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Birmingham Hip Replacement - Under 50

Fourteen year follow-up of Birmingham Hip Resurfacing in patients under the age of 50, by C. W. McBryde, R.B.C. Treacy, W.B. Pynsent & P.B. Pynsent.

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Birmingham Hip Replacement - Under 50

  1. 1. Fourteen year follow-up of Birmingham Hip Resurfacing in patients under the age of 50 C. W. McBryde, R. B. C. Treacy, W. B. Pynsent & P. B. Pynsent Research & Teaching Centre, Royal Orthopaedic Hospital, Birmingham, U.K
  2. 2. Survival of hip replacement in the under 50
  3. 3. Oct 2011 - 3668 THRs under age 55 15 year survival 62% uncemented and 58% cemented Finish arthroplasty register
  4. 4. The Case Series Single surgeon consecutive all- inclusive series (RBCT) All NHS (public) patients Data collected prospectively and supplemented retrospectively
  5. 5. Demographics 447 BHRs in 393 patients August 1997 to April 2006 267 (60%) male and 180 (40%) female Mean age 41.1 years (range 15-49) Median follow up 8.0 yrs (range 5.0- 14.0)
  6. 6. Indications for primary surgery
  7. 7. Surgery All performed by RBCT Laminar air flow theatre Posterior approach with release of glut. max. Posterior capsulectomy and anterior capsulotomy Head prepared with standard instrumentation Low viscosity cemented femur, uncemented acetabulum
  8. 8. Revisions, Oxford hip score, Radiology. 4 tranches of targeted mail shots to addresses from the ROH and Oswestry databases Personal home visit and telephone calls Patient tracking via independent private agency Very time consuming and expensive Methods
  9. 9. Time to find patients from 1st April 2009 Time (months) Numberofpatients
  10. 10. Estimated 10 year survival assuming all lost to follow-up have failed Survival at 10 years Cumulativeproportionsurviving As of December 2011 - none lost to follow-up
  11. 11. Cumulativeproportionsurviving Time (years) Survival 89.2% at 14 years Survival 95.1% at 10 years KM survival of 447 BHRs in patients under the age of 50
  12. 12. Revision Sex Age Diagnosis Head size Time (years) Reason for revision 1 f 49 OA 46 0.5 Loose-acet 2 m 44 OA 54 0.5 Infection 3 f 49 OA 42 0.7 #NOF 4 f 49 OA 46 1.8 NA 5 f 48 OA 46 2.2 Infection 6 f 43 OA 42 5.3 Infection 7 m 42 AVN 50 5.9 Loose-fem 8 f 26 DDH 42 6.3 Loose-fem 9 f 42 OA 42 6.7 Loose-fem 10 m 30 RA 46 7.1 NA 11 f 17 Inflam 42 9.4 Loose-fem 12 m 30 AVN 50 9.5 Loose-fem 13 f 17 AVN 42 9.9 AVN 14 f 49 OA 50 10.2 Pain 15 f 36 OA 46 10.8 Implant fracture 16 m 43 Perthe’s 50 11.8 Loose-fem
  13. 13. Cumulativeproportionsurviving Time (years) Aseptic femoral loosening
  14. 14. Cumulativeproportionsurviving Time (years) Infection #Nof Pain AVN
  15. 15. KM survival of 195 BHRs in male patients with OA under the age of 50 (aseptic revisions) Cumulativeproportionsurviving Time (years) Survival 100% at 14 years Male, OA under 50 years
  16. 16. KM survival of 105 BHRs in female patients with OA under the age of 50 (aseptic revisions) Cumulativeproportionsurviving Time (years) Survival 95.9% at 10 years Survival 87.2% at 14 years Female, OA under 50 years
  17. 17. Cumulativeproportionsurviving Time (years)
  18. 18. Male 10 year survival - 100% (100-100) Female 10 year survival - 95.9% (90.2-99.9) Cox-prop hazard - p = 0.024 Head size highly significant - small worse Cox-prop hazard - p = 0.004 7 deaths during follow-up - all unrelated Results
  19. 19. Oxford hip score -standards developed from 6,602 Time (years) Score(%) 95% 75% 50% 25% 5%
  20. 20. Oxford hip scores for under 50 group Time (years) Score(%) 711/1394 (51%) post -op scores below median standard
  21. 21. Oxford hip score Time (years) Score(%) Flooring effect. Do we need a different scoring system?
  22. 22. No comparative group Radiographic analysis available on 44% Metal ions not available Designer surgeon series Limitations of this case series
  23. 23. JBJS Br March 2012 - Melbourne group 230 BHRs mean fu 10 years 94.5% overall, male 97.5%, female 89.1% 7% lost to follow-up Women/ small size - is it still acceptable to resurface women? BHR results from independent centre
  24. 24. No aseptic failure in male patient with OA (195 cases 100% survival at 14 years) Higher revision rate in women - but still acceptable, within NICE guidelines Small sizes (<46) and other diagnoses (abnormal anatomy) be cautious Conclusions
  25. 25. Birmingham Hip resurfacing provides excellent results in previously difficult to treat group Reactions to metal debris are rare Bad designs and poor surgery have tarnished an otherwise great advance in hip surgery Conclusions

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