Total hip resurfacing in patients who are sixty years of age or older

Metal-on-metal total hip resurfacing arthroplasty has been associated with excellent early results in patients who are younger than sixty years of age, but it remains controversial whether this procedure is appropriate in older patients. The purpose of the present study was to compare the clinical and radiographic outcomes after hip resurfacing in two cohorts of patients: those who were sixty years of age or older, and those who were younger than sixty years of age.

Between November 2002 and August 2005, thirty-five patients (forty hips) who were sixty years of age or older were managed with metal-on-metal total hip resurfacing arthroplasty. The outcomes of these patients were compared with those of 130 patients (153 hips) who were younger than sixty years of age but otherwise had similar preoperative parameters and who had resurfacing arthroplasty performed during the same time interval and by the same surgeon. We evaluated Harris hip scores, Short Form-12 scores, and complications as well as radiographic alignment and radiolucencies.

At a mean follow-up time of thirty-six months, the mean Harris hip scores improved from 52 points to 94 points in the older patient cohort and from 53 points to 92 points in the younger patient cohort. The final Short Form-12 scores of the two groups were also similar. Two patients who were sixty years or older and five of the younger patients required conversion to a conventional total hip arthroplasty. Femoral neck fracture was the reason for one conversion in each group. There were no impending radiographic failures in either cohort.

Although national registries indicate that the risk of femoral neck fracture is higher in older patients, the present study found that these patients had excellent clinical outcomes that were similar to those of patients who were younger. We await longer follow-up results to determine further outcomes in these patients.