1. Role of Hip Resurfacing for the older patients Pascal A. Vendittoli, MD MSc FRSC Montréal, Canada

2. 2M pa 6.4M pa Evolving patients- more active

3. Literature Review 35 patients (40 hips): >65 years of age vs 130 patient (153 hips): <65 years F/U: 36 months Results: Harris Hip Scores and SF12 were similar No difference in the rate of complications/femoral neck fracture

4. Literature Review 57 patients: >65 years of age 52 males / 5 females F/U: 33 months No fracture AAOS 2010 poster Hip Resurfacing in the Older Population Mark Mullins et al. United Kingdom

5. Literature Review 295 Patients<55 years (range 14-49 years) vs 281 patients>55 years (range 50-78 years) UCLA scores and SF 12 scores were similar in both groups. No difference in survival between young and old patients

6. Australian joint replacement Registry Hip resurfacing has fewer complications when performed on men<65 years and women<55 years Australian Joint Replacement Registry Annual Report, 2007 The 7-year cumulative revision rate for patients <55 years = 4.7% >55 to 74 years = 5.6% Australin Joint Replacement Registry Annual Report, 2009

7. Pascal-A Vendittoli, MD Improved Clinical function Better patient satisfaction No Leg length discrepancy Better Range of motion No Dislocation No Tight pain Less Bone stock loss Easier Revision Why should we do HR vs THA?

8. Hip Resurfacing vs 28 mm Total Hip Arthoplasty Slightly higher clinical scores (WOMAC) Femoral bone conservation-easy revisability Better implant stability- reduced rate of dislocation More precise Biomechanical reconstruction vs

9. HR vs LDH THA No Functional Benefit Pascal-A Vendittoli, MD VS

10. Hip Resurfacing Real Benefits vs THA Femoral bone preservation for future revision, if needed Is there some downsides ?

11. HR and Femoral Neck Fractures Rate of fracture is higher in women patients with osteoporosis

12. Aseptic loosening of femoral component Femoral head necrosis Overpenetration of cement Campbell P et al CORR 2006 2 - 6 % Hip Int 2010

13. Simple Equation Femoral stem survival Versus Patient life expectancy Most current femoral implant designs Cemented or Uncemented > 15 years survivorship

14. Indications for resurfacing in subjects over 50 years old Deformity of proximal femur Presence of implants, which are difficult to remove Post Septic Arthritis Old femoral diaphysal osteomylitis

15. Post traumatic deformity of the Femur 68 years old male

16. Post traumatic femoral deformation

17. Post Septic Arthritis 63 years old male Haematogenous septic arthritis 1 y post infection

18. One example of infected HR

19. Old osteomylitis of the diaphysis

21. Significant Hardware 67 years old

22. Discussion There is no clear consensus on upper age limit for HR Litterature only reports short term data Great results of THA femoral stems No clear benefit HR vs THA except femoral bone preservation Increased failure risk with HR (neck fx and femoral loosening) Recommandation HR for the subject over 50 y old where femoral stem implantation would be challenging

23. When needed… in the older Now available: Extended metaphyseal fixation