Total hip arthroplasty has been an important surgical operation in orthopaedics in the 20th century. After many trails, major advancement in Total Hip Arthroplasty was made by Sir John Charnley in 1962, who introduced low friction arthroplasty. This consists of a polyethylene cup and 22.2 mm head, both components being fixed with methacrylate cement. In the following years there were many changes to this basic principle (model) of total hip arthroplasty. Patient education has become an important factor in improvement of function following total hip replacement.

1. Bone c
onserving hip
arthroplasty

2. Apollo Medicine 2012 December
Volume 9, Number 4; pp. 290e291 Editorial
Bone conserving hip arthroplasty
Y. Kharbanda
Total hip arthroplasty has been an important surgical opera-tion
in orthopaedics in the 20th century. After many trails,
major advancement in Total Hip Arthroplasty was made by
Sir John Charnley in 1962, who introduced low friction
arthroplasty. This consists of a polyethylene cup and
22.2 mm head, both components being fixed with methacry-late
cement. In the following years there were many changes
to this basic principle (model) of total hip arthroplasty.
Patient education has become an important factor in improve-ment
of function following total hip replacement. Improve-ment
in bearing surfaces, introduction of bioactive surfaces,
surgical approach and use of navigation have shown
improved results in short to mid-term follow-up.
Various studies have reported excellent to good outcome
of Charnley total hip arthroplasty. Short and mid term
follow-up have shown improved results in total hip arthro-plasty
using improved bioactive surfaces for cement less
fixation. Alternate bearing surfaces (metal on metal,
ceramic on ceramic) have shown lower wear rates. Intro-duction
of highly X-linked polyethylene has overcome
the limitations of conventional polyethylene. Concept of
femoral bone conservation1,2 and improvement in biome-chanical
restoration of hip joint has led to resurgence of
resurfacing hip arthroplasty. This is particularly attractive
to young and active people.
Resurfacing hip arthroplasty provides near normal
mechanics of the hip and allows patient to return back to
high activity including sports. However, it is mandatory for
success of hip resurfacing arthroplasty that femoral head and
neck are structurally intact. In cases of femoral osteonecrosis,
theremay be extensive cysts and head of the femurmay be defi-cient.
When there is abnormal proximal femur anatomy, resur-facing
operation may be difficult and there may be increase
incidence of complications. Early complications like fracture
neck of femur and avascular necrosis due to damage to the
blood supply of femoral head are the main concerns.6
Improved techniques in proper placement of implants and
surgical techniques has lowered incidence of these
complications.3,9 Improper seating of the implants remains
an issue where the femoral head is severely compromised.
Mid-head resection is a relatively new technique that
offers an alternative to resurfacing hip arthroplasty for severe
deficiency in femoral head secondary to avascular necrosis of
femoral head, developmental disorders such as post slipped
capital femoral epiphysis, post Perthes disease.4,5,7
McMinn DJ et al8 have reported a retrospective reviewed
cases of 164 patients (171 hips) who underwent reconstruc-tion
with Birmingham Mid-Head Resection device between
2003 & 2008. At a mean follow-up of 3.5 years (Range
2e7.5 years). They have reported four revisions including
two femoral failures, giving 3.5 year survivorship of 97.4%
& 98.7% with revision or reoperation for any reason &
femoral failure as the end points, respectively. Other workers
have also reported short-term follow-up of mid-Head resec-tion
with excellent results. Results of resurfacing Hip Arthro-plasty
in women is poor and therefore metal on metal
resurfacing Arthroplasty is not recommended.9,10,11 There
is also increase incidence of pseudotumors and therefore
long-term follow-up is required.
Mid-head resection may be useful for patients who
qualify for bone conserving procedure but have severe
femoral head deficiency. To achieve appropriate results,
patient selection is very important. Patients with severe
osteoporosis and extensive damage to head and base of
neck should be excluded and conventional total hip arthro-plasty
be considered in them. Concerns about metal ions in
blood remains and therefore metal on metal hip arthroplasty
is not recommended in females.
CONCLUSION
Short term results of this technique have shown excellent
results. There are no long term results of mid-head resection
technique available and its complications and survival
needs to be ascertained.
Senior Consultant, Orthopedics, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi 110076, India.
email: yatkharbanda@yahoo.co.in
Copyright 2012, Indraprastha Medical Corporation Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.apme.2012.10.005

3. Bone conserving hip arthroplasty Editorial 291
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