Immediate weight bearing after uncemented total hip arthroplasty with an anteverted stem: A prospective randomized comparison using radiostereometry A prospective randomised controlled trial comparing three alternative bearing surfaces in primary total hip replacement. Total hip arthroplasty and hemiarthroplasty in mobile, independent patients with a displaced intracapsular fracture of the femoral neck. A randomized, controlled trial. A double-blind study of 250 cases comparing cemented with cementless total hip arthroplasty. Cost-effectiveness and its impact on health-related quality of life. Use of an alumina-on-alumina bearing system in total hip arthroplasty for osteonecrosis of the hip. Fixed versus mobile weight-bearing prosthesis in total knee arthroplasty Patient’s perspective on direct anterior versus posterior approach total hip arthroplasty Total hip arthroplasty versus resurfacing arthroplasty in the treatment of patients with arthritis of the hip joint: single centre, parallel group, assessor blinded, randomised controlled trial Causes for revision of dual-mobility and standard primary total hip arthroplasty Comparison of mid-term clinical outcomes after primary total hip arthroplasty with Oxinium vs cobalt chrome femoral heads. Comparison of Fixed-Bearing and Mobile-Bearing Total Knee Arthroplasties A randomised controlled trial of total hip arthroplasty versus resurfacing arthroplasty in the treatment of young patients with arthritis of the hip joint No adverse effects of early weight bearing after uncemented total hip arthroplastyA randomized study of 20 patients Early clinical results of a high-flexion, posterior-stabilized, mobile-bearing total knee arthroplasty: a US investigational device exemption trial. Total Hip Arthroplasty Performed Through Direct Anterior Approach Provides Superior Early Outcome: Results of a Randomized, Prospective Study. Displaced intracapsular hip fractures in fit, older people: a randomised comparison of reduction and fixation, bipolar hemiarthroplasty and total hip arthroplasty. Resurfacing is Comparable to Total Hip Arthroplasty at Short-term Followup
Background In uncemented total hip arthroplasty with hydroxyapatite coating , early weight bearing is frequently practice d but there is still not much evidence to support this recommendation . Method In a prospect i ve r and omized study we evaluated the effect of partial and full weight bearing after  cementless total hip arthroplasty ( ABG ; Stryker-Howmedica ) using radiostereometric analysis ( RSA ) . Between February 1996 and February 2000 , 43 consecutive patients ( mean age 53 ( 41–63 ) years , 23 women ) with hip osteoarthrosis received an uncemented and hydroxyapatite-coated prosthesis with an anteverted stem . All patients were operated in a st and ardized way by three experienced surgeons and they were r and omized to partial ( P ) or full ( F ) weight bearing during the first 6 weeks after surgery . The patients in the partial weight bearing group were equipped with a pressuresensitive insole signaling when their load exceeded the prescribed weight limit . Results At 3-month follow-up , the mean proximal (+)/ distal ( - ) migration of the stem was -0.14 mm ( -1.93– 0.11 ) in group P and -0.31 mm ( -4.30–0.16 ) in group F ( p = 0.6 ) . At 1-year follow-up , the mean migration was –0.17 mm ( -2.18–0.21 ) and -0.28 mm ( -4.31–0.11 ) , respectively ( p = 0.9 ) . There was no significant difference in stem rotations either ( p < 0.2 ) . The cup translations , rotations , and femoral head penetration were similar in the two groups ( p < 0.1 ) . There were no re-operations during the first year . Interpretation We did not find any adverse effect of full weight bearing immediately after operation , which justifies use of this regimen after uncemented total hip arthroplasty of the ABG type The ideal bearing surface for young patients undergoing total hip replacement ( THR ) remains controversial . We report the five-year results of a r and omised controlled trial comparing the clinical and radiological outcomes of 102 THRs in 91 patients who were < 65 years of age . These patients were r and omised to receive a cobalt-chrome on ultra-high-molecular-weight polyethylene , cobalt-chrome on highly cross-linked polyethylene , or a ceramic-on-ceramic bearing . In all , 97 hip replacements in 87 patients were available for review at five years . Two hips had been revised , one for infection and one for peri-prosthetic fracture . At the final follow-up there were no significant differences between the groups for the mean Western Ontario and McMaster Universities osteoarthritis index ( pain , p = 0.543 ; function , p = 0.10 ; stiffness , p = 0.99 ) , Short Form-12 ( physical component , p = 0.878 ; mental component , p = 0.818 ) or Harris hip scores ( p = 0.22 ) . Radiological outcomes revealed no significant wear in the ceramic group . Comparison of st and ard and highly cross-linked polyethylene , however , revealed an almost threefold difference in the mean annual linear wear rates ( 0.151 mm/year versus 0.059 mm/year , respectively ) ( p < 0.001 ) BACKGROUND Hemiarthroplasty and total hip arthroplasty are commonly used to treat displaced intracapsular fractures of the femoral neck , but each has disadvantages and the optimal treatment of these fractures remains controversial . METHODS In the present prospect ively r and omized study , eighty-one patients who had been mobile and lived independently before they had sustained a displaced fracture of the femoral neck were r and omized to receive either a total hip arthroplasty or a hemiarthroplasty .  The mean age of the patients was seventy-five years . Outcome was assessed with use of the Oxford hip score , and final radiographs were assessed . RESULTS After a mean duration of follow-up of three years , the mean walking distance was 1.17 mi ( 1.9 km ) for the hemiarthroplasty group and 2.23 mi ( 3.6 km ) for the total hip arthroplasty group , and the mean Oxford hip score was 22.3 for the hemiarthroplasty group and 18.8 for the total hip arthroplasty group . Patients in the total hip arthroplasty group walked farther ( p=0.039 ) and had a lower ( better ) Oxford hip score ( p=0.033 ) than those in the hemiarthroplasty group . Twenty of thirty-two living patients in the hemiarthroplasty group had radiographic evidence of acetabular erosion at the time of the final follow-up . None of the hips in the hemiarthroplasty group dislocated , whereas three hips in the total hip arthroplasty group dislocated . In the hemiarthroplasty group , two hips were revised to total hip arthroplasty and three additional hips had acetabular erosion severe enough to indicate revision . In the total hip arthroplasty group , one hip was revised because of subsidence of the femoral component . CONCLUSIONS Total hip arthroplasty conferred superior short-term clinical results and fewer complications when compared with hemiarthroplasty in this prospect ively r and omized study of mobile , independent patients who had sustained a displaced fracture of the femoral neck The success of a total hip arthroplasty ( THA ) is dependent on many more parameters than simply the prosthesis used . This study has demonstrated that a r and omized controlled clinical trial of 250 patients comparing two types of hip prostheses ( cemented versus cementless ) with virtually complete follow-up examination is feasible . It also demonstrates that patients are willing to answer extensive quality -of-life question naires that allow complete assessment of the impact of hip arthroplasty on the patient 's overall health-related quality of life . This study has also demonstrated that THA is an extremely effective intervention when one assesses its ability to impact on patients health-related quality of life with no difference between cement versus cementless at two years ' follow-up examination BACKGROUND The results of total hip arthroplasty in patients with osteonecrosis of the femoral head are not always optimal . The use of alumina-on-alumina interfaces in young and active patients may decrease wear and lower the rate of aseptic loosening of the implant and appears to be an attractive alternative to the use of conventional cobalt-chromium-on-polyethylene bearings . The purpose of this study was to evaluate the safety and efficacy of the alumina-on-alumina bearing in patients with osteonecrosis and to compare this group of patients to a group of similarly treated patients with osteoarthritis and a group of patients who received conventional cobalt-chromium-on-polyethylene bearings . METHODS Patients were selected from a United States Investigational Device Exemption multicenter prospect i ve r and omized clinical study that was initiated in 1996 . Seventy patients with osteonecrosis of the femoral head ( seventy-nine hips ) received a cementless alumina-on-alumina bearing system and were directly matched to seventy-six patients with osteoarthritis of the hip ( seventy-nine hips ) who were managed with the same implant . Both groups were compared with twenty-five patients ( twenty-six hips ) with osteonecrosis and twenty-five patients ( twenty-six hips ) with osteoarthritis who were managed with a cementless cobalt-chromium-on-polyethylene bearing system . All patients received a cementless hydroxyapatite-coated femoral stem and were followed both clinical ly and radiographically . RESULTS The clinical outcomes for alumina-on-alumina bearings were similar for both osteonecrotic and osteoarthritic hips . The seven-year survival probability was 95.5 % for the osteonecrotic hips and 89.4 % for the osteoarthritic hips in the alumina-on-alumina bearing group and 92.3 % for the osteonecrotic hips and 92.9 % for the osteoarthritic hips in the cobalt-chromium-on-polyethylene bearing group . At the time of the most recent follow-up , the mean Harris hip score was 96 points for both the osteonecrotic and the osteoarthritic hips in the alumina-on-alumina group and 96 points for the osteonecrotic hips and 97 points for the osteoarthritic hips in the cobalt-chromium-on-polyethylene bearing group . CONCLUSIONS The results of the use of alumina-on-alumina and cobalt-chromium-on-polyethylene bearings in cementless st and ard total hip implants in patients with osteonecrosis and osteoarthritis were comparable . The low revision rate for the alumina-on-alumina bearing is encouraging and offers a promising option for younger , more active patients who have this challenging disease . LEVEL OF EVIDENCE Therapeutic Level III . See Instructions to Authors on jbjs.org for a complete description of levels of evidence Purpose This study was design ed to compare clinical , radiological , and general health results of two prostheses ( mobile vs. fixed weight-bearing devices ) that are used in total knee arthroplasty with a 5-year follow-up . Methods This r and omized controlled study was conducted from 2004 to 2010 in the Department of Orthopedic Surgery at two university hospitals in Isfahan , Iran . Three hundred patients with expected primary total knee arthroplasty ( TKA ) without severe deformity ( a fixed varus or valgus deformity greater than 20 ° ) received fixed weight-bearing ( n = 150 ) or mobile weight-bearing ( n = 150 ) devices . Clinical , radiological , and quality of life outcomes were compared between the two groups at six-month intervals for the first year , after which the comparisons were made annually for the next 4 years . Results Both groups had similar baseline characteristics . Although there was significant improvement in both groups , there was no significant difference between the groups with regard to the means of the Knee Society Scores , which were 92 ( SD : 12.1 ) for the fixed weight-bearing device and 93 ( SD : 14.2 ) for the mobile weight-bearing device ( n.s . ) at the final follow-up point . Radiographs showed that there was no significant difference in prosthetic alignment and no evidence of loosening . After TKA , the SF-36 score increased in both groups , but there was no statistical difference between the groups in quality of life at the final follow-up ( 62 ( 12.2 ) vs. 64 ( 14.3 ) , n.s . ) . There was no revision after 5 years . Conclusions In terms of clinical , radiological or general health outcomes for people who underwent TKA , the results of this study showed no clear advantage of mobile weight-bearing over the fixed weight-bearing prosthesis at the five-year follow-up . Level of evidence Purpose Total hip arthroplasty approach comparison focused on patient ’s perspective . The direct anterior approach ( DAA ) has gained immense popularity in the last decade and is widely advocated as a superior approach in terms of quicker recovery and better overall outcome . However , the question if the level of DAA promotion is justified seems to be rarely posed . Methods A single-surgeon consecutive series of patients who underwent bilateral THA , one in DAA and the other in posterior approach ( PA ) .  The same implant design and same component sizes were used for the both sides . All the operations were performed by a single surgeon under the same pre- and post-operative care protocol . Results Twenty-one patients underwent bilateral THA , mean age 60.09 years .  Oxford Hip Score ( OHS ) was used for functional outcome assessment . There were no statistically significant differences between two approaches in terms of functional outcome ( mean OHS for DAA series was 42.95 and that for the PA was 43.38 , p 0.07 at an alpha level of 0.05 ) . Fifteen patients gave the advantage to PA , and six patients favoured DAA . Conclusion By study design , we tried to reduce the biases and acquire approach appraisal from patient ’s perspective . We anticipated the outcome in favour of DAA , but the results favoring PA came as a surprise . Future prospect i ve r and omized studies on evaluation of DAA and other approaches not only from surgeon ’s or industry ’s point of view , performed on a larger and more uniform groups , are warranted to further explore the subjective differences between DAA and PA Objectives To compare the clinical and cost effectiveness of total hip arthroplasty with resurfacing arthroplasty in patients with severe arthritis of the hip . Design Single centre , two arm , parallel group , assessor blinded , r and omised controlled trial with 1:1 treatment allocation . Setting One large teaching hospital in the United Kingdom . Participants 126 patients older than 18 years with severe arthritis of the hip joint , suitable for resurfacing arthroplasty of the hip . Patients were excluded if they were considered to be unable to adhere to trial procedures or complete question naires . Interventions Total hip arthroplasty ( replacement of entire femoral head and neck ) ; hip resurfacing arthroplasty ( replacement of the articular surface of femoral head only , femoral neck remains intact ) . Both procedures replaced the articular surface of the acetabulum . Main outcome measures Hip function at 12 months after surgery , assessed using the Oxford hip score and Harris hip score . Secondary outcomes were quality of life , disability rating , physical activity level , complications , and cost effectiveness . Results 60 patients were r and omly assigned to hip resurfacing arthroplasty and 66 to total hip arthroplasty . Intention to treat analysis showed no evidence for a difference in hip function between treatment groups at 12 months ( t test , P=0.242 and P=0.070 for Oxford hip score and Harris hip score , respectively ) ; 95 % of follow-up data was available for analysis . Mean Oxford hip score was 40.4 ( 95 % confidence interval 37.9 to 42.9 ) in the resurfacing group and 38.2 ( 35.3 to 41.0 ) in the total arthroplasty group ( estimated treatment effect size 2.23 ( −1.52 to 5.98 ) ) . Mean Harris hip score was 88.4 ( 84.4 to 92.4 ) in the resurfacing group and 82.3 ( 77.2 to 87.5 ) in the total arthroplasty group ( 6.04 ( −0.51 to 12.58 ) ) . Although we saw no evidence of a difference , we can not definitively exclude clinical ly meaningful differences in hip function in the short term . Overall complication rates did not differ between treatment groups ( P=0.291 ) . However , we saw more wound complications in the total arthroplasty group ( P=0.056 ) and more thromboembolic events in the resurfacing group ( P=0.049 ) . Conclusions No evidence of a difference in hip function was seen in patients with severe arthritis of the hip , one year after receiving a total hip arthroplasty versus resurfacing arthroplasty . The long term effects of these interventions remain uncertain . Trial registration Current Controlled Trials IS RCT N33354155 , UKCRN 4093 Introduction The causes for revision of primary total hip arthroplasty ( THA ) are various and quite well known . The developing use of dual-mobility THA ( DM-THA ) seems a relevant option to decrease the risk of instability . Due to lack of long-term follow-up , this innovative retentive concept is suspected to increase the risk of polyethylene ( PE ) wear . the aim of the study was to analyse the causes for  DM-THA revision and assess whether or not its occurrence is different from that of fixed-st and ard ( FS ) THA , particularly for aseptic loosening or wear and /or osteolysis . Material s and methods The SoFCOT group conducted an observational prospect i ve multicentre study from 1 January 2010 to 31 December 2011 . Inclusion criteria comprised an exhaustive collection of 2044 first-revision THAs with 251 DM-THAs and 1793 FS-THAs . After excluding complications linked to patient factors ( infection and periprosthetic fractures ) , we performed a matched case – control study ( matching ratio 1:1 ) comparing two groups of 133 THAs . Results Revisions for aseptic loosening or osteolysis/wear were as frequent in DM-THA ( 58.7 % ) as in FS-THA ( 57.1 % ) ( p 0.32 ) ; 7.5 % of DM-THA were revised for dislocation versus 19.5 % of FS-THA ( p 0.007 ) . Discussion Revision for osteolysis/wear and aseptic loosening were as frequent in DM-THA as in FS-THA ;  revision for dislocation was less frequent in DM-THA . This confirms the efficiency of the DM concept regarding the risk of dislocation . Causes for revision were different between groups , and revisions for dislocation were less frequent in DM-THA . Only prospect i ve comparative studies could provide reliable information that may support broader use of the DM concept The purpose of this investigation was to assess the midterm clinical outcomes after implantation of Oxinium ( OX ) vs cobalt-chrome ( CC ) femoral heads .  Primary total hip arthroplasty ( THA ) procedures were performed in 100 patients . After r and omization , half of the patients received OX femoral heads and half received CC femoral heads . At a minimum follow-up of 2-years , stem survival was 98 % for both groups . The mean Harris Hip score was 92 for OX and 92.5 for CC , with mean WOMAC scores of 84.9 and 87 , respectively . For SF-12 , the OX group had mean physical and mental component scores of 45.2 and 53.8 and the CC group 49.2 and 52.6 , respectively . At a minimum follow-up of 2 years , clinical outcomes for THA procedures using OX and CC femoral heads appear equivalent The purpose of the current study was to directly compare the results of fixed-bearing and mobile-bearing total knee arthroplasties in the same patient who had bilateral simultaneous total knee replacements . A fixed-bearing total knee prosthesis ( AMK ) was implanted in one knee and a mobile-bearing total knee prosthesis ( LCS ) was implanted in the other knee in 116 patients . The average age of the patients was 65 years ( range , 33–70 years ) . The average followup was 7.4 years ( range , 6–8 years ) .  Clinical and radiographic followup was done using Knee Society and Hospital for Special Surgery knee rating systems at 6 weeks , 3 months , 6 months , 1 year after surgery , and yearly thereafter . Total knee score , pain score , mean functional score , and range of motion were comparable in both groups . Two knee replacements ( 2 % ) in one patient with AMK prostheses were revised because of complete wear of tibial bearing polyethylene . One knee replacement ( 1 % ) in one patient with an LCS prosthesis was revised because of dislocation of the medial tibial bearing polyethylene and one knee replacement ( 1 % ) in one patient with an LCS prosthesis was revised because of complete wear of the medial tibial bearing polyethylene . No knee had aseptic loosening or osteolysis in either group . After a minimum followup of 6 years , the results of fixed- and mobile-bearing total knee prostheses in the current series are favorable . However , there is no evidence to prove the superiority of the mobile-bearing total knee design Background Hip replacement ( arthroplasty ) surgery is a highly successful treatment for patients with severe symptomatic arthritis of the hip joint . For older patients , several design s of Total Hip Arthroplasty have shown excellent results in terms of both function and value for money . However , in younger more active patients , there is approximately a 50 % failure rate at 25 years for traditional implants . Hip resurfacing is a relatively new arthroplasty technique . In a recent review of the literature on resurfacing arthroplasty it was concluded that the short-term functional results appear promising but some potential early disadvantages were identified , including the risk of femoral neck fracture and collapse of the head of the femur . The aim of the current study is to assess whether there is a difference in functional hip scores at one year post-operation between Total Hip Arthroplasty and Resurfacing Arthroplasty . Secondary aims include assessment of complication rates for both procedures as well cost effectiveness . Methods / design All patients medically fit for surgery and deemed suitable for a resurfacing arthroplasty are eligible to take part in this study . A r and omisation sequence will be produced and administered independently . After consenting , all patients will be clinical ly review ed and hip function , quality of life and physical activity level will be assessed through question naires . The allocated surgery will then be performed with the preferred technique of the surgeon . Six weeks post-operation hip function will be assessed and complications recorded . Three , six and 12 months post-operation hip function , quality of life and physical activity level will be assessed . Additional information about patients ' out-of-pocket expenses will also be collected . Trial registration Current Controlled Trials IS RCT N33354155UKCLRN portfolio ID BACKGROUND Few guidelines are available whether early weight-bearing after an  uncemented total hip arthroplasty ( THA ) can be recommended or not . Stability and ingrowth may be jeopardized by immediate loading of the implant while functional recovery may be promoted and periprosthetic demineralization reduced . PATIENTS AND METHODS We did a prospect i ve study of 20 patients who were operated on with a hydroxyapatite-coated ( HA ) , uncemented total hip arthroplasty with a tapered stem because of unilateral arthrosis , and r and omized the patients to the immediate ( I ) or late ( L ) weight-bearing ( after 3 months ) group . The shoe on the operated side was equipped with an auditory device signaling when the patient placed a load on the extremity . The clinical assessment was done with the Harris hip score at the time of the operation and after 12 and 24 months . Radiographs and dual-energy x-ray absorptiometry ( DEXA ) were evaluated for migration , femoral remodeling and bone mineral density ( BMD ) after 3 , 6 , 12 and 24 months .  Tc-scintigraphy  was done after 6 , 12 and 24 months . RESULTS Postoperatively , the Harris hip score showed no group difference . After 3 months , we noted a large reduction in BMD around the stem prosthesis . This was most marked in the proximal regions and the bone loss was significantly larger in zone 1 , 4 and 5 in the L group . Distally , the BMD normalized with time , but the loss of bone persisted in the proximal zones after 24 months . An initial increase in the scintigraphic uptake ratio in all zones in both groups declined with time , but it was still increased on the operated side after 24 months . Several radiographic signs of bone remodeling were seen , but the patterns were similar in both groups . INTERPRETATION We found no adverse effect of immediate weight bearing with this prosthesis Between May 2001 and June 2004 , 388 total knee arthroplasty cases were enrolled in a prospect i ve , r and omized , multicenter investigational device exemption trial . Patients received either the investigational high-flexion mobile-bearing knee or a fixed-bearing control . At 2 to 4 years of follow-up , results in 293 patients with degenerative joint disease were compared using Knee Society Assessment and Function scores , radiographic results , complications analysis , and survival estimates . The mobile-bearing and fixed-bearing groups demonstrated similar , significant improvement over preoperative assessment s in Knee Scores , maximum flexion , and range of motion . One mobile-bearing arthroplasty required revision . Radiographic results were unremarkable , and implant-related complications were rare in both groups . At this early follow-up , the investigational high-flexion mobile-bearing knee and its fixed-bearing counterpart demonstrated comparable , effective performance Studies suggest that  total hip arthroplasty ( THA )  performed through direct anterior ( DA ) approach has better functional outcomes than other surgical approaches . The immediate to very early outcomes of DA THA are not known . A prospect i ve , r and omized study examined the very early outcome of THA performed through DA versus direct lateral approach . The functional outcomes on day 1 , day 2 , week 6 , week 12 , 6 months , and 1 year were measured . Patients receiving DA THA  had significantly higher functional scores during the early period following surgery . The difference in functional scores leveled out at 6 months OBJECTIVES To compare internal fixation , bipolar hemiarthroplasty and total hip arthroplasty for the management of displaced subcapital fracture of the hip in previously fit patients of 60 years or older . DESIGN A prospect i ve r and omised clinical trial . SETTING This multicentre trial was carried out in 11 Scottish hospitals with acute orthopaedic trauma units . PARTICIPANTS The participants were 298 previously fit patients of 60 years or older with displaced subcapital hip fractures . INTERVENTIONS The three surgical interventions for comparison were reduction and fixation , bipolar hemiarthroplasty and total arthroplasty ( total hip replacement ) . Participating surgeons elected to r and omise patients either among all three types of operation ( three-way r and omisation ) or just between fixation and hemiarthroplasty ( two-way r and omisation ) . MAIN OUTCOME MEASURES Clinical outcomes were mortality rates , reoperation rates and the complication rates associated with each procedure . Functional outcome was measured using a hip specific question naire [ Johanson Hip Rating Question naire ( HRQ ) ] and a general health status question naire [ EuroQol 5 Dimensions ( EQ-5D ) ] . Economic analysis compared the costs in the r and omised groups of hospital treatment for the initial and subsequent admissions for up to 2 years . RESULTS Altogether , 207 patients were r and omised among all three trial operations , and 91 between just  fixation  and  bipolar hemiarthroplasty . There were no statistically significant differences in clinical outcomes , but confidence intervals ( CIs ) were wide . At 2 years fixation failure reached 37 % among those allocated fixation and 39 % had undergone further surgery . Further surgery rates after hemiarthroplasty and total hip replacement were 5 % and 9 % , respectively . The group allocated fixation had significantly worse HRQ and EQ-5D scores than both arthroplasty groups at 4 and 12 months . At 24 months the results still favoured arthroplasty , but the overall HRQ and EQ-5D scores were no longer statistically significant . Total hip replacement had the best patient-assessed outcome scores . At 24 months the overall HRQ and EQ-5D scores for total hip replacement were significantly better than for hemiarthroplasty . The mean costs for the initial episode ranged from 6384 pounds Sterling for fixation to 7633 pounds Sterling for total hip replacement . The cost differences were largely due to differences in theatre costs and the cost of prostheses and hardware . The cumulative cost over 2 years of hemiarthroplasty was around 3000 pounds Sterling lower than for fixation ( 95 % CI 1227 pounds Sterling to 7192 pounds Sterling ) . Compared with total hip replacement , both fixation and hemiarthroplasty were characterised by increased costs arising from hip-replacement admissions . When total ( initial episode and subsequent hip-related admissions ) hip-related costs are compared , total hip replacement conferred a cost advantage of around 3000 pounds Sterling per patient ( versus hemiarthroplasty , 95 % CI -pounds Sterling 1400 to 7420 pounds Sterling ) . CONCLUSIONS In fit , older patients the results of the study show a clear advantage for arthroplasty over fixation ; arthroplasty was more clinical ly effective and probably less costly over a 2-year period postsurgery . The results suggest that total hip replacement has long-term advantages over bipolar hemiarthroplasty , but these findings are less definite . This study provided support for the use of total hip replacement to treat displaced intracapsular hip fractures in fit , older patients . A larger trial comparing total versus hemiarthroplasty for these fractures could help to verify these findings . It would also be useful to know whether the findings of this study apply to patients aged 60 years or less who are usually treated with reduction and fixation .  A clinical trial comparing arthroplasty versus fixation in patients older than 40 years would be a logical extension of the current study Abstract Metal-on-metal total hip resurfacing arthroplasty has had excellent reported results at early to midterm followup , and some studies suggest that outcomes are comparable to conventional THA . We compared the clinical and radiographic outcomes of two closely matched groups of 54 patients who underwent resurfacing and conventional THA , respectively . Each group consisted of 36 men and 18 women who had a mean age of 52 years and a mean body mass index of 29 kg/m2 . At a minimum followup of 24 months ( mean , 40 months ; range , 24–60 months ) , the mean Harris hip scores increased similarly in both groups ( from 52 to 90 points and from 50 to 91 points for the resurfacing and conventional groups , respectively ) . Radiographic outcomes , revision rates , complications , pain scores , and satisfaction ratings of the two groups were similar . The patients who underwent resurfacing had higher postoperative weighted activity scores than the patients who underwent conventional THA , although they had higher preoperative weighted activity scores as well . The early outcomes of resurfacing are comparable to those of conventional THA . Level of Evidence : Level III , therapeutic study . See the Guidelines for Authors for a complete description of levels of evidence
The present evidence indicated the similar performance in survivorship among CoC , CoPc , CoPxl and MoPxl bearing implants , and that all likely have superiority compared with the MoM and MoPc bearing implants in THA procedures .
PURPOSE Although many  total hip bearing implants  are widely used all over the world , simultaneous comparisons across the numerous available bearing surfaces are rare .
The purpose of this study was to compare the survivorship of total hip arthroplasty ( THA ) with six available bearing implants .