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August 18, 2010
Research Summary for My In-Service Presentation on Hip Replacement vs. Hip Resurfacing
Every semester, as part of my educational requirement, I have to ask a clinical question that related to the clinic setting that I am in and find research articles that answer that question. Following is my research question:
In patients with hip osteoarthritis, are there advantages in hip resurfacing compared to total hip replacement in terms of life of the appliance, surgical procedure, and rehabilitation time?
I have included my summary of the articles that I researched:
The demographics of patients who undergo hip replacement surgery are getting younger and more active than ever. These factors test the life of the appliances, increase the likelihood of revision surgery, and affect length of rehabilitation and final outcomes. More research is needed to compare the pros and cons of hip resurfacing and total hip replacement surgeries.
Examining whether these new procedures help preserve or improve bone remodelling is important, especially in young patients, should future hip surgeries be needed. According to Vendittoli et al. resurfacing preserves femoral bone, and, with proper physiological loading, allows for optimal remodelling and an increase in post-operative bone density of the femoral neck. The amount of bone removed from the acetabulum during resurfacing is comparable to traditional total hip arthroplasty.
Bone conservation, especially in patients who are under age 65, is critically important should the patient require future surgery with conventional total hip arthroplasty (THA). Resurfacing preserves femoral bone, but what quality of bone density exists at the femoral neck during the phases of healing following hip resurfacing? Cooke et al. found that femoral neck fracture, when it occurs, happens around 15 weeks following surgery. Decrease in bone mineral density in the first 6 weeks to three months following surgery would suggest that care must be taken in order to prevent femoral neck fracture for up to a year.
Gait is the most important component of hip replacement therapy. Therefore it is logical to compare gait patterns and hip biomechanics of patients who have undergone hip replacement and resurfacing surgeries. Surface hip arthroplasty patients tend to return to a normal gait pattern, whereas, total hip arthroplasty patients develop adaptive strategies for gait. This adaptive strategy is thought to control center of mass and help generate energy for the swing phase of gait. Hip abductor weakness alters gait in the frontal plane of both surgery groups and extra focus must occur here during rehabilitation. Nantel et al. suggest low-resistance strengthening in weight-bearing tasks, along with one-legged stance exercises.
At Lakeshore, our patient population is generally elderly, often with comorbidities that compromise bone density. However, as the baby boom generation ages, more and more patients under age 65 arrive having had hip surgery and complicating comorbidities. As hip arthroplasty surgeries become more innovative, it is helpful to discern if these new procedures create advantages or change the way we rehabilitate patients of all ages.
References:
1. PA Vendittoli, M Lavigne, J Girard, AG Roy. A randomised study comparing resection of acetabular bone at resurfacing and total hip replacement. J Bone Joint Surg. 2006;88-B:(8):997-1002.
2. Cooke NJ, Rodgers L, Rawlings D, McCaskie AW, Holland JP. Bone density of the femoral neck following Birmingham hip resurfacing: A 2-year prospective study in 27 hips. Acta Orthopaedica. 2009;80:(6):660–665.
3. Nantel J, Termoz N, Vendittoli PA, Lavigne M, Prince F. Gait Patterns After Total Hip Arthroplasty and Surface Replacement Arthroplasty. Arch Phys Med Rehabil. 2009;90: 463-469.
Posted by linda at August 18, 2010 3:43 PM
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