Resurfacing is Comparable to Total Hip Arthroplasty at Short-term Followup Two-year migration results of the ReCap hip resurfacing system—a radiostereometric follow-up study of 23 hips Causes of early failure in a multicenter clinical trial of hip resurfacing. A randomised controlled trial of total hip arthroplasty versus resurfacing arthroplasty in the treatment of young patients with arthritis of the hip joint A comparison of total hip resurfacing and total hip arthroplasty - patients and outcomes. The John Charnley Award: The Functional Outcome of Hip Resurfacing and Large-head THA Is the Same: A Randomized, Double-blind Study Resurfacing hip prostheses revisited: failure analysis during a 16-year follow-up. Birmingham Hip Resurfacing in Patients who are Seventy Years of Age or Older The Knee Arthroplasty Trial (KAT) design features, baseline characteristics, and two-year functional outcomes after alternative approaches to knee replacement. Stepwise introduction of a bone-conserving osseointegrated hip arthroplasty using RSA and a randomized study: II. Clinical proof of concept—40 patients followed for 2 years No adverse effects of early weight bearing after uncemented total hip arthroplastyA randomized study of 20 patients 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 Wagner resurfacing hip arthroplasty. The results of one hundred consecutive arthroplasties after eight to ten years. A new uncemented hydroxyapatite-coated femoral component for the treatment of femoral neck fractures: two-year radiostereometric and bone densitometric evaluation in 50 hips. Early results of primary Birmingham hip resurfacings. An independent prospective study of the first 230 hips. Bone remodelling around the Metha short stem in total hip arthroplasty: a prospective dual-energy X-ray absorptiometry study The Effect of Joint Space on Midterm Outcomes After Arthroscopic Hip Surgery for Femoroacetabular Impingement
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 There has been renewed interest for metal-on-metal hip resurfacing due to improved design and manufacturing of implants , better material s , and enhanced implant fixation . In contrast to conventional total hip replacements , only a few clinical hip resurfacing trials using radiostereometry ( RSA ) have been reported , and solely for the Birmingham hip resurfacing arthroplasty . The purpose of this RSA trial was to describe the migration pattern of a  new hip resurfacing system ( ReCap ) within the first two years after primary surgery . Twenty-six patients underwent total hip replacement .  The patients were followed-up for up to 24 months and were evaluated with the use of radiostereometric measurements .  The prosthesis showed mean translations and rotation close to zero . Maximum translation was seen along the transverse axis in the medial direction ( 0.13 mm ) . No statistically significant translation or rotation was seen at two-years follow-up , ( t-test , p < 0.05 , translation or rotation ) The purpose of this study was to evaluate the clinical outcomes and possible causes of early failure in a multicenter trial of metal-on-metal hip resurfacing . Two hundred patients were prospect ively enrolled and followed for an average of 31.2 months ( range , 12 - 54 months ) . Of 200 patients , 14 ( 7.0 % ) required revision surgery at a mean time of 19.5 months ( range , 3 - 47 months ) . Patients with failures were significantly younger and heavier than the nonfailures , and all were male . Patients who were revised did not differ from those who were not revised in terms of radiographic outcomes , but they did report lower functional outcome scores at all preoperative and postoperative testing intervals . Most failures ( 10/14 ) were related to early acetabular loosening . The learning curve was likely a factor in these cup failures . This report highlights the importance of patient selection and surgical technique in hip resurfacing arthroplasty . It is anticipated that further surgical experience will lead to a reduction in this high early failure rate 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 A comparison of pertinent preoperative and postoperative data relative to total hip resurfacing versus total hip arthroplasty ( THA ) would assist in evaluating current perceptions in outcome . We compared 50 consecutive metal-metal resurfacing replacements in 50 patients with 44 consecutive conventional total hip arthroplasties in 35 patients , who were implanted during the same time period , by the same surgeon , and followed prospect ively for 2 to 4 years . The patients undergoing hip resurfacing were 62 % male , 9 years younger , and 3.2 inches taller , with a lower mean body mass index and American Society of Anesthesiologists ( ASA ) grade than patients undergoing total hip arthroplasty .  Preoperatively , patients undergoing resurfacing had a lower Harris hip score ( 46 vs 52 points ) , more pain , higher UCLA ( University of California at Los Angeles ) activity scores ( 4.2 vs 3.6 ) , and better range of motion . Surgical time for resurfacing was 18 % longer , but there was less total blood loss and fewer transfusions . Postoperatively , there was no difference in Harris hip score ( 97 vs 96 ) . Patients undergoing resurfacing had higher function , Short Form-12 physical activity scores , and UCLA activity scores , but also a higher incidence of slight or mild pain . There were no differences in postoperative range of motion or dislocation ( one each ) . The preoperative characteristics and general health status of the average patient undergoing resurfacing are more favorable than that of the average patient undergoing conventional total hip arthroplasty . Caution should be applied in attributing differences in outcomes directly to the arthroplasty technology Better functional outcome is believed by some to occur after hip resurfacing ( HR ) than conventional 28-mm total hip arthroplasty ( THA ) in young and active patients with hip osteoarthritis . However , the postulated superior outcome of HR over THA may simply be the result of a bias in patient selection or the use of a larger femoral head . We therefore asked whether HR would demonstrate superior functional outcome when compared with a THA with a large-diameter femoral head in a r and omized , double-blind study . Gait speed and postural balance evaluations , functional tests , and clinical data were analyzed preoperatively and at 3 , 6 , and 12 months after surgery . Gait speed was used as the primary outcome measure . Forty-eight patients were r and omized in the study and a third group of 14 healthy subjects served as controls . The gait speed and postural balance evaluations , the performance at most functional tests , and clinical scores were similar in HR and large-head THA groups at each followup period . The operated patients reached most control group values at 3 months postoperatively . By these measures , HR did not provide better clinical function over large-head THA.Level of Evidence : Level I , therapeutic study . See the Guidelines for Authors for a complete description of levels of evidence We conducted a prospect i ve study of the clinical and radiographic variables related to the survival of 114 cementless resurfacing double-cup hip replacements ( RHR ) with a mean follow-up of 9 ( range : 1 - -16 ) years . Three patients died , and 22 were unavailable for the final review in 2003 . Sixty-one RHRs had to be revised to a total hip replacement . Failure analysis of these revised RHRs showed femoral head and neck resorption under the prosthesis in 33 , acetabular protrusion in seven , both femoral and acetabular resorption in 14 and a femoral-neck fracture in three . One hip had dislocated , and there were three hips with unexplained pain . The Kaplan-Meier 5-year mean survival was 92 % , the 10-year survival was 47 % ( 95 % CI 37 - -57 % ) and the 15-year survival was 30 % ( 95 % CI 20 - -40 % ) . Pre-operative joint destruction ( grade 1 ) , a high degree of radiological osteoporosis , a body mass index > 25 and prosthesis mismatch were significantly related to failure of the RHR . We believe that in young , non-obese patients with pre-operative radiological central destruction but without severe proximal femoral osteoporosis , a resurfacing arthroplasty may have some value . Our failures were mainly due to femoral resorption under the prosthetic femoral component There is no published literature to support mid to long term results of hip resurfacing ( HR ) arthroplasty in patients over the age of 70 years . The purpose of our study was to evaluate the function HR in this age group ( 70 or older at the time of surgery ) at medium to long term follow-up . Between July 1997 and November 2002 , the Oswestry Outcome Centre independently and prospect ively collected data on 5000 Birmingham Hip Resurfacings ( BHRs ) . 106 had been implanted in elderly patients who were 70 years of age or older . The post-operative Harris and Merle D'Aubigné and Postel ( MDP ) hip scores and causes for revision were used to ascertain function and implant survival . Hip scores for the older BHR patients were compared with those from younger patients . The average age at surgery of the elderly BHR cohort was 73.2 years ( range , 70.0 to 87.9 years ) with a mean follow-up of 7.1 years ( range , 0.5 to 10.9 years ) . Four patients had a femoral neck fracture and required conversion to a conventional total hip replacement . There were no patients lost to follow-up and no dislocations in this series . The median Harris hip score ( HHS ) was significantly better in the younger BHR group compared with the elderly BHR group , ( 96 vs. 94 p=0.008 ) . There was no significant difference in recovery rates after surgery . There was a significantly higher rate of revision in women than men among the elderly patients ( male= 1 of 65 ( 1.5 % ) ; women = 3 of 19 ( 15.8 % ) , p=0.03 ) . At latest follow-up the elderly patients continued to function well when compared with the younger BHR patients . There was a high mid to long term success rate after HR in patients who were 70 years of age or older , without the failure burden possibly anticipated . Elderly patients had a poorer functional outcome , but a difference in HHS of two points may be of only minor clinical significance BACKGROUND The aim of continued development of total knee replacement systems has been the further improvement of the quality of life and increasing the duration of prosthetic survival . Our goal was to evaluate the effects of several design features , including metal backing of the tibial component , patellar resurfacing , and a mobile bearing between the tibial and femoral components , on the function and survival of the implant . METHODS A pragmatic , multicenter , r and omized , controlled trial involving 116 surgeons in thirty-four centers in the United Kingdom was performed ; 2352 participants were r and omly allocated to be treated  with or without a metal backing of the tibial component ( 409 ) , with or without patellar resurfacing ( 1715 ) , and /or with or without a mobile bearing ( 539 ) . R and omization to more than one comparison was allowed . The primary outcome measures were the Oxford Knee Score ( OKS ) , Short Form-12 , EuroQol-5D , and the need for additional surgery . The results up to two years postoperatively are reported . RESULTS Functional status and quality -of-life scores were low at baseline but improved markedly across all trial groups following knee replacement ( mean overall OKS , 17.98 points at baseline and 34.82 points at two years ) . Most of the change was observed at three months after the surgery . Six percent of the patients had additional knee surgery within two years . There was no evidence of differences in clinical , functional , or quality -of-life measures between the r and omized groups at two years . CONCLUSIONS Patients have substantial improvement following total knee replacement . This is the first adequately powered r and omized controlled trial , of which we are aware , in which the effects of metal backing , patellar resurfacing , and a mobile bearing were investigated . We found no evidence of an effect of these variants on the rate of early complications or on functional recovery up to two years after total knee replacement Background We have developed a bone-conserving commercially pure titanium hip replacement system using osseointegration principles : a metaphyseal loading proximal femoral component affixing into the retained neck and metaphysis only , leaving the femoral canal untouched . The acetabular cup closely fits a dual-geometry cavity , avoiding stress protection at the dome . Patients and methods After extensive laboratory and clinical pilot trial investigations , the surface-engineered implants were su bmi tted to a prospect i ve r and omized controlled clinical trial involving 40 patients ( 40 hips ) , in which they were compared to the cemented Spectron femoral component and cementless Trilogy cup as control implant . The following clinical measures were used to monitor progress at regular intervals for the first 2 postoperative years : radiostereometric analysis ( RSA ) , Harris Hip Score , pain score , WOMAC , and SF-36 . Results After 2 years of follow-up , no statistically significant differences were seen between the groups concerning rotation or translation along the cardinal axes . The patients receiving the Gothenburg osseointegrated titanium ( GOT ) system had significantly higher Harris Hip Score at 6 months , suggesting more rapid recovery . WOMAC , SF-36 and pain analysis were similar for the first 2 postoperative years . Interpretation Our RSA data suggest that osseointegration was achieved for all patients receiving the GOT hip system . This bone-conserving prosthesis may provide a good alternative , especially for young and active patients 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 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 In a prospect i ve study of 100 consecutive Wagner resurfacing hip arthroplasties in ninety-three patients , the outcomes for all hips were determined for an eight to ten-year follow-up period . By survivorship analysis , the rate of survival of the arthroplasty was calculated to be 70 per cent at five years , but only 40 per cent at eight years . The major cause of failure was aseptic loosening of the acetabular or femoral component , or both . Fracture of the neck of the femur occurred in three hips . Although the medium-term results ( at fifty-six to eighty-three months ) were better than those in most comparable studies of resurfacing arthroplasty , the poor long-term results ( at ninety-one to 118 months ) show that meaningful studies of new prosthetic design s must continue for at least eight years , and , if at all possible , must include 100 per cent follow-up . The survival curve for the resurfacing arthroplasties in this study can serve as the basis for comparison of the early , medium , and long-term results of future design s of resurfacing hip prostheses Our aim in this pilot study was to evaluate the fixation of , the bone remodelling around , and the clinical outcome after surgery of a new , uncemented , fully hydroxyapatite-coated , collared and tapered femoral component , design ed specifically for elderly patients with a fracture of the femoral neck . We enrolled 50 patients , of at least 70 years of age , with an acute displaced fracture of the femoral neck in this prospect i ve single-series study . They received a total hip replacement using the new component and were followed up regularly for two years . Fixation was evaluated by radiostereometric analysis and bone remodelling by dual-energy x-ray absorptiometry .  Hip function and the health-related quality of life were assessed using the Harris hip score and the EuroQol-5D . Up to six weeks post-operatively there was a mean subsidence of 0.2 mm ( -2.1 to + 0.5 ) and a retroversion of a mean of 1.2 ° ( -8.2 ° to + 1.5 ° ) . No component migrated after three months . The patients had a continuous loss of peri-prosthetic bone which amounted to a mean of 16 % ( -49 % to + 10 % ) at two years . The mean Harris hip score was 82 ( 51 to 100 ) after two years . The two-year results from this pilot study indicate that this new , uncemented femoral component can be used for elderly patients with osteoporotic fractures of the femoral neck We describe the experience with the first consecutive 230 Birmingham hip resurfacings at our centre . At a mean follow-up of three years ( 25 to 52 months ) survivorship was 99.14 % with revision in one patient for a loose acetabular component and one death from unrelated causes . One patient developed a fracture of the femoral neck at six weeks which united unremarkably after a period of non-weight-bearing . The Harris hip score improved from a mean of 62.54 ( 8 to 92 ) to 97.74 ( 61 to 100 ) . The mean flexion improved from 91.52 degrees ( 25 to 140 ) to 110.41 degrees ( 80 to 145 ) . Most patients ( 97 % ) considered the outcome to be good or excellent . Our preliminary experience with this implant is encouraging and the results are superior to the earlier generation of resurfacings for the same length of follow-up Purpose On the basis of positive clinical results with mid- and long-term follow-up using the Mayo short stem , the Metha neck-preserving stem ( BBraun , Aesculap , Tuttlingen , Germany ) was introduced . The purpose of this study was to vali date the implant design by direct acquisition of bone remodelling data from total hip arthroplasty ( THA ) recipients using dual-energy X-ray absorptiometry ( DEXA ) . Methods After power analysis , 25 patients were included in this prospect i ve study . Patients were examined clinical ly and underwent DEXA examinations preoperatively and postoperatively at one week , six months and one and two years after THA . Gruen zones were adapted to the short stem design ( R1–R7 ) . Results The Harris Hip Score ( HHS ) increased significantly by 31 points . No stem had to be revised . Bone mineral density ( BMD ) in the greater trochanter decreased significantly from 0.78 g/cm2 postoperatively to 0.72 g/cm2 two years after surgery . Marginal changes were seen in the lateral distal regions ( R4–R5 ) . In the minor trochanter region , BMD increased significantly after two years by 12.9 % . In the calcar region , BMD exceeded the baseline value by 6.1 % two years after implantation . Conclusions Stress shielding seems to occur at the greater trochanter due to the vast cross-section of the implant . However , the aim of proximal load transfer of the Metha stem seems to be partially achieved . DEXA analysis revealed a concentrated load distribution on the medial portion of the femur , which is an important region to guarantee long-term implant survival Background : Excellent short-term results have been reported after  hip arthroscopic surgery to address femoroacetabular impingement ( FAI ) . Purpose /Hypothesis : The purpose of this study was to determine if patients with narrow joint spaces had inferior outcomes at a postoperative minimum of 5 years and if they had a higher conversion rate to total hip arthroplasty ( THA ) . The hypothesis was that patients with ≤2-mm joint spaces would report inferior outcomes and that patients with > 2-mm joint spaces would have improved survivorship ( no conversion to THA ) . Study Design : Cohort study ; Level of evidence , 3 . Methods : Between March 2005 and January 2008 , prospect ively collected data were analyzed for patients older than 18 years of age undergoing hip arthroscopic surgery for FAI . Radiographic measurements of joint space were collected , and hips were grouped as having preserved ( > 2 mm ) or limited ( ≤2 mm ) joint space . Outcome measures included the Western Ontario and McMaster Universities Arthritis Index ( WOMAC ) , modified Harris Hip Score ( MHHS ) , Hip Outcome Score ( HOS ) for activities of daily living and sports , and Short Form–12 ( SF-12 ) . Results : There were 559 patients included , 466 ( 83 % ) of whom were contacted . Fifty-four patients with limited joint spaces ( 86 % ) converted to THA , while only 63 patients with preserved joint spaces ( 16 % ) converted to THA . The mean survival time for patients with preserved joint spaces was 88 months ( 95 % CI , 85 - 91 months ) , and the mean survival time for patients with limited joint spaces was 40.0 months ( 95 % CI , 33.7 - 46.3 months ) ( P = .0001 ) . Complete follow-up outcome data were available on 323 patients , none of whom had THA , with a mean follow-up of 73 months . The mean postoperative HOS for activities of daily living and sports were significantly better in patients with preserved joint spaces ( 82 vs 62 [ P = .012 ] and 77 vs 47 [ P = .003 ] , respectively ) compared with those with limited joint spaces at a mean of 73 months postoperatively ( range , 60 - 97 months ) . Conclusion : Hip arthroscopic surgery for FAI result ed in significantly better outcomes and activity levels at minimum 5-year follow-up in patients with preserved joint spaces . Hips with limited joint spaces converted to THA earlier than did those with preserved joint spaces
Conclusions Revisions and reoperations are more frequent and occur earlier with metal-on-metal hip resurfacing , except when discontinued devices are removed from the analyses .
Background Metal-on-metal hip resurfacing was developed for younger , active patients as an alternative to THA , but it remains controversial .
Study heterogeneity , inconsistent outcome definitions , and unst and ardized outcome measures challenge our ability to compare arthroplasty outcomes studies .
Questions / purpose sWe asked how early revisions or reoperations ( within 5 years of surgery ) and overall revisions , adverse events , and postoperative component malalignment compare among studies of metal-on-metal hip resurfacing with THA  among patients with hip osteoarthritis .
Secondarily , we compared the revision frequency identified in the systematic review with revisions reported in four major joint replacement registries .