METAL-ON-METAL HIP RESURFACING ARTHROPLASTY USING THE DIRECT LATERAL APPROACH. FIRST RESULTS AND LITERATURE REVIEW

Background The rebirth of metal-on-metal hip resurfacing can be attributed to the advance of orthopaedic implants manufacturing as is to the evolution of the surgical technique. It has most commonly been done through the posterior surgical approach, but with risk of developing avascular necrosis of the femoral head where the prosthesis is embedded into. The article describes our experience with use of the direct lateral surgical approach. Patients and methods The Orthopaedic Hospital Valdoltra prosthetic registry was searched for patients who methods have had hip arthroplasties done. 25 such patients were found, 16 among them have been followed for at least a year. All 16 patients (18 operated hips) were males with primary hip osteoarthritis and mean age of 49 years. All but one were operated with direct lateral surgical approach, had the same type of prosthesis implanted and followed the same rehabilitation protocol. Results All patients were evaluated preoperatively as well as on follow-up examinations. A rise of Harris Hip Score (HSS) from 42 preoperatively to 98 at 1 year postoperatively was recorded. We had no major complications, except for slight acetabular component malposition in terms of decreased inclination in 1 patient and appearance of a Brooker Grade 1 or 2 heterotopic ossifications in 4 patients on postoperative X-rays. Conclusions Metal-on-metal hip resurfacing gained considerable reupraisal with new generations of prosthesis design. It provides considerable advantage compared to conventional total hip arthroplasty but is indicated only with a selected patient group and is technically more difficult. The use of direct lateral surgical approach has proved to be safe and reliable compared to the already proven posterior approach.