Survival, complications and functional outcome of the Birmingham hip resurfacing compared to cementless total hip arthroplasty.

Braaksma, C. (2015) Survival, complications and functional outcome of the Birmingham hip resurfacing compared to cementless total hip arthroplasty. thesis, Medicine.

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Abstract

Introduction MoM hip prostheses like the Birmingham Hip Resurfacing (BHR; Smith&Nephew, Warwick, United Kingdom) are currently the topic of intense scientific as well as public debate because of severe complications that are reported with the use of this prosthetic. The most commonly employed alternative to this prosthesis in a similar patient population is cementless total hip arthroplasty (THA). The primary aim of this study was to compare these groups with regards to revision rate, survival, complications and functional outcome. The secondary aim was to identify prognostic factors for revision. Method This retrospective cohort study describes all patients who underwent a BHR procedure or cementless THA with the Omnifit prosthesis (Stryker Howmedica Osteonics, Allendale, New Jersey) or Accolade prosthesis (Stryker AccoladeTM TMZF, Mahwah, New Jersey) between 1 January 2006 and 31 December 2012 in the St. Antonius Hospital, Utrecht, The Netherlands. The patient characteristics, type of prosthesis implanted, and reported complications, revisions and mortality, were retrospectively collected from the medical charts. Patients were sent several questionnaires; the Oxford Hip Score (OHS), Hip disability and Osteoarthritis Outcome Score Physical function Short form (HOOS-PS), pain scores, EQ-5D and questions regarding the occurrence of complications and revisions. Multiple stepwise logistic regression was performed to identify prognostic factors for revision. Survival was analysed with Kaplan Meier survival analysis and Cox proportional hazard analysis. Results The survival rate was 86.5% in the BHR group (n = 104) after an average of six years follow-up, 92.3% for the Omnifit prosthesis (n = 117) after five years follow-up and 100% in the Accolade group (n = 44) with a four-year follow-up (p = 0.080). In the BHR group, a smaller femoral component size and an implantation of a prosthesis on both sides was predicative for a higher risk of revision (respectively p = 0.007 and p = 0.022). Specific complications related to the BHR included fractures of the femoral neck, increased cobalt levels and adverse reaction to metal debris. Specific complications for the Omnifit prosthesis were ‘thigh pain', aseptic loosening and the occurrence of fissure of the proximal femur. The BHR group scored favourably compared to the Omnifit group at the HOOS-PS and the OHS (p = 0.001, p = 0.008) and had less pain at rest compared to the Omnifit group (p = 0.041). The results of the EQ-5D and pain scores during load were not significant different between groups. Conclusion Based on these study results, the BHR has higher revision rates than the Omnifit and the Accolade prostheses, although these results were not significant different. The BHR group had the lowest survival percentage after a median-term follow-up. However, the BHR scored better with regards to functional outcomes and had less pain at rest. The Omnifit and BHR prosthesis had both specific prosthesis-related complications. In the BHR group, patients with smaller femoral component size and bilateral hip arthroplasty were more likely to be subject to revision. The Accolade prosthesis had excellent survival and functional outcomes after a short-term follow-up and had moreover less outliers at outcome measures compared to the Omnifit and BHR prosthesis.

Item Type:	Thesis (Thesis)
Supervisor name:	Veen, Dr. M.R. and Wolterbeek, Dr. N. and St. Antonius Ziekenhuis, Leidsche Rijn and Gerritsma-Bleeker, Dr. C.L.E. and Martini Ziekenhuis
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:42
Last Modified:	25 Jun 2020 10:42
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/401

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