Metal on Metal Hip Resurfacing in Patients 45 Years of Age and Younger at Minimum 5-Year Follow-Up

Return to Sport After Hip Resurfacing Arthroplasty

Background

Femoroacetabular impingement and degenerative hip osteoarthritis (OA) affect athletes across a wide variety of sports. Hip resurfacing arthroplasty (HRA) has emerged as a surgical treatment for active individuals with end-stage hip OA to provide pain relief and allow return to high-impact activities. Return to professional sports after HRA has not been well characterized.

Purpose/Hypothesis

The aim of this study was to report on a series of elite athletes in a variety of sports who underwent HRA. We hypothesized that professional and elite-level athletes would be able to return to sports after HRA for end-stage hip OA.

Study Design

Case series; Level of evidence, 4.

Methods

A retrospective case series was conducted on professional athletes who underwent HRA at a single institution between 2007 and 2017. All surgeries were performed by a single surgeon using the posterolateral approach. Athletes' return to play and sport-specific performance statistics were obtained using self-reported and publicly available data sources. Athletes were matched to an age- and performance-based cohort to determine changes in performance-based metrics.

Results

Eight professional athletes were identified, including 2 baseball pitchers, 1 ice hockey defenseman, 1 foil fencer, 1 men's doubles tennis player, 1 basketball player, 1 ultramarathoner, and 1 Ironman triathlete. All 8 patients returned to sports; 6 of 8 (75%) patients were able to return for at least 1 full season at a professional level after surgery. There were no significant differences between performance statistics for athletes who returned to play and their preoperative performance measures for the years leading up to surgery or the age- and performance-matched cohort.

Conclusion

HRA remains a surgical alternative for end-stage hip OA in young, high-impact, active patients. While the primary goals of surgery are pain control and quality of life improvement, it is possible to return to elite-level sporting activity after HRA.

A Comparative Cohort Study With a 20-Year Age Gap: Hip Resurfacing in Patients Aged ≤35 Years and Patients Aged ≥55 Years

Background

This single-center retrospective cohort study aimed to evaluate and compare implant survival and patient-reported outcome measures in 2 distinct age groups separated by 20 years who underwent hip resurfacing arthroplasty (HRA).

Methods

Between 2005 and 2014, 2042 HRAs were performed by a single-surgeon, and 75 and 377 hips from patients aged ≤35 years and ≥55 years, respectively, were included in this study. Implant survival was determined for all available hips. Clinical features and patient-reported outcome measures were collected.

Results

Seven hips were revised, 4 for aseptic loosening of one or both components, one for infection, one for accelerated wear and metallosis, and one for femoral neck fracture. There was no difference in all-cause 10-year revision, with 97.1% (95% confidence interval 80.9 to 99.6) and 99.6% (95% confidence interval: 97 to 99.9) survivorship in younger and older patients, respectively (P = .246). Preoperatively, younger patients were less active than older patients on the Lower Extremity Activity Scale (LEAS) or University of California, Los Angeles, activity scale, but at follow-up, younger patients outpaced older ones.

Conclusion

Original to our study was the isolation and comparison of 2 distinct age groups. With excellent results in disparate age groups, HRA can be applied to a broad patient demographic and is suitable for those patients who want to achieve a high activity level as defined by Lower Extremity Activity Scale or University of California, Los Angeles, scores.