Total hip arthroplasty versus resurfacing arthroplasty in the treatment of patients with arthritis of the hip joint: single centre, parallel group, assessor blinded, randomised controlled trial

Abstract

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.

Patients Report Improvement in Quality of Life and Satisfaction After Hip Resurfacing Arthroplasty

“…These outcomes support and underscore recent reports on WOMAC scores [25,38,39,41,57,59,69,70] and Oxford Hip Scores [31,36,[56][57][58] from other authors and patient populations. Our SF-12 results are in agreement with published SF-12 and SF-36 outcomes, which demonstrate restoration of generic QoL approaching that of the normal population [16,41,56,58] (Table 4). Until recently, most reports focused on implant survivorship and did not consistently include validated patient-reported outcome measures that refer to QoL or other dimensions of patientperceived results of surgery, such as patient satisfaction and activity [16,41].…”

“…Our SF-12 results are in agreement with published SF-12 and SF-36 outcomes, which demonstrate restoration of generic QoL approaching that of the normal population [16,41,56,58] (Table 4). Until recently, most reports focused on implant survivorship and did not consistently include validated patient-reported outcome measures that refer to QoL or other dimensions of patientperceived results of surgery, such as patient satisfaction and activity [16,41]. Patient perception of the results of surgery and patient preferences are an increasingly important component of patient-informed and shared decision making in elective surgical procedures [13].…”

“…The latter has a relatively low incidence of 1.2% [1,2,62,63]. The incidence of fracture of the femoral neck in our study was 1.3% (two of 143 hips), which is relatively low and similar to the range of 0% to 2.5% reported in the literature [2,5,6,8,12,16,18,25,30,33,35,48,62,67].…”

Do Professional Athletes Perform Better Than Recreational Athletes After Arthroscopy for Femoroacetabular Impingement?

“…A change 7 to 10 points has been suggested to show a minimum clinically important difference in hip scores [3,12]. We chose a value of 5 to improve the robustness of the analyses.…”

The gait of patients with one resurfacing and one replacement hip: a single blinded controlled study

“…Three recent prospective randomised controlled trials have failed to detect a difference between HRA and total hip arthroplasty (THA). All were only powered to detect a 10 % difference in slow walking speeds or used conventional functional scores, which have well documented ceiling effects [4][5][6].…”