Comparative Outcomes of Resurfacing vs Total Hip Arthroplasty: A Systematic Review and Meta-Analysis.

Abstract

Background: Total hip arthroplasty (THA) and resurfacing hip arthroplasty (RHA) are widely used for treating hip joint disorders. While THA is the gold standard for hip replacement, RHA is increasingly used in younger, active patients due to bone preservation. This systematic review and meta-analysis compare functional outcomes, metal ions, complications, revision rates, survivorship and satisfaction between THA and RHA.

Methods: A systematic search of EMBASE, Cochrane Library and PubMed was conducted (inception-August 2024) to identify primary research articles for THA and RHA. Risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale. A meta-analysis using MATLAB applied a random-effects model to calculate pooled effect sizes for functional scores, revision rates, complications and metal ions.

Results: Initial search collated 2265 studies, of which 11 met inclusion criteria (2013-2021). Most frequently reported outcomes included complications, revision rates and UCLA. RHA showed better UCLA, HHS and chromium levels, while THA had better WOMAC and cobalt levels, although differences were nonsignificant. Total complications were higher with THA, though nonsignificant. The most common complications were aseptic loosening and dislocation for RHA and THA, respectively. Notably, when the dislocation rate was analysed in isolation, a statistically significant higher dislocation rate was demonstrated with THA. Revision rates were higher for THA, and survivorship was 85.5% compared to 89.5% (RHA), however, with no statistical difference. Statistically significant higher preference for RHA (66.1%) was reported in one study. Satisfaction was greater for RHA (87.8% vs 83.9%) and more patients perceived their hip as natural. One study reported significantly higher quality of life with THA.

Conclusion: Patient-reported outcomes, metal ions, complications, revision rates and survivorship were broadly similar between RHA and THA. However, dislocations were more frequent with THA, a key consideration when treating athletic patients. Greater satisfaction and preference with RHA suggest that it may be preferable when outcomes are otherwise comparable.Christoforos Demosthenous and Christos Pittalis are joined-first authors.