Patient Selection for Resurfacing Hip Arthroplasty

Abstract

Summary: The number of resurfacing hip arthroplasty procedures is constantly increasing in North America. Proper patient selection is one of the most crucial factors for determining a successful outcome of resurfacing hip arthroplasty. The purpose of this study was to summarize current opinion of the selection criteria; to present a matched series among resurfacing hip arthroplasty and standard total hip arthroplasty, evaluating potential advantages and disadvantages of each procedure. We prospectively collected all data (preoperative and postoperative) regarding patients who underwent resurfacing hip arthroplasty by the senior author at our institution between 2006 and 2008. We then matched them to a group of patients who received standard total hip arthroplasty during the same time period, based on age, gender, body mass index, and Charlson index. Pre- and postoperative protocols regarding thromboembolic prophylaxis, pain management, physical therapy, postoperative activity, and hip precautions (none) were the same in both groups. All complications were recorded and functional outcome was assessed using Short Form-36, WOMAC, University of California, Los Angeles (UCLA) activity score, and Harris hip score. Resurfacing had a longer average surgical time. The calculated blood loss was same in both groups. The amount of allogeneic blood transfusion was not significantly different in both groups. Narcotic medication used during the hospital stay was significantly higher in the standard total hip arthroplasty group. The length-of-stay was significantly less in patients undergoing resurfacing. There was no significant difference regarding functional outcome; however, both the preoperative and postoperative UCLA activity scores were significantly lower in the standard total hip arthroplasty. A resurfacing versus standard total hip algorithm was delineated, although resurfacing hip arthroplasty should not be considered as an alternative to standard total hip arthroplasty. Strict adherence to patient selection criteria and operative details are essential prerequisites for good outcome and the potential advantages of this technique include better functional outcome, higher activity level, and proximal femoral bone preservation for future revision.