Complications and mid to long term outcomes for hip resurfacing versus total hip replacement: a systematic review and meta-analysis

Two-Year Results of Ceramic-on-Ceramic Hip Resurfacing in an International Multicenter Cohort

BACKGROUND

Hip resurfacing arthroplasty (HRA) is a bone-conserving alternative to total hip arthroplasty. We present the 2-year clinical and radiographic follow-up of a novel ceramic-on-ceramic HRA in an international multicenter cohort.

METHODS

Patients undergoing HRA between September 2018 and January 2021 were prospectively included. Patient-reported outcome measures (PROMs) in the form of the Forgotten Joint Score, Hip Disability and Osteoarthritis Outcome Score Jr., Western Ontario and McMaster Universities Arthritis Index, Oxford Hip Score, and University of California, Los Angeles, Activity Score were collected preoperatively, and at 1 and 2 years postoperation. Serial radiographs were assessed for migration, component alignment, evidence of osteolysis or loosening, and heterotopic ossification formation.

RESULTS

The study identified 200 patients who reached a minimum 2-year follow-up (mean 3.5 years). Of these, 185 completed PROMs follow-up at 2 years. There was a significant improvement in Hip Disability and Osteoarthritis Outcome Score (P < .001) and Oxford Hip Score (P < .001) between the preoperative, 1-year, and 2-year outcomes. Patients had improved activity scores on the University of California, Los Angeles, Active Score (P < .001), with 45% reporting a return to high-impact activity at 2 years. At 1 and 2 years, the Forgotten Joint Score was not significantly different (P = .38). There was no migration, osteolysis, or loosening of any of the implants. No fractures were reported over the 2-year follow-up, with only 1 patient reporting a sciatic nerve palsy. There were 2 revisions, 1 for unexplained pain at 3 months due to acetabular component malposition and 1 at 33.5 months for acetabular implant failure.

CONCLUSIONS

The ceramic-on-ceramic resurfacing at 2 years postoperation demonstrates promising results with satisfactory outcomes in all recorded PROMs. Further long-term data are needed to support the widespread adoption of this prosthesis as an alternative to other HRA bearings.

Hip resurfacing versus total hip arthroplasty: a systematic review and meta-analysis of randomized clinical trials

PURPOSE

Total hip arthroplasty (THA) is the gold standard in the treatment of advanced hip osteoarthritis. However, hip resurfacing (HR) arthroplasty may present a viable alternative. The aim of this study was to compare complications, implant survivorship, and functional outcomes between HR and THA, to assess HR as a valid and safe alternative to THA.

METHODS

Inclusion criteria were randomized clinical trials (RCTs) published in English, comparing clinical outcomes and complications between HR and THA. A systematic review of the literature was performed on PubMed, Scopus and Cochrane Library, following the PRISMA 2020 statement, from January 1, 2015 to November 30, 2023. A meta-analysis was performed by Review Manager (RevMan) software version 5.4 to compare the rates of revisions, dislocations, infection, aseptic loosening and pseudotumor, and the clinical outcomes between the two groups. We used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to assess the risk of bias.

RESULTS

A total of 8 RCT were included, involving 844 patients (387 hips for HR group and 469 hips for THA group). The mean follow-up was 7.72 years. There were no statistically significant differences between the two groups for UCLA and WOMAC score, revision rate, infection, aseptic loosening and pseudotumor (all p > 0.05), while the dislocation rate was significantly lower in the HR group (p = 0.04).

CONCLUSIONS

HR is a safe and effective alternative to THA. However, several factors are involved to reduce the complication rate and achieve high implant survival.

Radiological Comparison of Canal Fill between Collared and Non-Collared Femoral Stems: A Two-Year Follow-Up after Total Hip Arthroplasty

Collared femoral stems in total hip arthroplasty (THA) offer reduced subsidence and periprosthetic fractures but raise concerns about fit accuracy and stem sizing. This study compares collared and non-collared stems to assess the stem-canal fill ratio (CFR) and fixation indicators, aiming to guide implant selection and enhance THA outcomes. This retrospective single-center study examined primary THA patients who received Corail cementless stems between August 2015 and October 2020, with a minimum of two years of radiological follow-up. The study compared preoperative bone quality assessments, including the Dorr classification, the canal flare index (CFI), the morphological cortical index (MCI), and the canal bone ratio (CBR), as well as postoperative radiographic evaluations, such as the CFR and component fixation, between patients who received a collared or a non-collared femoral stem. The study analyzed 202 THAs, with 103 in the collared cohort and 99 in the non-collared cohort. Patients' demographics showed differences in age (p = 0.02) and ASA classification (p = 0.01) but similar preoperative bone quality between groups, as suggested by the Dorr classification (p = 0.15), CFI (p = 0.12), MCI (p = 0.26), and CBR (p = 0.50). At the two-year follow-up, femoral stem CFRs (p = 0.59 and p = 0.27) were comparable between collared and non-collared cohorts. Subsidence rates were almost doubled for non-collared patients (19.2 vs. 11.7%, p = 0.17), however, not to a level of clinical significance. The findings of this study show that both collared and non-collared Corail stems produce comparable outcomes in terms of the CFR and radiographic indicators for stem fixation. These findings reduce concerns about stem under-sizing and micro-motion in collared stems. While this study provides insights into the collar design debate in THA, further research remains necessary.

Evaluation of an early-stage prototype polyurethane femoral head implant for hip arthroplasty

Introduction

Thi study evalautes a new bone-preserving femoral head cover that mimics the articular cartilage of the femoral head.

Methods

A specially developed polyurethane (PU) was evaluated in biocompatibility (cytotoxicity test) and mechanical response to tensile loading. In the cytotoxicity test, steam sterilized (SS) and ethylene oxide sterilized (EtO) PU samples were incubated separately in a cell culture medium. The seeded cell line MG-63 was then added to these sample-incubated cell culture mediums. One negative control group and one positive control group were also evaluated. The cells in each group were cultured for seven days before being quantified using the alamarBlue assay. In the mechanical test, the femoral head cover implants were separated into three groups of three samples. Each group represented a different implant insertion idea: direct insertion (uc sample) and another two insertion modes (is and ss samples) representing implants with enclosure mechanisms. The test consisted of distance-controlled cyclic tensile loadings followed by a failure test.

Results

The cytotoxicity test results show no significant difference in fluorescence intensity between the negative control, the three SS groups, and one EtO group (P > 0.05). However, the other two EtO groups exhibit significantly lower fluorescence intensity compared with the negative control (P < 0.05). In the mechanical test, the is samples have the highest cyclic loading force at 559.50 ± 51.41 N, while the uc samples exhibit the highest force in the failure test at 632.16 ± 50.55 N. There are no significant differences (P > 0.05) among the uc, is, and ss groups in terms of stiffness.

Conclusion

The cytotoxicity test and the mechanical experiment provide initial assessments of the proposed PU femoral head cover implant. The evaluation outcomes of this study could serve as a foundation for developing more functional design and testing methods, utilizing numerical simulations, and developing animal/clinical trials in the future.

Clinical outcomes and return to dance after total hip arthroplasty or hip resurfacing in professional dancers

Aims

Professional dancers represent a unique patient population in the setting of hip arthroplasty, given the high degree of hip strength and mobility required by their profession. We sought to determine the clinical outcomes and ability to return to professional dance after total hip arthroplasty (THA) or hip resurfacing arthroplasty (HRA).

Methods

Active professional dancers who underwent primary THA or HRA at a single institution with minimum one-year follow-up were included in the study. Primary outcomes included the rate of return to professional dance, three patient-reported outcome measures (PROMs) (modified Harris Hip Score (mHHS), Hip disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR), and Lower Extremity Activity Scale (LEAS)), and postoperative complications.

Results

A total of 49 hips in 39 patients (mean age 56 years (SD 13); 80% female (n = 39)) were included. Mean follow-up was 4.9 years (SD 5.1). Of these 49 hips, 37 THAs and 12 HRAs were performed. In all, 96% of hips returned to professional dance activities postoperatively. With regard to PROMs, there were statistically significant improvements in mHHS, HOOS-JR, and LEAS from baseline to ≥ one year postoperatively. There were complications in 7/49 hips postoperatively (14%), five of which required revision surgery (10%). There were no revisions for instability after the index procedure. Two complications (5.4%) occurred in hips that underwent THA compared with five (42%) after HRA (p = 0.007), though the difference by procedure was not significantly different when including only contemporary implant designs (p = 0.334).

Conclusion

Active professional dancers experienced significant improvements in functional outcome scores after THA or HRA, with a 96% rate of return to professional dance. However, the revision rate at short- to mid-term follow-up highlights the challenges of performing hip arthroplasty in this demanding patient population. Further investigation is required to determine the results of THA versus HRA using contemporary implant designs in these patients.

Resurfacing Hip Arthroplasty Is a Safe and Effective Alternative to Total Hip Arthroplasty in Young Patients: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed at comparing resurfacing hip arthroplasty (RHA) and total hip arthroplasty (THA) in terms of rate of complications, revisions, functional outcomes, blood loss, operative time and metal ions levels. The search was conducted on three databases (PubMed, Cochrane and Web of Science) updated until 13 October 2022. The inclusion criteria were RCTs) written in the English language, with no time limitation, comparing RHA and THA. Among the retrieved 4748 articles, 18 RCTs were eligible for a total of 776 patients (mean age 53.1 ± 5.0). A meta-analysis was performed. RHA reported significantly lower blood loss compared to THA (p < 0.001) but with longer operative time (p < 0.001). No statistically significant difference was found between RHA and THA in terms of complications (12.08% and 16.24%, respectively) and revisions (6.32% and 6.14%, respectively). Both RHA and THA provide excellent clinical results in a population of young and active patients. Functional outcomes were not significantly different between the groups. Moreover, no significant difference in metal ion levels was found. These findings provide evidence concerning the safety and clinical effectiveness of RHA. Because of its bone-preserving properties, the lack of drawbacks and good outcomes, RHA appears to be a valid alternative to THA in young and active patients.