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Resurfacing arthroplasty has become an attractive option for young patients who want to maintain a high activity level. One recent study reported modestly increased activity levels for patients with resurfacing compared to standard total hip arthroplasty (THA). We conducted a prospective randomized clinical trial to compare clinical outcomes of resurfacing versus large-head metal-on-metal total hip arthroplasty. We randomized 107 patients deemed eligible for resurfacing arthroplasty to have either resurfacing or standard THA. Patients were assessed for quality-of-life outcomes using the PAT-5D

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Background Previous studies have indicated poor outcomes in patients having revision of hip resurfacing resulting from adverse local tissue reaction and pseudotumor. Questions/purposes We reviewed all patients at our institution who had revision of failed large-head metal-onmetal total hip arthroplasty to determine (1) complications including reoperations; (2) radiologic outcomes; and (3) changes in serum ions after removal of the metal bearing.Methods From our research database, we identified 32 hips in 30 patients. Revisions were performed through a posterior approach; 17 were performed with a titanium fiber-metal shell and 15 with a porous tantalum shell, and 29 of the 32 revisions were performed with large (36-or 40-mm) femoral heads. Clinical records were reviewed and interviews conducted in the clinic or by telephone. Nineteen hips had a pre-or intraoperative diagnosis of adverse local tissue reaction, three had deep infection, and 10 had loosening of the acetabular component. Results Major complications occurred in 12 (38%) of the 32 revisions. Nine of 32 hips (28%) sustained dislocations. Four of 17 fiber-metal acetabular components failed to ingrow; none of the porous tantalum cups failed to ingrow. Seven repeat revisions were performed in six patients: three for acetabular loosening, three for recurrent dislocation, and one for recurrent adverse local tissue reaction. The mean WOMAC pain score was 78 of 100 and the function score was 83 of 100. Metal ion levels decreased after revision in most patients. Conclusions As a result of the high rate of failure of the fiber metal cups, we have elected to use an enhanced fixation surface with a high-porosity cup for revision of these cases. We observed a high rate of dislocation despite the use of 36-mm and 40-mm heads.

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Periprosthetic fractures are an increasingly common complication following joint replacement. The principles which underpin their evaluation and treatment are common across the musculoskeletal system. The Unified Classification System proposes a rational approach to treatment, regardless of the bone that is broken or the joint involved.

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