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, randomised 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 questionnaires. 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 randomly 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 cannot definitively exclude clinically 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 ISRCTN33354155, UKCRN 4093.

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We used Laser Doppler flowmetry to measure the effect on the blood flow to the femoral head/neck junction of two surgical approaches during resurfacing arthroplasty. We studied 24 hips undergoing resurfacing arthroplasty for osteoarthritis. Of these, 12 had a posterior approach and 12 a trochanteric flip approach. A Laser probe was placed under radiological control in the superolateral part of the femoral head/neck junction. The Doppler flux was measured at stages of the operation and compared with the initial flux. In both groups the main fall in blood flow occurred during the initial exposure and capsulotomy of the hip joint. There was a greater reduction in blood flow with the posterior (40%) than with the trochanteric flip approach (11%).

We report the early results and complications of resurfacing arthroplasty using the 'Trochanteric Flip Osteotomy' approach to the hip. There are no published clinical results of this approach used for resurfacing arthroplasty. One hundred consecutive patients were assessed prospectively for a minimum follow-up of 2 years (range 2-5 years). The Oxford Hip Score fell from a median of 30 pre-operatively to 5 at two years. Similar improvement was found in the UCLA Activity Score. There were no cases of component failure or fractures. However, nine patients had minor complications related to the osteotomy. Resurfacing Arthroplasty of the hip may be successfully performed through a trochanteric flip osteotomy. This surgical approach may avoid some of the complications associated with avascular necrosis of the femoral head.

Metal-on-metal hip resurfacing is a popular procedure for a select group of patients. A variety of surgical approaches are being utilised, each of which may be associated with specific complications. We describe an unusual complication following a Ganz trochanteric osteotomy approach, and the technique used to treat the subsequent periprosthetic fracture.