Hip resurfacing arthroplasty (HRA) is a femoral bone-preserving alternative to total hip arthroplasty (THA) for younger, active patients. However, complications such as fractures, loosening, and metal wear can require conversion to THA. In some cases, revision of both the acetabular and femoral components is required. We conducted a retrospective review of 15 patients who underwent conversion of HRA to THA at a single, academic tertiary care centre between January 2011 and April 2024. Demographic data, surgical details, implant characteristics, and indications for conversion were collected. Postoperative outcomes including complications, reoperations, and revisions were investigated. Revision-free survival was estimated using Kaplan-Meier analysis. The mean age was 53.2 years and mean time to conversion was 6.7 years. Indications for conversion included adverse reaction to metal debris (ARMD; n = 6), mechanical loosening (n = 3), component positioning and impingement (n = 3), periprosthetic fracture (n = 1), osteolysis/wear (n = 1), and prosthetic joint infection (PJI; n = 1). Common reasons for acetabular cup revision included ARMD (n = 6), loosening (n = 4), and positioning (n = 3). Dual-mobility (DM) constructs were used in 11 cases (73.3%). There were no dislocations. There was 1 90-day readmission due to persistent wound drainage which underwent debridement, antibiotics, and implant retention (DAIR) 14 days post-conversion. The average follow-up duration after the conversion procedure was 6.1 years. Kaplan-Meier analysis demonstrated 93% revision-free survival at one-year, which remained stable through 13 years. In this study of 15 both-component HRA conversions, we observed 93% revision-free survivorship at mid-term follow-up. While the small cohort size limits definitive conclusions, our findings suggest that revision of the acetabulum during conversion, particularly with dual-mobility constructs, may be an effective strategy to mitigate instability and manage metal-on-metal failure in appropriate patients. Further research with larger cohorts is warranted to confirm our findings.

Most resurfacing arthroplasty is performed using the posterior approach, while total hip arthroplasty is increasingly performed via the anterior approach with objective benefit noted in the sagittal plane kinematics. We surmised that the muscle releases needed for resurfacing arthroplasty using the posterior approach would reduce the strength of push-off as seen in gait studies of total hip arthroplasty. Method 19 healthy controls were compared with 17 posterior and 17 anterior patients for hip resurfacing, recruited from a prospective gait study of lower limb arthroplasty. PROMs and gait characteristics were captured more than 12months following surgery. Oxford Hip Score, MET score and gait were analysed using ground reaction forces and motion capture. Statistical parametric mapping was used across the entire gait cycle. Results The median and modal OHS was 48/48 for both groups. The mean MET was 13.1 for posterior and 12.6 for anterior. Top walking speed of 7.5km/hr for the control and posterior were similar to the 7km/hr of anterior. Ground reaction forces were symmetric at all speeds. Maximum sagittal plane motion of 42° for posterior and 45° for anterior were indistinguishable from the control group throughout the range of motion. Coronal plane range was 15° for both groups – identical to the healthy controls. Discussion The gait characteristics of these two groups were indistinguishable even at higher speeds from the healthy control group. The speed reached and the different gait characteristics did not differ, despite the substantial difference in soft tissue releases needed. There may be a benefit to using the anterior approach for resurfacing arthroplasty, but ground reaction forces and motion capture in a gait lab at 12 months was unable to detect any lasting impact of either approach. Surgeons should continue to use their preferred approach.

10-Year Results of Metal-on-Metal Hip Resurfacing with Computer-Assisted Navigation.

Acetabular Bone Preservation in H1 Ceramic Hip Resurfacing: A Comparison With A Conventional Metal-on-Metal Hip Resurfacing.

Outcomes of Conversion of Hip Resurfacing Arthroplasty to Total Hip Arthroplasty With Retention of the Acetabular Component.

Background: The role of the Birmingham Hip Resurfacing (BHR) implant in modern arthroplasty remains controversial. The purpose of this study was to evaluate the functional outcomes, radiological outcomes and revision rates following BHR in a single institution at a minimum of 10 years follow-up. Materials and methods: An observational study was undertaken evaluating patient demographics & surgical details. The overall revision rate was quantified, and postoperative functional status was defined using the modified Harris Hip Score (mHHS). Implant survivorship was illustrated utilising a Kaplan-Meier estimator plot. A further subgroup analysis was undertaken comparing those with a unilateral BHR (Group 1), bilateral BHRs (Group 2) and those who have underwent a unilateral BHR and contralateral non-MoM total hip arthroplasty (THA) (Group 3). Results: 126 BHR procedures undertaken in 103 patients with a mean follow-up of 15.3 years were suitable for inclusion. This cohort consisted of 109 males (86.5%), with a mean age of 56.7 years (SD ± 8.3) at time of index BHR. 8 BHRs (6.3%) had been revised at a mean of 11.2 years (SD ± 5.4) following index BHR at time of follow-up, with an overall implant survival rate of 97% and 94% at 10 and 15 years postoperatively. In the remaining BHR cases the mean MHHS, cobalt and chromium levels at time of most recent follow-up were 85.2 (SD ± 17.6), 50 nmol/L and 42.2 nmol/L respectively. No significant difference was identified between Groups 1, 2 and 3 in regards overall revision rates, functional outcomes, radiological changes and serum metal ion levels. Conclusions: BHR is associated with acceptable revision rates, functional outcomes and serum metal ion levels at a minimum of 10 years follow-up. BHR may potentially be considered as a viable alternative to THA in the carefully selected younger patient when undertaken in units with appropriate surgical expertise and follow-up.

A ceramic-on-ceramic hip resurfacing implant (cHRA) was developed and introduced in a Medicines and Healthcare products Regulatory Agency (MHRA)-approved clinical investigation. This study aimed to examine function and physical activity levels of patients with a cHRA implant using subjective and objective measures, both preoperatively and 12 months postoperatively. A total of 82 unilateral cHRA patients consented to this study as part of the larger MHRA-approved clinical investigation. In addition to their patient-reported outcome measures (PROMs), self-reported measures of physical activity and gait analysis were undertaken preoperatively (median 1.7 weeks (IQR 0.6 to 4.2)) and postoperatively (median 52.1 weeks (IQR 50.0 to 53.9)). These data were then compared with data from a group of 43 age-, sex-, and BMI-matched healthy controls. Kinetics and kinematics were recorded using an instrumented treadmill and 3D motion capture. Statistical parametric mapping was used for analysis. cHRA improved PROMs and self-reported physical activity from preoperative levels. cHRA improved top walking speed (5.75 km/hr (SD 1.04) vs 7.27 km/hr (SD 0.71)), achieved a more symmetrical ground reaction force profile (symmetry index value: 10.6% (SD 9.4) vs 0.9% (SD 2.1)), and increased hip range of motion (31.7° (SD 6.2°) vs 45.9° (SD 5.3°)) from preoperative levels. Postoperative data were not statistically distinguishable from the healthy controls in any domain. These short-term results of cHRA appear promising, with the potential to restore a near-normal gait pattern and overall quality of life.

Hip arthroscopy for apainful endoprosthesis is performed to confirm and evaluate or detect pathologies (sampling for microbiology/histology, function), which are treated during the procedure or can indicate treatment options for the further course of the procedure. Hip arthroscopy is indicated for the diagnostics of unclear persistent pain after implantation of ahip endoprosthesis (low-grade infection, metal reaction/metallosis, loosening/misplacement of prosthesis components) and for treatment (iliopsoas impingement, removal of biomechanically disruptive osteophytes, removal of free joint bodies and cam impingement in hip resurfacing arthroplasty, arthrolysis in cases of restricted movement). Local infections with the exception of the diagnostics of alow-grade infection, bone tumors near the joint, periprosthetic fractures and extensive periarticular ossification or arthrofibrosis with involvement of periarticular soft tissue (relative) are contraindications. As with arthroscopy of native hip joints, the procedure is performed on afracture table. Strict attention must be paid to precise positioning to avoid complications. Joint distraction is not performed in cases of an implanted endoprosthesis because no additional information can be expected from viewing the surfaces of the bearing couples and there is arisk of damaging the surfaces. Arthroscopy is carried out in the peripheral compartment in 10-30° flexion in the basic position via an anterolateral (AL) and anterior portal(A) as standard. Synovial fluid and tissue samples should be taken regularly for microbiological or histological examination. After adhesiolysis and synovectomy the exposed endoprosthesis is inspected and its function dynamically assessed. If iliopsoas impingement is present the release is performed using the transcapsular technique. The postoperative treatment regimen includes pain-adapted mobilization with full weight-bearing after the day of the operation onwards. Crutches are indicated for ca. 5days to harmonize the gait pattern. Physiotherapy exercises with permitted full range of motion are carried out from the 1stpostoperative day and should generally be continued until the 6thpostoperative week. In the period from 2010-2025, 22hip arthroscopies were performed on 20patients (14female, 6male; 2female patients underwent arthroscopy twice) with an average age of 59years (39-78 years) and an average of 3.5years (0.75 months to 14.5 years) after arthroplasty. In each case 2portals were created. The average operation time was 45 min (25-79 min). The results were evaluated after an average of 2.5years (0.3-12.8 years), 4patients underwent only diagnostic arthroscopy, an infection was detected twice and excluded two times. Of the infections one was treated with re-arthroscopy and one patient with an anterior cystic mass underwent an open reoperation. For the remaining 16arthroscopies, overall 12(75%) patients reported an improvement in preoperative symptoms. An iliopsoas release for impingement was performed 12times. In 10(83%) of these cases postoperative improvement with pain reduction was noted without any relevant loss of flexion strength. Mechanical joint symptoms were preoperatively present in 12patients and were eliminated by the operation in 10cases (83%). No complications were noted.

Abstract Background Emerging evidence from US-based studies suggests ethnic minority patients may experience poorer outcomes following hip and knee arthroplasty. However, evidence within the NHS is limited. This nationwide cohort study examined ethnic disparities in (1) all-cause mortality and (2) postoperative outcomes following total hip arthroplasty (THA), total knee arthroplasty (TKA), hip resurfacing (HRA), and unicompartmental knee arthroplasty (UKA) in England Methods A retrospective cohort study was conducted using linked national datasets: HES, CPRD and ONS, between 1998–2021. Caucasian and ethnic minority patients were matched in a 5:1 ratio on the basis of propensity scores. The primary outcome was all-cause mortality, as Firth-corrected Cox proportional hazard ratios (HRs). Secondary outcomes included postoperative complications within one year, as Odds Ratios (ORs). Statistical significance was set at P < 0.05. Results Among 958 443 procedures, 182 353 Caucasian patients were matched to 47 695 ethnic minority patients. Ethnic minority status was associated with lower all-cause mortality (HR: 0.78, 95% c.i.: 0.76–0.81, P < 0.01), but higher odds of complications: critical care admission (OR: 1.74, 95% c.i.: 1.67–1.81, P < 0.01), myocardial infarction (OR: 1.36, 95% c.i.: 1.17–1.57, P < 0.01), venous thromboemolism (OR: 1.39, 95% c.i.: 1.31–1.47, P < 0.01), readmission (OR: 1.46, 95% c.i.: 1.41–1.50, P < 0.01), and longer length of stay (β = 0.67 days, 95% c.i.: 0.59–0.75, P < 0.01). Conclusions This study highlights significant ethnic disparities in postoperative outcomes. These findings underscore the importance of tailored, risk-stratified care strategies that account for differential perioperative risks and long-term trajectories across ethnic groups.

Abstract Background Over 60 000 metal-on-metal (MoM) hip implants have been implanted in the UK. Since 2017, MHRA guidelines have mandated broad surveillance, classifying any risk factor as high risk. This approach places major demands on services and risks over-surveillance. We aimed to develop a risk-adapted, three-tier pathway to safely reduce unnecessary follow-up. Methods We analysed 845 patients with MoM hip resurfacing and large-head total hip arthroplasty. The primary outcome was abnormal MRI or revision. Logistic regression identified independent predictors, translated into a clinical risk score, and ranked by each predictor relative contribution. Kaplan–Meier survival and interval-specific revision rates guided long-term risk estimates and follow-up intervals. Results Tier-1 predictors (adjusted OR) were female sex (2.0), bilateral (1.7) GFR < 60 (1.6), age < 50y (1.4), head size < 48 mm (1.2), and high-risk implant (1.2). Tier-2 predictors were abnormal X-ray (9.6), pain (2.8), abnormal metal-ion level (2.6), and other symptoms (1.4). The hierarchical model achieved sensitivity 0.69, specificity 0.73, and AUROC 0.71 at the Youden threshold. The MHRA approach had sensitivity 0.85, specificity 0.33, and AUROC 0.68. At 20 years, survival was 91.2% overall, 86.8% in high-risk, and 92.7% in low-risk groups. Beyond 10 years, cumulative revision risk was higher in high-risk patients (9.4 versus 4.1%); notably, 73.9% of late revisions in the low-risk group were symptomatic. Conclusions We propose a three-tier pathway: (1) baseline stratification; (2) surveillance of high-risk patients every 3 years with symptoms, radiographs, and optional metal ions; (3) MRI for Tier-2 abnormalities. Low-risk patients have limited benefits from follow-up beyond 10 years unless symptomatic.

Birmingham hip resurfacing (BHR) is an alternative to bone-sparing total hip arthroplasty; however, failures may be associated with the cementing technique. This study aimed to evaluate the characteristics of the cement layer and potential failure mechanisms. BHR explants were analyzed using radiographic evaluation, stereomicroscopy, scanning electron microscopy (SEM), and histopathology. The cement layer was nonuniform, with excessive thickness in the dome regions and insufficient lateral coverage. Increased cement penetration values exceeded recommended thresholds. SEM analysis revealed inhomogeneous cement with cracks, air inclusions, and loosening at the cement–prosthesis interface. BHR failure may be associated with a complex interplay between cementation parameters, cement mantle morphology, and the biological response at the bone–cement interface, as well as interactions at the cement–prosthesis interface. Microscopic evaluation may provide valuable insights into the mechanisms potentially contributing to BHR prosthesis failure.

Introduction:By tracking joint replacement implants, surgical techniques, and patient-reported outcomes, joint replacement registries are an important research and quality improvement tool. In the recent, history registries have identified early implant failures before government organizations such as the FDA. There is notable variability in the breadth and depth of information collected by joint replacement registries, and the goal of this study was to be the first to compare the major joint replacement registries around the world.Methods:Registries were identified from registry reports, publications, institutional records, and PubMed search. Registries were included in the study if there were publicly available reports summarizing the data contained in the registry. The annual report for each registry was reviewed for joint replacement volume of primary total hip arthroplasty, total knee arthroplasty, UKA, hip resurfacing, patellofemoral arthroplasty, revision total hip arthroplasty, and revision total knee arthroplasty. The presence or absence of numerous core registry features and additional registry features was identified for each registry.Results:The largest registries in cumulative joint replacement volume in descending order were as follows: National Joint Registry, American Joint Replacement Registry, Australian Orthopaedic Association National Joint Replacement Registry, Swedish Arthroplasty Register, Dutch Arthroplasty Register, Michigan Arthroplasty Registry Collaborative Quality Initiative, Norwegian Arthroplasty Register, and New Zealand Joint Registry. Australian Orthopaedic Association National Joint Replacement Registry, Swedish Arthroplasty Register, Michigan Arthroplasty Registry Collaborative Quality Initiative, and New Zealand Joint Registry have complete reporting on core registry features. American Joint Replacement Registry and Norwegian Arthroplasty Register provide near-complete reporting on the core registry features with only one feature partially reported. None of the registries have complete reporting of additional registry features such as use of robotics, surgeon-level data and reports, and external research access.Discussion:Despite the variability and the breadth of information contained in the worldwide registries, the information contained in these registries creates notable opportunities for the improvement of joint replacement surgery.

Periprosthetic femoral fractures (PFFs) are a serious complication of total hip arthroplasty (THA) and are expected to become more frequent as older patients live longer with osteoporotic bone and well-fixed implants. This review summarizes recent evidence to support rational prevention and management. A narrative review of contemporary clinical, registry, and biomechanical studies on proximal femoral PFFs was performed, focusing on epidemiology and risk factors, femoral stem design and biomechanics, classification, treatment of Vancouver B fractures, and peri-operative optimization. Registry and cohort studies show that PFFs occur mainly in frail older patients, with 1 year mortality similar to that after fragility hip fracture. Early post-operative fracture risk is consistently higher after uncemented than cemented THA, while composite beam cemented stems and collared cementless stems appear to reduce risk compared with polished taper slip and collarless designs. Short stems and hip resurfacing have theoretical advantages for proximal load transfer but have not shown consistent protection against PFF. Conventional Vancouver and Unified Classification System schemes are less reliable around polished taper slip stems; interface based concepts that focus on cement–bone integrity may better guide management. For selected Vancouver B2 and B3 fractures, especially in physiologically high-risk patients, open reduction and internal fixation can achieve outcomes comparable with revision when the cement–bone interface is intact. Early surgery in orthogeriatric pathways appears important. A design-specific, physiology-led approach combining implant selection, interface-based classification, selective fixation, and peri-operative optimization is central to improving outcomes in PFF. • Design-specific stem risks summarized, beyond cemented versus uncemented. • Interface-based classification proposed for polished taper slip fractures. • Evidence supports ORIF as alternative to revision in selected B2/B3 periprosthetic femoral fractures. • Peri-operative optimization and hip fracture style pathways emphasized. • Short stems and resurfacing critically appraised for fracture risk.

Metal-on-metal (MoM) hip resurfacing (HR) has shown excellent results and survivorship, particularly in male patients or those meeting specific selection criteria. However, revision risks remain high for female patients and those with smaller femoral head sizes (≤ 48 mm), casting doubt on the suitability of MoM HR for these groups. Consequently, ceramic-on-ceramic (CoC) HR has been introduced as a potential alternative. This study aims to evaluate the five-year survivorship of CoC HR, focusing on the impact of gender and implant size on revision rates. A retrospective, multi-center analysis was conducted, encompassing 604 consecutive patients (330 males, 264 females) with a mean age of 50 years (range 20–80 years) who underwent CoC HR between September 2018 and June 2024. No patients were lost to follow-up, and all revisions were documented. Survivorship at five years was assessed through Kaplan-Meier analysis, while a Cox proportional hazards model evaluated the influence of gender and femoral head size on revision risk. The mean follow-up was 3.6 years, ranging from 2.4 to 5.7 years. Overall five-year survivorship for CoC HR was 98.2% (95% CI: 96.7%–99.0%). When analyzed by gender, survivorship was 98.1% for males (95% CI: 95.7%–99.1%) and 98.4% for females (95% CI: 95.7%–99.4%). Analysis by femoral head size revealed similar outcomes, with 98.4% survivorship for head sizes ≤ 48 mm (95% CI: 95.9%–99.4%) and 98.0% for head sizes ≥ 48 mm (95% CI: 95.6%–99.1%). Multivariate analysis showed no statistically significant differences in revision risk associated with gender or femoral head size. The odds ratio (OR) for males was 1.2 (95% CI: 0.21–6.9; p = 0.84), and an increase in head size by 1 mm was linked to an OR of 1.0 (95% CI: 0.81–1.23; p = 0.99), indicating minimal influence from these factors. Ten revisions were observed: three due to periprosthetic fracture, two due to aseptic loosening, four from persistent pain, and one instance of femoral head collapse secondary to avascular necrosis. Five-year outcomes for CoC HR indicate excellent survivorship, with no significant variation based on gender or implant size. These findings are favorable compared to MoM HR, where female patients and smaller component sizes have been associated with lower survivorship. CoC HR may offer a durable alternative to MoM HR with a reduced risk of adverse reactions, though longer follow-up is essential to confirm durability and clinical efficacy.

Anterior THA has gained popularity despite challenges with femoral exposure, particularly when performed “off-table”. Femoral-sided complications during anterior THA may be mitigated by utilizing fluoroscopy, navigation/robotics, and/or anatomical landmarks as references (historically the femoral greater/lesser tuberosity). The purpose of this study was to assess use of the obturator externus tendon femoral origin (termed ‘E-spot’) as an intraoperative landmark during anterior approach THA. Aims were to determine whether ‘E-spot’ could 1) be identified reliably and 2) aid in the intraoperative judgement of femoral component position. A prospective cohort study of consecutive patients undergoing primary THA by the senior author between October 2022 and October 2024 was conducted. Early clinical outcomes and complications were assessed up to 2 years of follow up. THA was performed similarly to standard descriptions of DAA or ABMS with the patient positioned supine on a regular OR table. Systematic capsular release facilitated femoral preparation in all cases. The pubofemoral ligament, superior capsule/obturator internus were released in all cases (while protecting gluteus medius and minimus) to enable femoral mobilization and elevation via a femoral elevator retractor behind the greater trochanter. We attempted to visualize and preserve the obturator externus tendon in all cases as a marker of completeness of femoral release. Anatomic referencing via relation to ‘E-spot’ (rather than fluoroscopy or navigation) was utilized to judge femoral component position and placement. There were 460 primary hip arthroplasty procedures completed by during the study period. 154 patients (33%) were excluded for analysis as they underwent a posterior approach, being performed for patients having severe morbid obesity (BMI>45) or hip resurfacing. 306 hips in 300 patients that were performed via DAA (51) or ABMS (255) approaches were analyzed. Indications in 306 cases were primary/post-traumatic osteoarthritis, dysplasia, protrusio and displaced femoral neck fracture. 12 THAs were performed bilateral simultaneously (2.6%) and the rest unilateral. In terms of outcomes, ‘E-spot’ could 1) be reliably identified as well as 2) the stem to E-spot distance measured in every case (306 out of 306). There was 1 periprosthetic fracture (Vancouver B2) requiring revision surgery at 2 months postoperatively and 1 dislocation at 3 months postoperatively (0.65% overall early complication rate). No other surgical complications were observed (including greater trochanteric fracture, femoral perforation, or femoral component subsidence). In anterior approach THA performed supine on a regular OR table, identifying ‘E-spot’ via systematic capsular release is a safe and reliable method of enabling femoral exposure and referencing femoral component position. This technique does not require the use of fluoroscopy or other adjunctive technology. Similar to the way the transverse acetabulum ligament (‘TAL’) can be used on the acetabular side, ‘E-spot’ may be useful as an intraoperative landmark or 'lighthouse' during femoral preparation (i.e. ‘TAL of the femur’). Based on these results, we now routinely use E-spot to determine the completion of femoral capsular release, assess femoral component position, assure hip stability, and protect the trochanter during off-table anterior THA.

Conversion of a failed metal-on-metal (MoM) resurfacing to a total hip arthroplasty (THA) is reportedly a straightforward procedure; however, little has been published regarding implant survivorship, complications and functional results after revision. The primary goal of this study was to assess the outcomes following MoM resurfacing revision. In addition, we tried to assess if the mode of failure had an effect on post-revision outcomes. We reviewed 76 patients that underwent conversion THAs for failed MoM hip resurfacing in our institution. The mean patient age at revision was 58.1 years (range, 32.6–75.4). Causes for revision were adverse local tissue response (ALTR)(25%), loosening of the cup (23.7%), loosening of the head (n=16.4%) femoral neck fracture (13.2%), early femoral head collapse due to avascular necrosis (11.7%), periprosthetic joint infection (PJI) (3.8%) pain without a clear cause (6.2%). All femoral components were revised either to a single-wedged stem (88%) or a cylindrical stem (12%). A hemispherical cup was used in all acetabular revisions (n=65). The cup was not revised in 11 cases (partial revisions). The most recent radiographs were reviewed, while re-revisions and complications were documented. We assessed clinical outcomes using the Harris Hip Score and UCLA Score. Outcomes of conversion THAs according to mode of resurfacing failure were compared. Mean follow up was 10.6 years (range, 3.9–20 years). At final follow up 4 patients were deceased, so 72 patients were available for assessment. The mean HHS score was 86.2 (SD: ±12.9) and the mean UCL was 6.5 (SD: ±2). Seven patients had re-revisions. Five of them had their index revision due to ALTR (2 partial revised resurfacings, 2 developed instability, 1 persisting pain due to pseudotumor) and 2 for infections (1 persisting PJI, 1 acute PJI). The rest of THAs were deemed stable at the most recent radiographs assessment. There were not significant differences in patient reported outcomes in terms of different modes of failure (p>0.05). Survival of conversion THAs was 91.8% at 10 years. Overall, the outcomes after revision for failed MoM hip resurfacings seem to be very good. Conversion THA in this patient group yielded a favorable 10-year survival. Even though patient reported outcomes did not differ between modes of failure, repeat revisions seem to be more frequent in patients with ALTR.

This study compares PROMs between patients who underwent hip arthroscopy prior to hip resurfacing arthroplasty (HRA) to a matched cohort of HRA patients without prior arthroscopy. A retrospective cohort study was performed of patients who underwent a HRA from 2016 to 2021 with minimum 2-year follow-up. Patients with prior arthroscopy were matched 1:3 with controls on age, sex, BMI, and ASA classification. Subjects completed HOOS JR, FJS, SANE, and PROMIS for physical function, pain intensity, and pain interference. The Mann-Whitney U test was used for intergroup mean comparisons and Fisher's exact test for categorical variables. 20 patients with prior hip arthroscopy were matched to 60 controls (mean age: 47.1 ± 7.2 years; BMI: 29.5 ± 4.2, 96% male). Patients who underwent hip arthroscopy prior to HRA reported significantly greater pain (33.8 vs. 13.2, p = 0.011), poorer FJS (46.6 vs. 70.5, p = 0.030), physical function (43.7 vs. 50.9, p = 0.018), SANE rating (59.9 vs. 82.6, p = 0.005), and satisfaction (66.1 vs. 88.1, p = 0.006) after HRA. 11 patients (55.0%) stated that their hip resurfacing procedure met their expectations compared to 52 patients (86.7%) in the control group. Patients who underwent hip arthroscopy prior to HRA have an association with significantly worse patient-reported outcome metrics, poor postoperative satisfaction, and higher postoperative pain.

Hip resurfacing arthroplasty offers a femoral bone preserving procedure that allows high function activities. Understanding what happens to the bone inside the head component in resurfacing has always been limited by metal artefact. The development of ceramic resurfacing has allowed much better visualisation into well-functioning resurfacings. Our aim was to investigate postoperative MRI imaging of ceramic hip resurfacing. All participants underwent ceramic hip resurfacing using the ReCerf implant (MatOrtho Ltd). All procedures were performed by a single surgeon through an extended posterior approach. Patients underwent MRI at various time frames postoperatively ranging from 4 to 56 months postoperative. Secondary objectives included patient-reported outcomes and complications. We identified 12 cases involving 9 patients, comprising 6 females and 3 males, with an average age of 46.8 years at the time of resurfacing. The mean follow-up period was 37 (range 13-56) months. The overall findings from the MRI imaging were: 18% (2/11) demonstrated features of avascular necrosis, 27% (3/11) had evidence of femoral neck thinning, no patients had excessive cement mantles. The average Oxford Hip Score prior to the procedure was 24, which increased to 43 following the procedure. This study represents the first known investigation of ceramic hip resurfacings utilising postoperative MRI imaging. The findings indicate that the residual anatomy of the femoral head and neck can be effectively visualised and interpreted.The application of MRI imaging offers valuable insights into the successes and potential complications associated with this new generation of hip resurfacing procedures.

This study aimed to compare preoperative education level, income level, and geographical birthplace between patients undergoing metal-on-metal hip resurfacing (MoM-HR) and those receiving a conventional uncemented total hip arthroplasty (THA). All patients with osteoarthritis who underwent a MoM-HR or an uncemented THA registered in the Swedish Arthroplasty Register 1999-2014 were included (n = 15,871). National databases provided additional information on household income and the highest achieved education. 1481 MoM-HR patients were matched to 1481 uncemented THA patients based on age, sex, and Charlson comorbidity index. Odds ratios (OR) of MoM-HR surgery depending on socioeconomic variables were calculated using logistic regression analysis. The OR of having MoM-HR surgery was lower among patients with lower education level compared to those with a university degree. Also, 37% of the MoM-HR patients had an income in the 2 highest quintiles compared to 32% of uncemented THA patients. There was no difference in accessibility of MoM-HR surgery between patients born in or outside Sweden. In Sweden, within a universal healthcare coverage system, lower socioeconomic status in terms of education level was associated with decreased accessibility to innovative hip surgery, i.e., MoM-HR.

ABSTRACTCeramic‐on‐ceramic hip resurfacing arthroplasty (CoC‐HRA) has been developed to eliminate metal ion concerns which have been associated with metal‐on‐metal hip resurfacing arthroplasty (MoM‐HRA) while maintaining similar functionality. The aim of the study was to examine gait function pre‐ and postoperatively between CoC‐HRA, MoM‐HRA, and THA using subjective and objective measures with comparison to a healthy control group. Nineteen unilateral CoC‐HRA, 19 unilateral MoM‐HRA, and 18 unilateral THA gender, age, and BMI matched participants completed patient‐reported outcome measures (PROMs) (Oxford hip score [OHS] and metabolic equivalence of task score [MET]) and underwent gait analysis on an instrumented treadmill, preoperatively (2–8 weeks) and then postoperatively (40–52 weeks). Spatiotemporal measures and vertical ground reaction forces (GRF) were recorded. Statistical parametric mapping was used to detect differences in GRF between affected and nonaffected leg and to healthy controls. Preoperatively, there were no differences between groups in PROMs or objective measures. All groups showed an improved OHS postoperatively with only CoC‐HRA and MoM‐HRA demonstrating significant increase in MET. Postoperatively, TWS in both HRA groups improved with no difference to CON while THA was unable to demonstrate improvements. Postoperatively, at 6.5 km/h, THA demonstrated an asymmetric GRF profile, whereas CoC‐HRA and MoM‐HRA showed no differences between legs. In comparison of the affected leg GRF, THA demonstrated a weaker push off when compared to both resurfacing groups and CON. CoC‐HRA and MoM‐HRA showed no significant differences to CON. CoC‐HRA emerges as a potential alternative to MoM‐HRA, effectively addressing metal ion release concerns while retaining similar functional benefits.