Randomized comparison of reduction and fixation, bipolar hemiarthroplasty, and total hip arthroplasty. Treatment of displaced intracapsular hip fractures in healthy older patients. Uncemented HA-coated Implant is the Optimum Fixation for TKA in the Young Patient Displaced intracapsular hip fractures in fit, older people: a randomised comparison of reduction and fixation, bipolar hemiarthroplasty and total hip arthroplasty. The results of the titanium-coated RM acetabular component at 20 years: a long-term follow-up of an uncemented primary total hip replacement. Treatment of femoral neck fractures with total hip replacement versus cemented and noncemented hemiarthroplasty. 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 Leg length discrepancy, dislocation rate, and offset in total hip replacement using a short modular stem: navigation vs conventional freehand. A feasibility randomised controlled trial of pre-operative occupational therapy to optimise recovery for patients undergoing primary total hip replacement for osteoarthritis (PROOF-THR) Stepwise introduction of a bone-conserving osseointegrated hip arthroplasty using RSA and a randomized study: I. Preliminary investigations—52 patients followed for 3 years A randomised controlled trial of total hip arthroplasty versus resurfacing arthroplasty in the treatment of young patients with arthritis of the hip joint Patient Relevant Outcomes after total hip replacement. A comparison between different surgical techniques A prospective randomised controlled trial comparing three alternative bearing surfaces in primary total hip replacement. Modified direct anterior approach in minimally invasive hip hemiarthroplasty in a geriatric population: a feasibility study and description of the technique Cementless primary total hip replacement. Four to eight year results with the Zweymüller-Alloclassic prosthesis. Effect of augmented cup fixation on stability, wear, and osteolysis: a 5-year follow-up of total hip arthroplasty with RSA. What Works Best, a Cemented or Cementless Primary Total Hip Arthroplasty?: Minimum 17-year Followup of 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.
BACKGROUND Orthopaedic surgeons vary in their management of displaced intracapsular fractures of the hip in healthy older patients . The aim of this investigation was to determine the functional , clinical , and re source consequences of three different types of surgical treatment . METHODS The study was a multicenter r and omized controlled trial . Reduction and fixation was compared with bipolar hemiarthroplasty with cement and total hip replacement with cement .  Participating surgeons elected to r and omize their patients to be treated with either one of the three types of procedures or with either fixation or bipolar hemiarthroplasty .  Functional outcomes were measured with a hip-rating question naire and the EuroQol health status measure . Clinical outcomes included mortality and complications . The direct health service costs were compared . Participants were followed up for two years . RESULTS Two hundred and seven patients were r and omized to be treated with one of the three operations , and ninety-one were r and omized to be treated with either fixation or bipolar hemiarthroplasty .  There were no differences in the mortality rates among the treatment groups . The rate of secondary surgery was highest in the fixation group ( 39 % compared with 5 % in the group treated with bipolar hemiarthroplasty and 9 % in the group treated with total hip replacement ) . The fixation group had the worst hip-rating- question naire and EuroQol scores at four and twelve months . The total hip replacement group had significantly better functional outcome scores at twenty-four months than the other two groups . Although fixation was initially the least costly procedure , this short-term advantage was eroded by significantly higher costs for subsequent hip-related hospital admissions . CONCLUSIONS Arthroplasty is more clinical ly effective and cost-effective than reduction and fixation in healthy older patients with a displaced intracapsular fracture of the hip . The long-term results of total hip replacement may be better than those of bipolar hemiarthroplasty Fixation of the tibial component in total knee arthroplasty in younger patients remains controversial . We evaluate the results of three different types of fixation of the Profix total knee arthroplasty  in a r and omized controlled trial of 97 consecutive knees ( 85 patients ) with osteoarthrosis or inflammatory arthritis with 2-year followup of all patients . We r and omized patients to three different types of fixation of the tibial component : cemented , uncemented ( HA coated ) with screws , or uncemented ( HA coated ) without screws . We performed clinical evaluations and radiostereometric analysis at 6 weeks , and 3 , 6 , 12 and 24 months postoperatively . The knees in the uncemented groups migrated more than those in the cemented group during the first 3 months , but at 2 years we observed no differences . The uncemented implants  displayed all migration within the first 3 months . The cemented implants did not stabilize but had continuously increasing migration during the followup . Cementless implants without screws  did not migrate more than implants with screws and displayed similar pattern of migration , indicating screws do not improve fixation .  Uncemented fixation using hydroxyapatite-coated implants without screws seems to be the best solution for the younger patient . Level of Evidence : Therapeutic Level I. See the Guidelines for Authors for a complete description of levels of evidence 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 In a prospect i ve study , 93 unselected consecutive uncemented hip arthroplasties were performed in 80 patients using the  titanium-coated RM acetabular component and the CLS femoral component .  The mean age of the patients at operation was 52 years ( 28 to 81 ) . None were lost to follow-up . In the 23 patients who had died ( 26 hips ) only one acetabular component had been revised . In the 57 living patients ( 67 hips ) , 13 such revisions had been performed . Of the 14 revisions , seven were for osteolysis , five for loosening and two for infection . Survival analysis of this implant showed a total probability of survival of 83 % ( 95 % confidence interval 73 to 90 ) , with all revisions as the endpoint , and a probability of 94 % ( 95 % confidence interval 87 to 98 ) with revision for aseptic loosening as the endpoint , indicating reliable long-term fixation of the titanium-coated RM acetabular component A prospect i ve study of displaced femoral neck fractures was conducted with patients r and omized into three groups :  cemented total hip replacement ( THR ) , cemented hemiarthroplasty ( UHR-C ) , and noncemented hemiarthroplasty ( UHR-NC ) .  Eighty-nine patients were treated for displaced ( Garden type 3 or 4 ) fracture with a prosthesis ; 39 patients had THR , 37 had UHR-C , and 13 had UHR-NC .  No difference was found in the level of pain , ambulation , or aids required between the THR group and the UHR-C group , except for active community ambulators , who demonstrated decreased endurance capability when treated with UHR-C. The patients treated with UHR-NC had increased pain and decreased ambulation and required assistive devices . The most significant complication was dislocation , which occurred in 7 patients with THR and 2 with UHR-C. The mortality rate at 2 years was 18 % ; all but two of the deaths were in patients with one of five different medical diseases : clinical ly significant cardiac or pulmonary disease , cancer , alcoholism , or psychosis . The mortality rate was insignificant in patients younger than 70 years of age . Roentgenographic review showed only 2 of 76 cemented stems with progressive cement-bone demarcation , with one patient requiring revision for a loose prosthesis . No evidence of protrusio was seen with the use of the bipolar cap . The uncemented hemiarthroplasties demonstrated lucency between the metal and bone in the proximal femur in 9 of 13 stems . The authors make recommendations regarding hip replacement 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 We present a match-paired study between computer-assisted and freeh and techniques using a short modular femoral stem ( Metha ; B. Braun Aesculap , Tuttlingen , Germany ) in  total hip replacement ( THR ) .  Surgical time , clinical outcome , dislocation rate , limb length , and offset in 44 patients with ideal indication for this more conservative implant were assessed . Despite both longer surgical time and similar early outcomes , the results showed how computer-assisted techniques allow easier management of limb length discrepancy and offset restoring . We believe that navigated short modular stems are safe for less invasive THR Objective : To assess the feasibility of a pre-operative occupational therapy intervention for patients undergoing primary total hip replacement . Design : Single blinded feasibility r and omised controlled trial , with data collection prior to the intervention , and at 4 , 12 , and 26 weeks following surgery . Setting : Recruitment from two NHS orthopaedic outpatient centres in the West Midl and s , UK . Subjects : Patients awaiting primary total hip replacement due to osteoarthritis were recruited . Following pre-operative assessment , patients were individually r and omised to intervention or control by a computer-generated block r and omisation algorithm stratified by age and centre . Interventions : The intervention group received a pre-surgery home visit by an occupational therapist who discussed expectations , assessed home safety , and provided appropriate adaptive equipment . The control group received treatment as usual . Outcomes : The study assessed the feasibility of recruitment procedures , delivery of the intervention , appropriateness of outcome measures and data collection methods . Health related quality of life and re source use were recorded at 4 , 12 and 26 weeks . Results : Forty-four participants were recruited , 21 were r and omised to the  occupational therapy  intervention and 23 to usual care . Analysis of 26 week data included 18 participants in the intervention group and 21 in the control . The intervention was delivered successfully with no withdrawals or crossovers ; 5/44 were lost to follow-up with further missing data for participation and re source use . Conclusions : The feasibility study provided the information required to conduct a definitive trial . Burden of assessment would need to be addressed . A total of 219 patients would be required in an efficacy trial Background We developed a total hip system using osseointegration guidelines , a metaphyseal-loading proximal femoral replacement in the retained neck and a dual-geometry titanium shell in the acetabulum . Patients and methods A r and omized controlled clinical trial was undertaken in 52 patients ( 53 hips ) , using the cemented Spectron stem and cementless Harris-Galante II cup as control implants  ( 24 patients in experimental group , 29 control patients ) . Clinical measures of Harris Hip Score ( HHS ) , pain score and radiostereometric analysis ( RSA ) at regular intervals for up to three years were used to monitor progress . Results No statistically significant differences were found in HHS and pain score ; the stability of the cementless experimental implant was also comparable to that of the cemented controls by RSA . 3 revisions were required for migration in the experimental group and 1 was required for component dislocation in the control group . Interpretation Our findings indicate the practicality of osseointegration of titanium implants , but suggest that current performance is inadequate for clinical introduction . However , the stable fixation achieved in the retained neck in the majority of patients is indicative of osseointegration . This finding will encourage technical and design improvements for enhancement of clinical osseointegration and should also encourage further study . Periprosthetic osteolysis might be avoided by the establishment and maintenance of direct implant-bone connection : “ osseointegration ” 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 Objective To investigate differences in pre- and postoperative patient-relevant outcome between hybrid total hip replacement ( THR ) and cemented THR in patients with primary osteoarthritis ( OA ) . Methods 245 consecutive patients were included in the study . 68 of the patients ( mean age 62 ) were operated on with hybrid THR and 177 ( mean age 74 ) were operated on with cemented THR .  All patients were investigated preoperatively and 0.5 , 1 and 3.6 years postoperatively with two self-administered question naires , SF-36 and WOMAC ( Western Ontario and MacMaster Universities Osteoarthritis Index , LK 3.0 ) . Results Preoperatively , there was a difference in the SF-36 subscales RP ( role physical ) and GH ( general health ) where the patients with the hybrid THR attained better scores . At 3.6-years the patients with the hybrid THR reached better scores in all SF-36 subscales except BP ( bodily pain ) and GH . Further , they had better scores in WOMAC function . However , after adjusting for age , sex , follow-up time and baseline values there were no differences in outcome between the two different surgical techniques . Conclusion This medium term ( 3–5 years ) , controlled , open cohort study , using patient-relevant outcome measures , did not reveal any differences between hybrid THR and cemented THR for OA at 3.6 years after surgery . Since the study had 75–94 % power to detect the clinical ly significant score difference of 10 points , we suggest that any difference in outcome between these two methods is small and may require a large-scale , blinded , r and omized trial to show 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 ) Introduction The direct anterior approach ( DAA ) is generally accepted method for minimal invasive arthroplasty of the hip . As good results for total hip arthroplasty are already published , there is a lack of evidence for the implantation of bipolar hip hemiarthroplasty ( BHH ) in elderly patients with osteoporosis after femoral neck fracture . Material s and methods For hip arthroplasty using a direct anterior approach ( DAA ) in elderly patients with femoral neck fractures , a number of modifications of the original technique are being described . The modified DAA considers in particular the co-morbidity and the bone quality of the geriatric patient population . A consecutive series of 16 hemiarthroplasties using this technique is presented . In all 16 cases , the BHH was implanted in modified DAA technique . Mobility measured by 4-item Barthel Index , pain via visual analogue scale ( VAS ) , duration of surgery , external length of incision and blood loss were evaluated . Results There was no major operative complication during the procedures . The pain level decreased from 7 ( preoperatively ) to 0 at postoperative day 40 . The Barthel Index increased from 5 at first postoperative day to 40 at day 40 . Early postoperative mobilisation is efficiently accelerated . Mean operating time was 71 min ; the medium skin incision length was 8 cm . The mean haemoglobin level decreased from 118 g/dl preoperatively to 101 g/dl at first postoperative day . Conclusion The described modifications of the DAA help to implant a BHH gently in elderly patients with increasing risk of complications like iatrogenic fractures , wound or prosthesis infections and haematoma . This will hopefully lead to a faster rehabilitation and lower mortality rate for patients with femoral neck fractures in the future One hundred and twenty-nine consecutive cementless primary total hip arthroplasties with Zweymüller-Alloclassic grit-blasted titanium components  were evaluated prospect ively at an average follow-up of 5.9 years . The clinical results were grade d as excellent or good in 116 hips ( 90 % ) , fair in 12 , and poor in one due to a fracture of the femoral shaft at operation leading to early stem loosening and delayed ring loosening . Failure was defined as definite aseptic loosening , and the final survivorship at 8 years was 99.3 % for the SL-stem , and 99.1 % for the CSF-threaded cup . These early results compare favourably with those of total hip arthroplasties using new cementing techniques To evaluate different modes of cementless fixation of hemispherical cups , we operated on 87 hips in 81 patients using 4 different means of cup fixation . The hips were r and omly assigned to fixation with press-fit technique only ( PF ) , or with augmentation with screws ( S ) , pegs ( P ) , or hydroxyapatite ( HA ) coating . The patients were evaluated with radiostereometric analysis ( RSA ) for cup migration and wear , conventional radiography for osteolysis , and Harris Hip Score for clinical outcome over 5 years . The fixation of the cups did not differ between the groups , but HA showed a tendency to decrease proximal migration . HA-coated cups displayed the best interface with hardly any signs of radiolucent lines , indicating a superior sealing effect of the HA coating . Cups with screws or pegs had more radiolucent lines and osteolytic lesions than the other groups . Radiolucent lines were correlated to higher proximal migration , young age , and female gender ( r2=.2 ) . The wear rate of the ethylene oxide-sterilized polyethylene liner was high ( 0.2 mm/y ) but did not differ between the groups . Two cups with a perioperative fracture of the acetabular rim showed large initial migration but stabilized thereafter Background  Total hip arthroplasty ( THA )  has been associated with high survival rates , but debate remains concerning the best fixation mode of THA . Questions / purpose sWe conducted a r and omized controlled trial ( RCT ) with 250 patients with a mean age of 64 years between October 1987 and January 1992 to compare the results of cementless and cemented fixation . Patients and Methods Patients were evaluated for revision of either of the components . One hundred twenty-seven patients had died ( 51 % ) and 12 ( 4.8 % ) were lost to followup . The minimum 17-year followup data ( mean , 20 years ; range , 17–21 years ) for 52 patients of the cementless group and 41 patients of the cemented group were available for evaluation . Results Kaplan-Meier survivorship analysis at 20 years revealed lower survival rates of cemented compared with cementless THA . The cementless tapered stem was associated with a survivorship of 99 % . Age younger than 65 years and male gender were predictors of revision surgery . Conclusions The efficacy of future RCTs can be enhanced by r and omizing patients in specific patient cohorts stratified to age and gender in multicenter RCTs . Including only younger patients might improve the efficacy of a future RCT with smaller sample sizes being required . A minimum 10-year followup should be anticipated , but this can be expected to be longer if the difference in level of quality between the compared implants is smaller . Level of Evidence Level I , therapeutic study . See Guidelines for Authors for a complete description of levels of evidence 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
Patients experienced significant post-THR improvements in Harris Hip scores , but this did not differ between impact types .
Recipients of cross-linked vs. conventional polyethylene cup liners experienced reduced femoral head penetration and revision .
There was no impact of femoral stem fixation and cup shell design on implant survival rates .
Evidence on mortality and complications ( aseptic loosening , femoral fracture ) was inconclusive .
BACKGROUND Evolvements in the design , fixation methods , size , and bearing surface of implants for  total hip replacement ( THR ) have led to a variety of options for healthcare professionals to consider .
The need to determine the most optimal combinations of THR implant is warranted .
This systematic review evaluated the clinical effectiveness of different types of THR used for the treatment of end stage arthritis of the hip .