Long-term Follow-up of Hip Resurfacing Arthroplasty Patients: A Comprehensive Review of Outcomes Over 15 Years

Purpose: Hip resurfacing arthroplasty (HRA) has emerged as a promising alternative to total hip arthroplasty (THA) for managing severe osteoarthritis, especially in younger, active males seeking a return to high impact activities. While short to medium-term follow-up studies have demonstrated favorable clinical outcomes and survival rates, there is increasing interest in the long-term durability of HRA, in terms of implant survivorship and patient outcomes and attitudes. The existing body of literature on HRA longevity is predominantly limited to follow-up periods of up to 10 years. As such, the purpose of this study was to evaluate the long-term survivorship of HRA with a minimum follow-up period of fifteen years.

Methods: A retrospective review of hip resurfacing arthroplasties performed by a single surgeon at a high-volume surgical center between 2006-2008 was conducted. Given that the majority of these patients were male, we elected to focus exclusively on male patients to control for potential confounding factors related to sex and standardize our findings. Patient demographics were collected including age, BMI, and laterality. Patient reported outcome measures (PROMs) including Hip Disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS-JR), Harris Hip Score (HHS), Visual Analogue Scale (VAS), and UCLA Activity Scores were collected at fifteen years post-operation. Subject satisfaction surveys were also collected, and Kaplan-Meier survival analyzed implant revisions.

Results: A total of 312 patients (369 hips) out of 470 (543 hips) with a minimum 15-year follow up were included in this study, representing a follow-up rate of 66.4%. The mean age at surgery was 50.5 ± 7.8 years and the mean BMI was 27.9 ± 4.3 kg/m2. The mean scores for HOOS JR, HHS, VAS, and UCLA activity scores at final follow-up were 97.5 ± 6.7, 96.7 ± 8.3, 0.3 ± 0.9, and 7.9 ± 1.9, respectively. Out of the 369 HRA implants, 24 were revised to total hip arthroplasty, indicating 93.5% survivorship. Excluding patients who required revision, 98.9% of patients expressed satisfaction with the procedure.

Conclusions: Positive outcomes in PROMs and subject satisfaction scores accompanied by high implant survival, indicate that the metal-on-metal HRA procedure exists as a safe and effective solution for end-stage osteoarthritis in young (50.5 ± 7.8 years) male patients at long-term follow-up. Favorable outcomes persisting 15-years after primary procedure suggests that HRA may serve as a viable alternative to THA, its longstanding counterpart, at high-volume centers with proper expertise of the procedure. This avenue warrants further exploration in the future of our study, with potential implications for the optimization of patient care and surgical decision-making in this population.