Uncemented hip resurfacing in patients over 65: 16-year outcomes from a large, single-surgeon series.

Abstract

Background: Hip resurfacing is often reserved for younger, active patients due to concerns over implant durability and fracture risk in older patients. However, there is a lack of long-term data evaluating outcomes in patients over 65 years old at time of surgery. This study addresses this gap by directly comparing implant survivorship, failure and complication rates, and clinical outcomes in a younger control cohort from the same large single-surgeon series (> 6000 cases).

Methods: We queried a large, prospective institutional clinical database comprising over 7000 hip resurfacing cases performed by a single, high-volume surgeon; findings may not be generalizable to lower-volume or less-experienced centers. From this cohort, we identified 395 cases in patients ≥ 65 years (mean age 68.8) and 5,106 cases in patients < 65 years of age at time of surgery. All included patients had a minimum of 2-year follow-up, and 88.4% of the study cohort had up-to-date follow-up.

Results: There was no difference in the 98.6% 10- and 98.2% 16-year Kaplan-Meier implant survivorship of our over-65 study group when compared to a younger under-65 control group. These results exceed the NICE (National Institute for Clinical Excellence) criteria and registry benchmarks for total hip replacement from three major registries. The early femoral failure rate (femoral failure occurring < 1 year postoperative) was only 0.3%, which compares favorably with total hip arthroplasty perioperative fracture data. The long-term femoral fracture rate over the duration of this study was 1.3% for this older cohort, lower than what was reported for total hip arthroplasty.

Conclusions: This is the first known long-term study to demonstrate that hip resurfacing patients over 65 can achieve implant survivorship rates equivalent to younger resurfacing patients and superior to national total hip arthroplasty registry benchmarks. These findings challenge age-based restrictions and support expanded candidacy for hip resurfacing in select older adults when managed by experienced surgeons.