Hip resurfacing arthroplasty: short-term survivorship of 4,401 hips from the Finnish Arthroplasty Register

Abstract

Background and purposePopulation-based registry data from the Nordic Arthroplasty Register Association (NARA) and from the National Joint Register of England and Wales have revealed that the outcome after hip resurfacing arthroplasty (HRA) is inferior to that of conventional total hip arthroplasty (THA). We analyzed the short-term survival of 4,401 HRAs in the Finnish Arthroplasty Register.MethodsWe compared the revision risk of the 4,401 HRAs from the Register to that of 48,409 THAs performed during the same time period. The median follow-up time was 3.5 (0–9) years for HRAs and 3.9 (0–9) years for THAs.ResultsThere was no statistically significant difference in revision risk between HRAs and THAs (RR = 0.93, 95% CI: 0.78–1.10). Female patients had about double the revision risk of male patients (RR = 2.0, CI: 1.4–2.7). Hospitals that had performed 100 or more HRA procedures had a lower revision risk than those with less than 100 HRAs (RR = 0.6, CI: 0.4–0.9). Articular Surface Replacement (ASR, DePuy) had inferior outcome with higher revision risk than the Birmingham Hip Resurfacing implant (BHR, Smith & Nephew), the reference implant (RR = 1.8, CI: 1.2–2.7).InterpretationWe found that HRA had comparable short-term survivorship to THA at a nationwide level. Implant design had an influence on revision rates. ASR had higher revision risk. Low hospital procedure volume worsened the outcome of HRA. Female patients had twice the revision risk of male patients.

Are Females at Greater Risk for Revision Surgery After Hip Resurfacing Arthroplasty With the Articular Surface Replacement Prosthesis?

“…Furthermore, only one previous study focused specifically on the ASR TM prosthesis, which is known to have a lower survival rate than other MoM devices [29]. This is likely attributable to the specific design differences between the ASR TM and similar hip resurfacing devices.…”

“…It has been reported that 29% to 34% of hip resurfacing arthroplasties have been performed in females [6,29,31]. Some studies have indicated that females receiving hip resurfacing arthroplasties with MoM prostheses are at an especially high risk of revision surgery and report higher levels of pain compared with males [3,14].…”

601 metal-on-metal total hip replacements with 36 mm heads a 5 minimum year follow up: Levels of ARMD remain low despite a comprehensive screening program

“…[17][18][19][20][21][22][23][24] Implants such as the ASR system (DePuy Orthopaedics, Johnson & Johnson, Warsaw, IN, USA) experienced high failure rates and were recalled from the market. [25][26][27][28] The same concerns were extended to all metal on metal bearing hip replacements/resurfacings and in 2012 The Medicines and Healthcare Products Regulatory Agency (MHRA) (UK) issued guidelines to assess the performance and safety of these implants.…”

Hip resurfacing arthroplasty versus large-diameter head metal-on-metal total hip arthroplasty: comparison of three Designs from the Finnish Arthroplasty Register

“…The short-term survival of the BHR resurfacing in Finland is worse than in Australia and in England and Wales. Despite this, the BHR has been one of the best performing resurfacing designs in Finland (20).…”