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Randomized Controlled Trial
. 2012 Apr 19:344:e2147.
doi: 10.1136/bmj.e2147.

Total hip arthroplasty versus resurfacing arthroplasty in the treatment of patients with arthritis of the hip joint: single centre, parallel group, assessor blinded, randomised controlled trial

Matthew L Costa  1 , Juul Achten, Nicholas R Parsons, Richard P Edlin, Pedro Foguet, Udai Prakash, Damian R Griffin; Young Adult Hip Arthroplasty Team
Collaborators, Affiliations
Randomized Controlled Trial

Total hip arthroplasty versus resurfacing arthroplasty in the treatment of patients with arthritis of the hip joint: single centre, parallel group, assessor blinded, randomised controlled trial

Matthew L Costa et al. BMJ. .

Abstract

Objectives: To compare the clinical and cost effectiveness of total hip arthroplasty with resurfacing arthroplasty in patients with severe arthritis of the hip.

Design: Single centre, two arm, parallel group, assessor blinded, randomised controlled trial with 1:1 treatment allocation.

Setting: One large teaching hospital in the United Kingdom.

Participants: 126 patients older than 18 years with severe arthritis of the hip joint, suitable for resurfacing arthroplasty of the hip. Patients were excluded if they were considered to be unable to adhere to trial procedures or complete questionnaires.

Interventions: Total hip arthroplasty (replacement of entire femoral head and neck); hip resurfacing arthroplasty (replacement of the articular surface of femoral head only, femoral neck remains intact). Both procedures replaced the articular surface of the acetabulum.

Main outcome measures: Hip function at 12 months after surgery, assessed using the Oxford hip score and Harris hip score. Secondary outcomes were quality of life, disability rating, physical activity level, complications, and cost effectiveness.

Results: 60 patients were randomly assigned to hip resurfacing arthroplasty and 66 to total hip arthroplasty. Intention to treat analysis showed no evidence for a difference in hip function between treatment groups at 12 months (t test, P=0.242 and P=0.070 for Oxford hip score and Harris hip score, respectively); 95% of follow-up data was available for analysis. Mean Oxford hip score was 40.4 (95% confidence interval 37.9 to 42.9) in the resurfacing group and 38.2 (35.3 to 41.0) in the total arthroplasty group (estimated treatment effect size 2.23 (-1.52 to 5.98)). Mean Harris hip score was 88.4 (84.4 to 92.4) in the resurfacing group and 82.3 (77.2 to 87.5) in the total arthroplasty group (6.04 (-0.51 to 12.58)). Although we saw no evidence of a difference, we cannot definitively exclude clinically meaningful differences in hip function in the short term. Overall complication rates did not differ between treatment groups (P=0.291). However, we saw more wound complications in the total arthroplasty group (P=0.056) and more thromboembolic events in the resurfacing group (P=0.049).

Conclusions: No evidence of a difference in hip function was seen in patients with severe arthritis of the hip, one year after receiving a total hip arthroplasty versus resurfacing arthroplasty. The long term effects of these interventions remain uncertain.

Trial registration: Current Controlled Trials ISRCTN33354155, UKCRN 4093.

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Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: funding from the National Institute of Health Research, University of Warwick, and University Hospitals Coventry and Warwickshire NHS trust; consultant surgeons at the University Hospitals Coventry and Warwickshire NHS trust have received research project funding and provided paid educational support to meetings sponsored by manufacturers of both total hip arthroplasty and resurfacing arthroplasty implants, but not in relation to this study.

Figures

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Fig 1 Patient flow diagram
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Fig 2 Temporal trends in hip function scores after surgery. Data are mean (95% confidence interval)
See this image and copyright information in PMC

Comment in

References

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