Metal-on-metal resurfacing of the hip in patients under the age of 55 years with osteoarthritis

TLDR

Conventional hip replacement in young osteoarthritis patients has yielded poor outcomes, prompting the introduction of metal‑on‑metal resurfacing as a less invasive alternative. The study reports 446 resurfacing procedures (384 patients) performed by a single surgeon using cemented femoral stems and hydroxyapatite‑coated uncemented acetabular cups, with a maximum follow‑up of 8.2 years (mean 3.3). At follow‑up, the procedure had a 99.98 % survival rate, a mean Oxford hip score of 13.5, and allowed most patients to maintain heavy work and active leisure, supporting its suitability for young, active patients.

Abstract

The results of conventional hip replacement in young patients with osteoarthritis have not been encouraging even with improvements in the techniques of fixation and in the bearing surfaces. Modern metal-on-metal hip resurfacing was introduced as a less invasive method of joint reconstruction for this particular group. This is a series of 446 hip resurfacings (384 patients) performed by one of the authors (DJWM) using cemented femoral components and hydroxyapatite-coated uncemented acetabular components with a maximum follow-up of 8.2 years (mean 3.3). Their survival rate, Oxford hip scores and activity levels are reviewed. Six patients died due to unrelated causes. There was one revision (0.02%) out of 440 hips. The mean Oxford score of the surviving 439 hips is 13.5. None of the patients were told to change their activities at work or leisure; 31% of the men with unilateral resurfacings and 28% with bilateral resurfacings were involved in jobs that they considered heavy or moderately heavy; 92% of men with unilateral hip resurfacings and 87% of the whole group participate in leisure-time sporting activity. The extremely low rate of failure in spite of the resumption of high level occupational and leisure activities provides early evidence of the suitability of this procedure for young and active patients with arthritis.