 10 years hip resurfacing has become increasingly popular in Europe and North America as an alternative to the more invasive procedure of total hip replacement. Rather than remove the entire femoral head and neck leading to difficulties should the hip replacement need to be revised, resurfacing conserves much more of the patient’s healthy femur and this has been shown to be of great benefit to many patient groups, especially younger and more active patients.Modern Hip Resurfacing includes a huge number of high-quality images designed to guide the reader through the procedure. Mr McMinn is the acknowledged innovator in the technique and has assembled a team of experts in all aspects of the resurfacing procedure, from materials science to the surgical procedure itself. This book represents a comprehensive resource for all orthopedic surgeons wanting to incorporate hip resurfacing into their surgical work and provides a compelling story that reinforces the place resurfacing has taken in the surgeon’s armamentarium.

Foreword 6
Preface 8
Acknowledgments 10
Contents 12
Contributors 14
Chapter 1 16
Development Perspectives 16
Metal on Metal Total Hip Replacement 20
Why Were Metal on Metal Prostheses Abandoned? 25
Difficulty with Manufacture of Cobalt Chrome 25
Ease of Manufacture of Polyethylene 25
Good Initial Results of Metal on Polyethylene Prostheses 25
Michael Freeman, MD, FRCS: His Part in the Downfall of Metal on Metal 25
Sir John Charnley’s Influence 27
Results Obtained Using 500-kg Pendulum 30
Development of My Metal on Metal Hip Resurfacing 31
The Corin Years 31
Pilot Series 33
The Hybrid Series 39
The MMT Years 47
References 56
Chapter 2 57
Materials and Metallurgy 57
Casting Method 64
Thermal Treatments of Cast Alloys 68
The Development of the Birmingham Hip Resurfacing Device 72
Summary 75
References 77
Chapter 3 78
Machining Processes 78
Machining and Finishing 78
Effect of Metallurgical Condition on Machining 78
Available Standards and Measuring Methods 79
Machining Operations 83
Turning 83
Superfinishing 84
Spherical Honing 84
Development of the BHR Sphere Honing Process 85
Exploring Geometric Effects of Sphere Honing 85
Final Finishing 88
Conclusion 90
Chapter 4 91
Hip Joint Tribology 91
Wear and Wear Mechanisms 91
Friction and Lubrication 91
Tribology Testing Using Hip Simulators 91
The Effect of Diameter on the Tribology of a Metal on Metal Implant 96
Theoretical Calculations 97
38-mm-Diameter BHR Head 97
50-mm-Diameter BHR Head 97
Experimental Work 97
The Effect of Clearance on the Tribology of a Metal on Metal Implant 98
The Effect of Cup Orientation on the Tribology of a Metal on Metal Implant 99
Summary 100
References 101
Chapter 5 102
Corrosion and Its Contribution to Metal Release 102
Localized Corrosion 102
Mechanically Enhanced Corrosion 102
Role of Metallurgy in Corrosion 103
Clinical Relevance of Corrosion 103
References 103
Chapter 6 104
Retrieval Analysis 104
Retrievals 104
Methodology 106
Microscopy 106
Device Positioning 106
Case 1: Corin McMinn Device Implanted 1996 Explanted at 5 Years 1 Month
Case 2: S& N Device (BHR)
Case 3: DePuy ASR Device Reported as Explanted at Approximately 2 Years
Case 4: S& N Device (BHR)
Case 5: Zimmer Device (Durom) Explanted at 7 Months
Discussion 116
References 116
Chapter 7 117
Cementing Technique in Birmingham Hip Resurfacing 117
Introduction 117
Bone Mineral Density Cement Study 117
Quantitative Analysis of Cement Penetration 118
Results 118
Discussion 121
Suggested Cementing Technique 121
References 121
Chapter 8 123
Migration Studies 123
The Role of RSA in Assessment of New Implants 123
RSA and Resurfacing 124
Specific RSA Studies of Resurfacing Implants 124
References 126
Chapter 9 127
Vascularity of the Femoral Head in Hip Resurfacing 127
Introduction 127
Anatomy of the Femoral Head Blood Supply 128
Femoral Head Perfusion Studies 129
Retrieval Studies 129
Postoperative Imaging of the Femoral Head 130
The Case for Preserved Viability of the Femoral Head 131
Magnetic Resonance Angiographic Studies 131
Discussion 132
References 133
Chapter 10 135
Femoral Head Blood Supply Studies 135
References 137
Chapter 11 138
Acetabular Bone Conservation 138
Method 138
Observations 138
References 139
Chapter 12 140
Femoral DEXA Studies in Hip Arthroplasty 140
References 142
Chapter 13 143
Metal Ions 143
Cobalt-Chrome Alloy 143
Metal Ions 143
Biochemical Role of Cobalt, Chromium, and Molybdenum 143
Bearing Wear In Vitro and In Vivo 146
In Vitro Wear Measurements 146
In Vivo Wear Measurement 148
Source of Metal Ions In Vivo 149
Metal Particle Versus Metal Ion Release In Vivo 150
Transport of Metal Particles 152
Transport of Metal Ions 152
Clearance of Metal Ions 153
Measurement of Systemic Metal Exposure 154
Analytical Techniques 154
Specimen Selection 155
Metal Ion Levels in Arthroplasty 155
Metal Ion Sequelae Including DNA and Chromosome Damage and Carcinogenesis 157
Placental Transfer 164
Metal Hypersensitivity 165
Tests for Hypersensitivity 167
Lymphocyte Transformation Test 167
Leukocyte Migration Inhibition Factor Test 168
Conclusion 168
References 168
Chapter 14 170
Patient Selection and Timing of Operation 170
Indications 170
Contraindications 170
The Ideal Candidate for a Hip Resurfacing 171
Timing of Operation 171
References 173
Chapter 15 174
Anesthesia, Pain Control, and Thromboprophylaxis 174
Anesthesia 174
Preoperative Assessment 174
Choice of Anesthetic 175
The Technique Currently Used in Birmingham 175
Pain Control 178
Thromboprophylaxis 178
References 181
Chapter 16 182
Anesthesia with Special Emphasis on Pain Control 182
Injectant 182
Catheter 182
Injection Technique 183
Catheter Placement 184
Ancillary Measures 184
Measures to Restrict Drugs to Site of Injection 184
Wound Drains 184
Postoperative Management 184
Recovery Room 184
Opioids 185
Oral and Transdermal Medication 185
Top-up 185
Reinjection 185
Comments 185
References 186
Chapter 17 187
Templating for the Birmingham Hip Resurfacing from Conventional X-Rays 187
Chapter 18 190
Computer Templating of Hip Resurfacing Arthroplasty 190
Introduction 190
Methods 190
Discussion 192
References 193
Chapter 19 194
Patient Positioning and Exposure 194
Chapter 20 228
Acetabular Preparation and Insertion of the Standard Birmingham Hip Resurfacing Cup 228
Chapter 21 242
Acetabular Preparation and Insertion of the Dysplasia Birmingham Hip Resurfacing Cup 242
Chapter 22 269
Implantation of the Femoral Component of the Birmingham Hip Resurfacing 269
Closure 297
Chapter 23 304
Birmingham Mid-Head Resection Prosthesis and Its Implantation 304
Chapter 24 321
Guides, Jigs, and Navigation-Assisted Birmingham Hip Resurfacing 321
Femoral Alignment Jigs 322
Experience with BrainLab Navigation for the Femoral Component of the BHR 330
Jigs and Alignment Devices to Assist with Acetabular Component Placement of the BHR 331
References 334
Chapter 25 335
Management of Complex Anatomy 335
Hip Dysplasia 335
Dysplasia Before the Development of Severe Hip Arthritis 335
Dysplasia with Arthritis (Preoperative Considerations) 335
BHR in Mild to Moderate Dysplasia (Manageable with a Regular BHR Cup) 338
BHR in Severe Acetabular Insufficiency (Managed with a Dysplasia Cup) 340
Femoral Derotation Osteotomy 342
Summary 343
Perthes Disease 343
Preoperative Considerations 343
Operative Technique 344
Summary 345
Slipped Capital Femoral Epiphysis 346
Summary 347
References 348
Chapter 26 350
Outcomes and Standards for Hip Resurfacing 350
Introduction 350
Component Survival 350
Health Status 350
Disability Outcomes 351
Conclusion 355
References 355
Chapter 27 357
Results of Birmingham Hip Resurfacing in Different Diagnoses 357
Osteoarthritis, Destructive Arthritis, Traumatic Arthritis, and Avascular Necrosis 357
Osteoarthritis 358
Radiologic Evaluation 358
Young Patients with Osteoarthritis 362
Avascular Necrosis of the Femoral Head 365
Post-traumatic and Early Destructive Arthritis 366
Childhood Hip Disorders 367
Dysplasia 368
BHR in Mild to Moderate Dysplasia (Regular Cup) 368
BHR in Severe Acetabular Insufficiency (Dysplasia Cup) 368
Conclusion 369
References 370
Chapter 28 371
Complications and Revisions of the Birmingham Hip Resurfacing 371
Introduction 371
General Complications 371
Local Complications 373
Nerve Palsy 373
Revisions 374
Femoral Neck Fracture 375
Femoral Head Collapse 376
Infection 377
Dislocation 379
Unexplained Pain 380
Reoperations 380
Conclusion 381
References 383
Chapter 29 384
Rehabilitation After the Birmingham Hip Resurfacing 384
Day of Operation (Day 0, Postoperative) 384
Stockings/Tyco Calf Compressor 384
Drains 384
Recovery Ward 384
Day 1 Postoperative 385
Blood Test 385
Physiotherapy 385
Do's and Don'ts Prior to Mobilization 385
Day 2 Postoperative 385
Day 3 Postoperative 386
Days 4 to 5 Postoperative 388
Day 6 Postoperative 388
Four Weeks Postoperative 391
Driving 393
Return to Work 393
Six to 8 Weeks Postoperative 393
Hydrotherapy 393
Gymnasium 394
Return to Activities 394
Golf/Tennis 394
Skiing 396
Future Long-Haul Flights 396
Dental Treatment 396
References 396
Chapter 30 397
Recovery and Rehabilitation 397
Adequate Preparation 397
Appropriate Anesthetic Technique 397
Meticulous Postoperative Pain Management 398
Eliminating Unnecessary Interventions and Medications 398
Active Normalization of Physiology After Surgery 398
Immediate Mobilization 398
Reducing Hospital Stay 399
Postoperative Surveillance and Rescue 400
References 400
Chapter 31 401
Final Thoughts 401
References 405
Chapter 32 406
Conservative total Articular Replacement Arthroplasty: Minimum 20-Year Follow-Up 406
Introduction 406
Materials and Methods 406
Patient Population 406
Surgical Procedure and Implants 407
Patient Follow-Up 407
Statistical Analysis 408
Results 408
Clinical Results 408
Radiographic Analysis 409
Revision of the Resurfacing Prosthesis 409
Prosthesis Survival 409
Discussion 410
Conclusion 411
References 412
Index 413