Hip Resurfacing vs Total Hip Arthroplasty in Patients Younger than 35 Years: A Comparison of Revision Rates and Patient-Reported Outcomes

Abstract

Background: Hip resurfacing arthroplasty (HRA) and total hip arthroplasty (THA) are two treatment options for end-stage degenerative hip conditions. The objective of this single-center retrospective cohort study was to compare implant survival and patient-reported outcomes (PROs) in young patients (35 years) who underwent HRA or THA. Methods: All patients aged 35 years or younger who underwent HRA or THA with a single high-volume arthroplasty surgeon between 2004 and 2015 were reviewed. The sample included 33 THAs (26 patients) and 76 HRAs (65 patients). Five-year implant survival and minimum 2-year PROs were compared between patient cohorts. Results: Three patients in the THA group (9%) were revised within 5 years for instability (n ¼ 1), squeaking (n ¼ 1), or squeaking with a ceramic liner fracture (n ¼ 1). No patients who underwent HRA were revised. The University of California, Los Angeles, activity score, modified Harris Hip score, and Hip Dysfunction and Osteoarthritis Outcome Scores for Joint Replacement increased by 74%, 64%, and 49%, respectively, among all patients. Compared to the HRA cohort, patients who underwent THA had lower preoperative and postoperative University of California, Los Angeles, activity, modified Harris Hip score, and Hip Dysfunction and Osteoarthritis Outcome Scores for Joint Replacement scores, yet there were no differences in the absolute improvements in any of the three measures between the two groups. Conclusions: Excellent functional outcomes were seen in young patients undergoing either HRA or THA. Although young patients undergoing THA started at lower preoperative baseline and postoperative PROs than patients undergoing HRA, both groups improved by an equal amount after surgery, suggesting that both HRA and THA afford a similar degree of potential improvement in a young population.

The 50 Most-Cited Articles Regarding Hip Resurfacing

“…published a 2019 cohort study showing better self-reported hip function scores with HR than with THA, primarily in scores of functions of daily living (90% vs 84%, respectively) and sport and recreation (77% vs 68%, respectively) [ 15 ]. One study evaluating HR vs THA in patients younger than 35 y showed excellent functional outcomes with both procedures and no statistical difference between patient-reported outcomes when comparing the 2 [ 16 ]. Another study demonstrated no differences in short-term outcomes when comparing the Oxford, the Western Ontario and McMaster Universities Osteoarthritis Index, and Harris Hip Scores, as well as the activity scores of young patients with HR vs a THA [ 17 ].…”

Hip Resurfacing Arthroplasty: Past, Present and Future

“…Within five years, 9% (n=3) of patients in the THA group required revision due to complications such as instability (n=1), squeaking (n=1) or ceramic liner fracture (n=1), whereas no patients in the HRA group were revised. 50 Both HRA and THA resulted in significant improvements in PROMs, including the University of California, Los Angeles Activity (UCLAA) score (74% increase in both groups), modified Harris Hip score (HHS) (64% increase in HRA vs. 66% increase in THA), and Hip Dysfunction and Osteoarthritis Outcome Scores for Joint Replacement (49% increase in both groups). 50 Despite lower preoperative and postoperative PROMs in the THA group, the absolute improvements in these measures did not differ significantly between the two groups.…”

“…50 Both HRA and THA resulted in significant improvements in PROMs, including the University of California, Los Angeles Activity (UCLAA) score (74% increase in both groups), modified Harris Hip score (HHS) (64% increase in HRA vs. 66% increase in THA), and Hip Dysfunction and Osteoarthritis Outcome Scores for Joint Replacement (49% increase in both groups). 50 Despite lower preoperative and postoperative PROMs in the THA group, the absolute improvements in these measures did not differ significantly between the two groups. The researchers concluded that both HRA and THA can be suitable surgical options for young patients.…”

“…[47][48][49] A recent study by LeBrun et al compared the patient reported outcome measures (PROMs) and revision rates of these procedures in 101 patients aged 35 or younger. 50 Of these patients, 76 underwent HRA and 33 underwent a primary THA. Within five years, 9% (n=3) of patients in the THA group required revision due to complications such as instability (n=1), squeaking (n=1) or ceramic liner fracture (n=1), whereas no patients in the HRA group were revised.…”

Contemporary Aseptic Revision Total Hip Arthroplasty in Patients ≤50 Years of Age

“…Registry data suggested that the choice of bearing surface and femoral-head size may also influence the risk of future revision 15 . Studies of contemporary THA performed without cement in patients <50 years of age have demonstrated rates of revision of 5% to 29% at intermediate-term follow-up 3,8,15-18 , with common failure modes including dislocation and aseptic loosening of the acetabular component.…”