The clinical and radiological outcomes of hip resurfacing versus total hip arthroplasty: a meta-analysis and systematic review

Abstract

Background and purposeHip resurfacing (HRS) procedures have gained increasing popularity for younger, higher-demand patients with degenerative hip pathologies. However, with concerns regarding revision rates and possible adverse metal hypersensitivity reactions with metal-on-metal articulations, some authors have questioned the hypothesized superiority of hip resurfacing over total hip arthroplasty (THA). In this meta-analysis, we compared the clinical and radiological outcomes and complication rates of these 2 procedures.MethodsA systematic review was undertaken of all published (Medline, CINAHL, AMED, EMBASE) and unpublished or gray literature research databases up to January 2010. Clinical and radiological outcomes as well as complications of HRS were compared to those of THA using risk ratio, mean difference, and standardized mean difference statistics. Studies were critically appraised using the CASP appraisal tool.Results46 studies were identified from 1,124 citations. These included 3,799 HRSs and 3,282 THAs. On meta-analysis, functional outcomes for subjects following HRS were better than or the same as for subjects with a THA, but there were statistically significantly greater incidences of heterotopic ossification, aseptic loosening, and revision surgery with HRS compared to THA. The evidence base showed a number of methodological inadequacies such as the limited use of power calculations and poor or absent blinding of both patients and assessors, possibly giving rise to assessor bias.InterpretationOn the basis of the current evidence base, HRS may have better functional outcomes than THA, but the increased risks of heterotopic ossification, aseptic loosening, and revision surgery following HRS indicate that THA is superior in terms of implant survival.

Incidence of Heterotopic Ossification after Surface and Conventional Total Hip Arthroplasty: A Comparative Study Using Anterolateral Approach and Indomethacin Prophylaxis

“…At a minimum 1-year followup, Rama et al [6] found an increased incidence and severity of ectopic bone formation in SRA compared to conventional THA, hypothesizing the need to routinely adopt preventive measures after hip resurfacing procedures. Similarly, in a recent meta-analysis study, a significantly higher presence of HO was detected in resurfaced hips [7]. …”

The failure of survivorship

“…6 A further systematic review comparing hip resurfacing with THR demonstrated that while resurfacing may give a better functional outcome, THR has better survivorship. 7 It is important to note that, as with survivorship, using PROMs alone can cause problems. Logistically, questionnaires are more labour intensive and expensive to collect than survivorship data.…”

Surgical management of hip osteoarthritis

“…Reported disadvantages include increased risk of femoral neck fracture, more bone loss on the acetabular side, a more difficult operation requiring larger incisions, and increased risk of systemic exposure to metal ions resulting from wear of the metal-on-metal bearing surface. [44][45][46][47][48][49] Hip resurfacing is predominantly considered for the young active patient with end-stage osteoarthritis. 47 Early and mid-term follow-up generally has shown comparable results to those of standard replacement.…”