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What Are the Risks Accompanying the Reduced Wear Benefit of Low-clearance Hip Resurfacing?

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Clearance is an important determinant of metal-metal bearing function. Tribologic theory and laboratory evidence suggest low clearance (LC) reduces wear but with a potential to increase friction and clinical reports show LC resurfacings have high implant failure rates. Thus, the role of LC is unclear.

Questions/Purposes

We asked: is in vivo wear as reflected by cobalt (Co) and chromium (Cr) levels reduced in LC bearings, and if so, is this benefit offset by increased friction as assessed by implant-bone interface changes?

Methods

We retrospectively reviewed 26 patients with LC resurfacings. We assessed Co and Cr levels in blood and urine, hip function, and radiographic adverse features. These data were compared with those from 26 patients with a similar resurfacing but with conventional clearance (CC) from a previous study. Minimum followup was 4.0 years (mean, 4.1 years; range, 4.0–4.7 years).

Results

Co and Cr ion comparisons showed three phases: in the first 2 months, there was no difference between the cohorts; at 2 to 24 months, the CC group showed higher levels; and subsequently, levels in the two groups converged. A mean Oxford hip score of 13 and step activity of 1.9 million cycles per year in the LC group were similar to those of the CC group. Cup radiolucencies were seen in three patients in the LC group and none in the CC group.

Conclusions

Lower Co and Cr levels suggest lower wear in the LC resurfacings in the intermediate term, but the presence of radiolucencies raises the concern that higher bearing friction is affecting implant fixation. A larger clearance than the theoretically predicted ideal may be required to allow for minor manufacturing imperfections, component deformation, and progressive changes in the in vivo lubricant.

Level of Evidence

Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Author information

Authors and Affiliations

  1. The McMinn Centre, 25 Highfield Road, Edgbaston, Birmingham, B15 3DP, UK

    Joseph Daniel FRCS MS(Orth), Hena Ziaee BSc(Hons), Chandra Pradhan FRCS MCh(Orth) & Derek McMinn MD, FRCS

  2. Implant Development Centre, Smith and Nephew Orthopaedics UK Ltd, Leamington, UK

    Amir Kamali PhD, MEng

Authors
  1. Joseph Daniel FRCS MS(Orth)
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  2. Hena Ziaee BSc(Hons)
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  3. Amir Kamali PhD, MEng
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  4. Chandra Pradhan FRCS MCh(Orth)
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  5. Derek McMinn MD, FRCS
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Corresponding author

Correspondence to Joseph Daniel FRCS MS(Orth).

Additional information

The institution of one or more of the authors (JD, CP, HZ, DM) has received funding from Smith & Nephew Orthopaedics UK Ltd (Warwick, UK). One of the authors (AK) has or may receive payments or benefits, in any one year, an amount in excess of $ 100,000. All other authors certify that he or she, or a member of his or her immediate family, has not and will not receive payments directly related to this work.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. This work was performed at The McMinn Centre (Birmingham, UK) and the Implant Development Centre, Smith & Nephew Orthopaedics UK Ltd (Leamington, UK).

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Daniel, J., Ziaee, H., Kamali, A. et al. What Are the Risks Accompanying the Reduced Wear Benefit of Low-clearance Hip Resurfacing?. Clin Orthop Relat Res 470, 2800–2809 (2012). https://doi.org/10.1007/s11999-012-2476-3

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  • DOI: https://doi.org/10.1007/s11999-012-2476-3

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