Can patients return to high-impact physical activities after hip resurfacing? A prospective study.

PURPOSE: Although the resumption of low-impact sports activities is compatible with total hip arthroplasty (THA), participation in high-impact sports seems problematic, and there is no consensus as to whether it is advisable. The purpose of this article is to evaluate the quality and possibility of resuming high-impact physical activities after hip resurfacing. MATERIALS: The study was performed in an on-going, single-surgeon, prospective series of 215 resurfacing arthroplasties (RSA). Mean follow-up was 44.1 months (range, 39.1-54.5). Clinical evaluation included the Postel-Merle d'Aubigné (PMA) score, the Oxford hip score, the Harris hip score (HHS), Devane score, and UCLA activity score. A specific questionnaire analysing sports activities was administered to each patient to assess the number and level of physical activities performed (both before the operation and at final follow-up). RESULTS: In the series of 202 consecutive patients (215 RSA), 50 patients (55 RSA) engaged regularly in at least one high-impact activity before their operation and the onset of pain, 102 patients practised at least one intermediate-impact activity, and the 50 remaining patients undertook only low-impact activities. Harris hip score increased from 44.8 (range, 23-68) before the operation to 97.8 (range, 85-100) at the last follow-up. Mean time to sports resumption after surgery was 14.6 weeks (range, 7-29). The resumption rate was 98 % for sports of any impact level and 82 % for high-impact activities. No osteolysis or implant loosening was observed at follow-up. No revision was performed. CONCLUSION: In 2012, no consensus recommendations yet exist for the resumption of sports activities after RSA. Existing recommendations concern only conventional THA. We believe that RSA allows younger and more active patients to resume physical and sports activities without restriction. The rate of return to sports after RSA appears to be excellent and unequalled by conventional hip prostheses. High-impact sports seem to be compatible with hip resurfacing, although no long-term studies have analysed the impact of these activities on wear and/or aseptic loosening.

Running activity after hip resurfacing arthroplasty: a prospective study.

BACKGROUND: The ability to return to sports activities (especially running) after hip resurfacing arthroplasty seems to be very important for young and active patients who have developed osteoarthritis. PURPOSE: To assess the quality of return to sports after hip resurfacing arthroplasty by examining the time spent running, weekly mileage, and the possibility of returning to competition in a series of patients. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A prospective, consecutive series of 202 patients (215 hip resurfacings) was assessed to evaluate the possible resumption of running activity (time spent, weekly mileage, return to competition). Of this initial cohort, 40 patients (43 resurfacings, 21%) practiced running preoperatively. Mean age at hip resurfacing arthroplasty was 50.7 years (range, 31-61 years). No patients underwent revision surgery. A questionnaire was administered to assess the number, type, and level of sports activities. Among patients who practiced running, we determined, preoperatively and at last follow-up, their weekly mileage and whether they were competitors. RESULTS: At last follow-up, 33 of 40 patients (36/43 hips) still practiced running (P = .74), with 91.6% of them resuming running. Mean average recovery time before running at a level assessed as good by patients was 16.4 weeks (range, 5-36 weeks). The number of patients running more than 4 hours per week increased from 18 to 23. Similarly, the time devoted to running at last follow-up remained high (mean, 3.1 hours per week) with no statistically significant difference from the preoperative period (P = .54). Moreover, patients were still engaged in competition without statistical difference between the 2 periods (P = .82). CONCLUSION: Running is possible after hip resurfacing, and runners can even return to some level of competition, but this short follow-up series of hip resurfacing in athletes should be interpreted with caution regarding implant survival.

Metal-on-metal hip arthroplasty in patients thirty years of age or younger.

BACKGROUND: Total hip arthroplasty in patients younger than thirty years of age represents a long-term challenge. As polyethylene wear secondary to a high activity level could be problematic, hard-on-hard bearings have been proposed to reduce wear. The aim of this retrospective case series was to assess the clinical and radiographic results of primary metal-on-metal total hip arthroplasty in patients thirty years of age or younger. METHODS: We retrospectively studied thirty-four patients (forty-seven hips) who had undergone metal-on-metal total hip arthroplasty and analyzed the radiographic and clinical measurements after a mean duration of follow-up of 108 months (range, 62.4 to 153.6 months). The mean age of the patients at the time of surgery was twenty-five years (range, fifteen to thirty years). The diameter of the head of the femoral component was 28 mm in all hips except five, in which it was 32 mm. The metal-on-metal bearing was the same in all patients. RESULTS: The mean Merle d'Aubigné score increased from 10.6 (range, 1 to 14) to 17.1 (range, 12 to 18). No wear was found on the latest radiograph, but osteolysis was noted in three femora and two acetabula. Two revisions were performed, one because of impingement secondary to cup malorientation and the other because of acetabular loosening with osteolysis. Kaplan-Meier analysis with revision of either component as the end point revealed a ten-year survival rate of 94.5% (95% confidence interval, 80% to 98.6%). The survival rate of the femoral stem was 100%. CONCLUSIONS: These encouraging intermediate-term results indicate that hip arthroplasty with metal-on-metal bearing components may be a suitable solution for young and active patients with hip osteoarthritis or osteonecrosis of the femoral head.