Hip Resurfacing Shows Higher Failure Rate Than Replacement

Use of smaller head sizes linked to higher failure rates in both men and women

TUESDAY, Oct. 2 (HealthDay News) -- Hip resurfacing has an "unacceptably high" failure rate, particularly in women, according to a study published online Oct. 2 in The Lancet.

Alison J. Smith, from the University of Bristol in the United Kingdom, and colleagues analyzed the National Joint Registry for England and Wales for primary total hip replacements (THRs) performed between 2003 and 2011 to assess the survival of different sizes of metal-on-metal resurfacing, compared with survival for conventional stemmed THRs.

The researchers found that there were 434,560 primary THRs, including 31,932 resurfacings. There was worse implant survival in women undergoing resurfacing than in conventional THR, regardless of head size. In 55-year-old women, the predicted five-year revision rates were 8.3 percent with a 42-mm resurfacing head, 6.1 percent with a 46-mm resurfacing head, and 1.5 percent with a 28-mm cemented metal-on-polyethylene stemmed THR. For men, resurfacing with smaller femoral heads resulted in poor implant survival. In 55-year-old men, the predicted five-year revision rates were 4.1 percent with a 46-mm resurfacing head, 2.6 percent with a 54-mm resurfacing head, and 1.9 percent with a 28-mm cemented metal-on-polyethylene stemmed THR. Only 23 percent of male resurfacing patients had head sizes of 54 mm or above.

"Hip resurfacing only resulted in similar implant survivorship to other surgical options in men with large femoral heads, and inferior implant survivorship in other patients, particularly women," the authors write. "We recommend that resurfacing is not undertaken in women and that preoperative measurement is used to assess suitability in men."

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