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Surgeons warn of performing metal-on-metal hip resurfacing on women younger than 40 years old

At 8 years follow-up, the investigators found a 25% revision rate in younger women with a pseudotumor.

Issue: Issue 6 2009

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A study of patients who underwent hip resurfacing in Oxford, England, shows an overall revision rate of 4% for pseudotumor at 8 years and a 25% revision rate for the condition in women younger than 40 years old.

“Based on the findings of this study, we would recommend that resurfacing is performed with caution in women, especially those under 40 years of age,” lead investigator Sion Glyn-Jones, FRCS, told Orthopaedics Today Europe. “However, we still recommend that resurfacing is performed in men.”

He presented the research at the British Orthopaedic Association Annual Congress 2009.

Prospective survival analysis

“As we were seeing increasing numbers of patients with pseudotumors being referred from out of our region, we were keen to establish the true incidence of this condition to avoid overstating its importance. The only way to do this was to examine the incidence in our own population in Oxford,” he said.

Using information collected from their own research database, Glyn-Jones and his colleagues performed a prospective survival analysis on 1,419 patients who had metal-on-metal hip resurfacing procedures performed between 1999 and 2008. The patients were 53 years old on average at the time of implantation, and 90% had a primary preoperative diagnosis of osteoarthritis. Slightly more than half of the patients were men.

While the investigators found a small overall revision rate due to pseudotumor, they found that women younger than 40 years old were at risk of undergoing a revision due to the condition.

Smaller components

“Women may be at increased risk because they tend to have smaller components, which are less likely to achieve hydrodynamic lubrication,” Glyn-Jones said. “Smaller components are also more sensitive to malpositioning.

“Women also have an increased range of movement, which may increase the risk of impingement and edge-loading,” he added.

Glyn-Jones noted that the study is based on information from a single center. “However, our incidence rates for pseudotumors are similar to, if not lower than, those reported from other centers,” he said.

His group’s long-term goal is to create methods for identifying at-risk patients and improve implantation techniques.

For more information:

• Sion Glyn-Jones, FRCS, can be reached at Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3 7LD, England; +44-(0)1865-227374; e-mail: sion.glyn-jones@ndorms.ox.ac.uk. He has no direct financial interest in any product or company mentioned in this article.

Reference:

• Glyn-Jones S, Pandit H, Doll H, et al. The risk factors for developing an inflammatory pseudotumor following hip resurfacing: A survival analysis. Presented at the British Orthopaedic Association Annual Congress 2009. Sept. 15-18, 2009. Manchester.