Data from a 243 patient, prospective longitudinal study comparing asymptomatic individuals who have undergone hip resurfacing arthroplasty to those who had ceramic on polyethylene total hip arthroplasty (THA) has just been published. The team who pulled together this first-of-its-kind study were from Hospital for Special Surgery (HSS) in New York, and they enrolled patients who had received these surgeries between March 2014 and February 2019.
Their study, “Adverse Local Tissue Reactions are Common in Asymptomatic Individuals After Hip Resurfacing Arthroplasty: Interim Report from a Prospective Longitudinal Study,” appears in the July 8, 2021 edition of Clinical Orthopaedics and Related Research.
The HSS researchers looked at MRI images, collected blood serum ion levels and used the Hip Disability and Osteoarthritis Outcome Score survey at baseline, year 1, year 2, and year 3—each with 1-year intervals.
The team found that at all four follow-up times, patients with unilateral hip resurfacing arthroplasty had higher cobalt and chromium serum ion levels than those with unilateral ceramic on polyethylene bearings. In addition, more patients who had a hip resurfacing arthroplasty developed adverse local tissue reactions (ALTR) or metallosis on MRI than did patients who got ceramic on polyethylene bearings.
Hollis Potter, M.D., chairman of the Department of Radiology and Imaging and the Coleman Chair in MRI Research at HSS and the study’s senior author, told OTW, “While the majority of these high functioning individuals with HRA [hip resurfacing arthroplasty] had no adverse local tissue reaction, longitudinal yearly evaluation disclosed that more patients who received a HRA developed ALTR or metallosis on MRI than patients who had ceramic on polyethylene bearings (hazard ratio 4.8 (95% CI 1.2-18.4); p=0.02).”
“Further, the presence of periprosthetic fluids collections posterior to the hip joint, in the absence of MR features of metallosis or an adverse local tissue reaction (low signal intensity debris or thickened synovial lining) are common, and by themselves are not indicative of an ALTR. Serum ion levels were inconsistent in the diagnosis of an ALTR.”
“These data underscore that adverse local tissue reactions can occur in high functioning, asymptomatic individuals with good function scores and that serum ion levels and symptoms alone are not predictive of the presence and magnitude of adverse local tissue reactions.”
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Edwin Su, M.D., an attending orthopedic surgeon at HSS and a co-author on this work, commented to OTW, “This study highlights the value in using MRI to evaluate patients with metal-on-metal hip resurfacing. It demonstrates that metal levels or clinical performance do not always correlate with MRI findings of adverse local tissue reaction, and therefore all of this information is valuable in the evaluation of such a patient. Just as I would not recommend the sole use of metal ion levels in deciding management of a patient, similarly, I would not utilize MR information alone to make decisions. All of the information—clinical picture, metal ions, and MR information—should be used in concert in managing the patient with a metal-on-metal hip resurfacing.”
The 1st paragraph said the study compared hip resurfacing to total hip replacement. I didn’t see language reflecting this premise. But I am interested in getting a hip resurface verses a total hip. I have been and plan to be very physically active as long as I can walk on 2 legs. Fencing, cycling, and tennis are my top activities. I am turning 65 this month, but I should have still been offered hip resurfacing as an option by my doctors. They only talked about total hip. As a surgical technologist involved with my fair share of hip surgeries, I wanted to hear options other than total hip but my questions kept getting redirected and generally ignored by each doctor I spoke to. It’s like other doctors don’t want to step on the first doctor’s diagnosis. It seems that my being a woman and also considered to be old; ergo: over 60, are factors in disregarding me as an active individual who deserves every opportunity to stay that way. I looked at your patient testimonials regarding hip resurfacing and did not notice any females in that group. Is it a common practice not to offer hip resurfacing to women?
The hip resurfacing procedure is less likely to be appropriate for women, based on the anatomical differences between typical male and female skeletons. The biggest and most consequential risk of the hip resurfacing procedure is post-operative fracture of the femoral neck. This risk is much higher for a woman’s femur for multiple reasons, including pelvic width and post-menopausal bone density loss.
Correction: the testimonials were on a different website.