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Research Article

The clinical and radiological outcomes of hip resurfacing versus total hip arthroplasty: a meta-analysis and systematic review

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Pages 684-695 | Received 27 Feb 2010, Accepted 26 Jul 2010, Published online: 11 Nov 2010
 

Abstract

Background and purpose Hip resurfacing (HRS) procedures have gained increasing popularity for younger, higher-demand patients with degenerative hip pathologies. However, with concerns regarding revision rates and possible adverse metal hypersensitivity reactions with metal-on-metal articulations, some authors have questioned the hypothesized superiority of hip resurfacing over total hip arthroplasty (THA). In this meta-analysis, we compared the clinical and radiological outcomes and complication rates of these 2 procedures.

Methods A systematic review was undertaken of all published (Medline, CINAHL, AMED, EMBASE) and unpublished or gray literature research databases up to January 2010. Clinical and radiological outcomes as well as complications of HRS were compared to those of THA using risk ratio, mean difference, and standardized mean difference statistics. Studies were critically appraised using the CASP appraisal tool.

Results 46 studies were identified from 1,124 citations. These included 3,799 HRSs and 3,282 THAs. On meta-analysis, functional outcomes for subjects following HRS were better than or the same as for subjects with a THA, but there were statistically significantly greater incidences of heterotopic ossification, aseptic loosening, and revision surgery with HRS compared to THA. The evidence base showed a number of methodological inadequacies such as the limited use of power calculations and poor or absent blinding of both patients and assessors, possibly giving rise to assessor bias.

Interpretation On the basis of the current evidence base, HRS may have better functional outcomes than THA, but the increased risks of heterotopic ossification, aseptic loosening, and revision surgery following HRS indicate that THA is superior in terms of implant survival.

TS co-designed the study, identified published studies, extracted data, appraised studies, performed the statistical analysis, and was involved in the preparation of the manuscript. RN identified published studies, extracted data, appraised studies, and was involved in the preparation of the manuscript. SD and CH co-designed the study and were involved in the preparation of the manuscript.

We thank the Sir Thomas Browne Library at the Norfolk and Norwich University Hospital for their assistance in gathering the articles that formed the basis of this paper. We also thank Mr Gavin McArt, Norfolk and Norwich University Hospital, for his assistance in the initial search conducted, and the corresponding authors who provided additional data to assist in the completion of the meta-analysis—in particular, Professor Pascal-André Vendittoli, University of Montreal, Dr David Hall, Queen Margaret's Hospital, Dunfermline, Professor Donald Howie and Mrs Margaret McGee of the University of Adelaide and Royal Adelaide Hospital, and Mr Nish Chirodian of the Norfolk and Norwich University Hospital.

No competing interests declared.