Chan Mun Khin, Caudwell Michelle, Suchowersky Andrew, Ashton Andrew
Orthopaedic Unit, Orange Health Services, Orange, New South Wales, Australia.
Department of Orthopaedics, Auckland City Hospital, Auckland, New Zealand.
ANZ J Surg. 2019 Sep;89(9):1016-1021. doi: 10.1111/ans.15036. Epub 2019 Mar 14.
The Birmingham Hip Resurfacing (BHR) system (Smith and Nephew) was developed as an alternative to conventional total joint replacement for younger, more active patients. Among other complications exists the risk for femoral component failure. The only marketed revision option for such a complication involves exchange of all components for a total replacement arthroplasty. This presents as a considerable and potentially unnecessary operative burden where revision of only the femoral prosthesis would suffice. We have analysed revision options for BHR in the context of periprosthetic femoral fractures with a stable acetabular component.
Technical details of dual mobility hip systems available in Australia were collated and analysed to assess for potential 'off label' use with an existing BHR acetabular component. These data were then compared with the custom-made Smith and Nephew dual mobility implant with respect to clearance and sizing.
Two dual mobility articulation modalities from two companies were identified as appropriate for potential usage with four products analysed in detail. These two demonstrated acceptable sizing and clearance measurements.
Comparison between readily available dual mobility prostheses with custom-made implants showed off label dual mobility prosthetic use to be a viable alternative for femoral-only revisions with in situ BHR. Single component revision has several advantages which include: a less complex surgical procedure, shorter operative time, decreased blood loss and the expectation of resultant lower morbidity. Furthermore, this less complex revision surgery should give comparable results to that of primary total hip arthroplasty.
伯明翰髋关节表面置换（BHR）系统（施乐辉公司）是为年轻、活动量较大的患者开发的传统全关节置换术的替代方案。除其他并发症外，还存在股骨部件失效的风险。针对这种并发症，唯一上市的翻修选择是将所有部件更换为全髋关节置换术。在仅更换股骨假体就足够的情况下，这带来了相当大且可能不必要的手术负担。我们在髋臼部件稳定的假体周围股骨骨折的背景下分析了BHR的翻修选择。
整理并分析了澳大利亚现有的双动髋关节系统的技术细节，以评估与现有的BHR髋臼部件“标签外”使用的可能性。然后将这些数据与施乐辉公司定制的双动植入物在间隙和尺寸方面进行比较。
确定了两家公司的两种双动关节模式适合潜在使用，并对四种产品进行了详细分析。这两种产品的尺寸和间隙测量结果均可接受。
市售双动假体与定制植入物的比较表明，标签外使用双动假体是原位BHR仅股骨翻修的可行替代方案。单部件翻修有几个优点，包括：手术过程不太复杂、手术时间更短、失血量减少以及预期发病率更低。此外，这种不太复杂的翻修手术应能产生与初次全髋关节置换术相当的效果。
