Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jun 18, 2024; 15(6): 554-559
Published online Jun 18, 2024. doi: 10.5312/wjo.v15.i6.554
Examining the “revisability” benefit of hip resurfacing arthroplasty
Jose George, Adam J Taylor, Thomas P Schmalzried
Jose George, Adam J Taylor, Thomas P Schmalzried, Department of Orthopedics, Harbor UCLA Medical Center, Torrance, CA 90509, United States
Author contributions: George J, Taylor AJ, and Schmalzried TP contributed equally to this work; George J and Taylor AJ performed the primary literature search, data extraction, analysis of data, and writing of the manuscript; Schmalzried TP was the principal surgeon of the study, conceptualized the idea of the study, helped with the methodology, writing, and supervision of the study; and all authors have read and approved the final version.
Institutional review board statement: The study was reviewed and approved by John F. Wolf M.D. Human Subjects Committee (Approval No. 18CR-32450-01R).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The author(s) received no financial or material support for the research, authorship, and/or publication of this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at josegrg2019@gmail.com. Consent for data sharing was not obtained from participants but the presented data are anonymized and risk of identification is low.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/.
Corresponding author: Jose George, MD, Surgeon, Department of Orthopedics, Harbor UCLA Medical Center, 1000 W Carson Street, Box 422, Torrance, CA 90509, United States. josegrg2019@gmail.com
Received: January 31, 2024
Revised: April 20, 2024
Accepted: April 26, 2024
Published online: June 18, 2024
Processing time: 134 Days and 1.8 Hours
Abstract
BACKGROUND

Hip resurfacing arthroplasty (HRA) is an alternative to total hip arthroplasty (THA) that is typically reserved for young active patients because it preserves bone. However, the benefits of HRA only hold true if conversion THA after failed HRA provides acceptable outcomes.

AIM

To compare patient reported outcomes for conversion THA after HRA failure to primary THA.

METHODS

A retrospective review of 36 patients (37 hips) that underwent conversion THA for failed HRA between October 2006 and May 2019 by a single surgeon was performed. Patient reported outcomes [modified Harris Hip Score (mHHS), University of California Los Angeles (UCLA) activity score] were obtained via an email-based responder-anonymous survey. Outcomes were compared to normative data of a primary THA cohort with similar demographics. Subgroup analysis was performed comparing outcomes of conversion THA for adverse local tissue reaction (ALTR) vs all other causes for failure.

RESULTS

The study group had a lower mHHS than the control group (81.7 ± 13.8 vs 90.2 ± 11.6, P < 0.01); however, both groups had similar UCLA activity levels (7.5 ± 2.3 vs 7.2 ± 1.6, P = 0.51). Patients that underwent conversion for non-ATLR causes had similar mHHS (85.2 ± 11.5 vs 90.2 ± 11.6, P = 0.11) and higher UCLA activity levels (8.5 ± 1.8 vs 7.2 ± 1.6, P < 0.01) compared to the control group. Patients that underwent conversion for ATLR had worse mHHS (77.1 ± 14.5 vs 90.2 ± 11.6, P < 0.01) and UCLA activity levels (6.1 ± 2.3 vs 7.2 ± 1.6, P = 0.05) when compared to the control group.

CONCLUSION

Patient outcomes equivalent to primary THA can be achieved following HRA conversion to THA. However, inferior outcomes were demonstrated for ALTR-related HRA failure. Patient selection and perhaps further studies examining alternative HRA bearing surfaces should be considered.

Keywords: Total hip arthroplasty; Hip resurfacing arthroplasty; Conversion total hip arthroplasty; Adverse local tissue reaction; Patient reported outcome measures

Core Tip: We aim to examine the “revisability” benefit of hip resurfacing arthroplasty (HRA): Are outcomes of conversion to total hip arthroplasty (THA) after failed metal-on-metal-HRA worse compared to primary THA? This study expands the literature by examining patient reported outcomes between HRA revision and primary THA, and outcomes between HRA revision and revision THA. HRA patients revised to THA have worse clinical outcomes compared to primary THA and the outcome is dependent on the etiology of failure.