Hip Resurfacing is Associated with Significantly Shorter Length of Stay and Increased Postoperative Mobilization than Total Hip Arthroplasty

Abstract

Abstract Metal-on-metal hip resurfacing (HRA) is performed as an alternative for total hip arthroplasty (THA) for symptomatic hip osteoarthritis in young, active male patients. This article seeks to determine if there is a difference in postoperative pain, mobilization, and opioid consumption between HRA and THA. A single-institution total joint arthroplasty database was utilized to identify adult patients who underwent elective HRA or THA between 2016 and 2019. Baseline demographic data along with operative time and Charlson Comorbidity Index (CCI) were collected. Patients were matched by age, sex, race, smoking status, body mass index (BMI), and CCI. Morphine milligram equivalents (MME) and visual analog scale scores were collected. Activity Measure for Post-Acute Care (AM-PAC) was used to determine physical therapy progress. A total of 7,387 cases were identified: 96.59% THA (7,135) and 3.41% HRA (252). HRA patients were significantly younger (52.52 vs. 64.04 years; p  < 0.001), had higher BMI (30.03 vs. 29.40; p  = 0.029), and were almost exclusively male as compared with the THA cohort (98.8% vs. 42.2%; p  < 0.001). HRA patients had lower CCI scores (0.36 vs. 1.14; p  < 0.001). Surgical time was greater for HRA (124.81 vs. 103.82 minutes; p  < 0.001). HRA patients had significantly shorter length of stay (LOS) than THA patients (1.17 vs. 1.48 days; p  < 0.001) and had significantly better AM-PAC scores (21.52 vs. 20.65; p  = 0.032). HRA patients exhibited a trend toward home discharge (0.4% vs. 2.4%; p  = 0.057). Aggregate opioid consumption (23.63 vs. 27.89 MME; p  = 0.321) and pain scores (3.47 vs. 3.28; p  = 0.438) were not different between matched cohorts. HRA patients are younger, almost exclusively male, and have lower CCI scores at time of surgery. HRA is associated with significantly shorter LOS and greater mobilization measures. They tended to have a higher rate of home discharge. Both groups had similar pain scores and opioid consumption. Level III  Retrospective Cohort Study.