| Background and purposes: Of all the species, only humans have the bipedal gaits and carry on every activity with unique pairs of lower extremities. Smooth movement and stability of human hip joints are essential factors for all necessary function of lower extremities. Various diseases could cause malfunction of hip joints. Presently, the total hip resurface arthroplasty (HRA) is one of the most effective procedures to reconstruct the function of hip joints. Evolution in design technology and metallurgy helps solve and overcome many of the problems that plagued early resurfacing designs, such as high wear rates and massive bone loss with cemented acetabular components. Statistically, the average age of patients undergoing HRA is decreasing dramatically. In addition, post-operative expectations of patients, back to their normal lives and recreation are placing a higher demand on the longevity of the artificial prostheses. Thus, new implant designs and bearing surface have been introduced, indicating the resurgence of hip resurfacing in the last decade. As a result, advanced HRA figures as a popular and reasonable choice among many kinds of hip arthroplasty. As indications for total hip replacement (THR) began to include younger patients and those with a more active life style, the longevity of the implant became a concern. Evidence suggested that these patients had experienced relatively higher rates of early implant failure and the multiple revisions. Current hip resurfacing systems utilize a hybrid design, one cemented femoral head with press-fit acetabular components, which preserves more original hip anatomy, natural biomechanics transmission, and optimizes range of motion with inherent stability. The preservation of bone stock and durable longevity of HRA enable patients to enjoy an active lifestyle without increasing the morbidity of possible future revision. Consequently, HRA represents an attractive alternative treatment and is well received nationally. Conditions improved in early- and mid-period have been further favorable in comparison with traditional hip arthroplasty by proper patients selection and well-trained skill.The purpose of the study is to analyze the follow-up results of the primary HRA at HauZhung University of Science and Technology subsidiary Union Hospital dept. of orthopedics. According to the standard Harris Hip Score (1969) and Hungerford rating, we evaluate the therapeutic effects of HRA and the succeeding rate of the selected patients in order to provide the primary gist for estimation of the prognosis, therapeutic effect, and the postoperative care of HRA in these different diseases. Materia] and Methods: 52 patients (55 hips) who had received primary HRA in our department during 2007-2009, in which we obtained the pre-operation evaluation and follow-up regularly for 8 weeks, 6 months, and 12 months. There were 27 males and 16 females, altogether 43 cases (45 hips) included in the data and subsumed to study. The average duration of follow-up was 12 months (2 to 17 months). We divided these patients into 3 groups according to the primary diagnosis: Avascular necrosis of femoral head (ANFH), Osteoarthritis (OA), and Ankylosing spondylitis(AS). 18 cases for unilateral HRA, 1 case for one side HRA and opposite THA, and 1 case for bilateral HRA of total 20 cases (21 hips) in ANFH group; 12 cases for unilateral HRA and 1 case for bilateral HRA of total 13 patients (14 hips) in OA group; all 10 cases (10 hips) for unilateral HRA in AS group. Their average age is 44.6 years old (ranged 31-57 years old). All patients have suffered hip pain and limitation of movement. The mean Harris hip score (HHS) of 64.6 points (ranged 45-73.5) preoperatively. We have performed standard surgical technique of HRA on patients, and evaluated the effects of HRA among different hip joint diseases by utilizing the classified hip score, which is based on standard content of Harris Hip Score. The follow-up data have been collected and sent to SPSS software carrying on preliminary statistics analysis. Furthermore, we have used the Hungerford standard to appraisal the succeeding rate of HRA.Result: The data of 43 patients (45 hips) out of 52 HRA patients were collected completely during the study. 82.6% of 52 patients replied full information and 17.4% of patients were missing. The average duration of follow-up was 12 months (2 to 17 months). The mean Harris score has advanced from 64.6 points preoperatively to 90.1 points at the end time of final follow-up. The result revealed that the mean Harris score of the ANFH group (average age 43.7 years old) has increased from 62.6 points preoperatively to 92.0 points at the finale; the OA group (44.6 years old) from 66.2 points to 89.8 points; the AS group (48.0 years old) from 65.5 points to 87.4 points. 3 patients received bilateral simultaneous HRA, in which 2 cases were done by bilateral HRA and 1 case by unilateral HRA and opposite THR. Among the 45 hips, one ANFH patient (2.2%) complained of moderate pain and loss of independent movement; one OA patient with the cardiovascular disease led to limitation and poor tolerance of functional activities; one AS patient (2.2%) developed recurrence in 8 weeks postoperatively and relied on the crutches in successive 6 months due to the flexion contracture of the hip with mild pain, abnormal gaits, and the limitation of functional activities. From 6 to 12 months follow-up in OA patients, the postoperative function had no distinct difference. No more severe complications, such as neuromuscular paralysis, embolism, dislocation or fracture, etc. occurred in our study. All patients had satisfying improvement in the hip function and movement.In the comparative analysis of the 3 groups of patients with classified Harris score, we found that ANFH group has a good result with mean Harris score of 92.0 points (p<0.05), subdivision in Pain of 41.8 points (mean, p<0.05); the OA group has the score of 89.8 points; the mean score of AS group is relatively low (87.4 points). The hip function of the simultaneous bilateral resurfacing patients had virtually normal level at 6 months postoperatively. Some OA patients used NSAIDs might lead the deviation of the analysis. Recurrence appeared in AS patients decreased the points of HHS. In addition, the score under 80 points were found in 2 cases. One had the previous deformity history, crippled after resurfacing, and the other had the sustained joint irritation postoperatively. Based on Harris system, 27 hips excellent, 16 hips good, 2 hips moderate and the overall effectiveness were 95.5%. According to Hungerford standard, the average succeeding rate was 95.3%.Conclusion: Patients selection is the prerequisite to the success of the procedure. The arthroplasty should be performed by surgeons with considerable experience in hip reconstruction. The optimal surgical pathway for resurfacing is that surgeons initially use the approach by which they are most comfortable to reduce unnecessary faults, raise implants probability of succeeding and reconstruct the hip as normality. The classified hip rating mode not only eliminates the defects of Harris hip score (1969) in clinical evaluation of the effects of HRA, but also provides further objectivity in analyzing the results, and instructions to physical rehabilitation systematically. The ratio of those patients lost in follow-up is a major factor affecting the analysis of HRA efficacy. It is certainly important to promote the follow-up of resurfacing for predicting the prognosis and comparing the effects of HRA precisely in different hip diseases. Therefore, it is absolutely necessary to set up the national HRA registry system and managed mail to help provide needed clinical statistical data. It will be used to improve the surgical technique of our country, especially for orthopedic surgeons. Compared with foreign studies, the finding is that the HRA has fewer examples available as well as unpopular in China nowadays due to several aspects, such as medical characteristics, health care policy, and economic factor, etc. Consequently, the suboptimal analysis existed so that the statistical deviation of the results was inevitable. The proper selection criteria of HRA for Orientals will expectedly make more beneficiaries in China. Therefore, the conventional total hip replacement should be executed to the ANFH patient with the unacceptable residual femoral head defect. The HRA demonstrates the efficacy to both ANFH and OA patients in alleviation of hip pain, ideal range of motion, and normal life resumed within a short time. The successful simultaneous bilateral hip resurfacing enables the hip to perform almost normal joint function postoperatively. Avoiding early full body-weight loading is essential to reduce the femoral neck fracture accidents. The exercise will help facilitate the recovery of cardiopulmonary function in the patients with cardiovascular diseases while hip pain is relieved after resurfacing. Recurrent syndromes of ankylosing spondylitis might take pace in the AS patients and diminish the joints range of motion or walking ability. Hence, the long-term prevention, correction of deformity and the postoperative care should include the social and psychological support. This study found HRA presented the excellent results in the early-period follow-up without other severe complications. It is a great achievement revealed in our surgical technique level and the credible accomplishment, development from our medical team. To educate the cognition of prostheses and the methods of correct movement, carrying out the definitive rehabilitation and the good doctor-patient relationship after HRA, have profound influence on patients' whole lives. Finally, the continued follow-up and advanced study to confirm the recent conclusion is definitely required.
|
PDF Full Text Request