Hip resurfacing in patients with severe osteoarthritis and blocked medullary canal.

Abstract

This study evaluated the effectiveness of hip resurfacing in patients with femoral deformities or retained femoral implants. Implant removal and conversion total hip replacement (CTHR) have been associated with increased operative time, blood loss, and cost. Removing intramedullary nails in particular can be difficult and can result in a more difficult recovery and/or complications. Hip resurfacing can be performed with a blocked femoral canal and has the possible additional benefits of a less-complex procedure, improved functional outcomes, better patient survivorship, and a possibly less-complicated revision should a failure occur. The author performed hip resurfacing in 61 patients (65 hips) with a blocked femur who had been advised elsewhere that they could not undergo THR without also undergoing additional surgical procedures. The perioperative complexity of resurfacing was evaluated by recording operative time, blood loss and functional outcomes using the Harris Hip Score (HHS) and Short-Form 12 (SF-12) questionnaire. Implant survivorship was evaluated by the need for revision surgery. At 9 years' mean follow-up (range 5-19 years), 59 of the 61 patients presented for postoperative evaluation. The mean operative time was 104 minutes and the mean blood loss was 300 cc. The mean HHS improved from 41 to 92 ( p < 0.001) and the mean SF-12 physical and mental scores improved from 26 to 49 and from 44 to 54, respectively ( p < 0.001). None of the procedures failed or required revision. Canal-sparing hip resurfacing is a successful and less complicated option than CTHR when there is deformity or retained implant blocking the femoral canal.