Is there evidence to support an indication for surface replacement arthroplasty?: a systematic review

Area of Science:

• Orthopedic surgery
• Biomechanical engineering

Background:

• Surface replacement arthroplasty (SRA) is a hip surgery alternative to traditional total hip arthroplasty (THA).
• SRA presents unique challenges including higher costs, metal ion production, and hypersensitivity concerns.
• SRA requires greater surgical precision compared to THA.

Purpose of the Study:

• To systematically review and compare complication rates, patient-reported outcomes, stress shielding, and hip biomechanics between SRA and THA.
• To evaluate the clinical advantages of SRA to justify its use over THA.

Main Methods:

• A systematic literature review was conducted using MEDLINE and EMBASE databases.
• Inclusion criteria focused on Level I-III evidence comparing primary SRA and THA with at least one year of follow-up.
• Analysis included 27 articles encompassing 4182 patients.

Main Results:

• Fracture and infection rates were comparable between SRA and THA.
• SRA demonstrated significantly lower dislocation rates compared to THA.
• Patient-reported outcomes were equivalent, with SRA showing higher activity scores and improved return to high-level activities.
• SRA better restored native hip biomechanics and reduced proximal femoral stress shielding.

Conclusions:

• SRA offers potential advantages for young, active males with osteoarthritis, including enhanced return to high-level activities and sports.
• SRA demonstrates superior restoration of native hip biomechanics and reduced stress shielding.
• Long-term follow-up is necessary to confirm the ultimate survivorship of SRA compared to THA.