Wong Zachary, Saluja Anand, Andrew Jordan Louis, Spaan Jonathan, Su Edwin
Texas College of Osteopathic Medicine, Fort Worth, TX, USA.
Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA.
Arthroplast Today. 2025 May 29;33:101721. doi: 10.1016/j.artd.2025.101721. eCollection 2025 Jun.
Hip-resurfacing arthroplasty (HRA) has grown in popularity as an alternative to total hip arthroplasty (THA) but is primarily utilized and indicated in younger patients with sufficient bone stock and aspirations of returning to higher level of physical activity. While the mechanical structure of HRA implants allows for sparing of the femoral neck and more anatomical weight-bearing distribution, questions surround its viability in older patients, specifically those aged 65 years or older. We undertook this study to compare the results of HRA vs THA in a population of older patients, with specific focus on patient-reported outcome measures.
A retrospective, propensity-matched study was conducted on patients aged 65 years or older who underwent either HRA or THA via posterior approach. Patients were matched in a 1:1 ratio based on age, body mass index, and race. Patient-reported outcome measures, including Hip Disability and Osteoarthritis Outcome Score Joint Replacement, Lower Extremity Activity Scale, Visual Analog Scale pain scores, and modified Harris Hip Score were compared at preoperative, 6-week, 1-year, and minimum 2-year follow-ups.
Seventy patients in each group were included. HRA patients demonstrated significantly higher Hip Disability and Osteoarthritis Outcome Score Joint Replacement and Lower Extremity Activity Scale scores at 1-year and final follow-ups. Visual Analog Scale pain scores were lower, and modified Harris Hip Score was higher for HRA patients at the final follow-up. No revisions were reported in the HRA group while one revision due to infection occurred in the THA group.
In carefully selected patients aged 65 years or older, HRA can provide comparable or superior outcomes to THA. However, the decision between HRA and THA should be individualized, considering patient factors and potential risks.
髋关节表面置换术（HRA）作为全髋关节置换术（THA）的替代方法，其应用日益广泛，但主要适用于有足够骨量且期望恢复更高水平体力活动的年轻患者。虽然HRA植入物的机械结构能够保留股骨颈并实现更符合解剖学的负重分布，但对于老年患者，特别是65岁及以上的患者，其可行性仍存在疑问。我们进行这项研究以比较老年患者中HRA与THA的结果，特别关注患者报告的结局指标。
对65岁及以上经后路行HRA或THA的患者进行一项回顾性、倾向评分匹配研究。根据年龄、体重指数和种族将患者按1:1比例匹配。在术前、6周、1年和至少2年随访时比较患者报告的结局指标，包括髋关节残疾和骨关节炎结局评分关节置换、下肢活动量表、视觉模拟量表疼痛评分以及改良Harris髋关节评分。
每组纳入70例患者。HRA组患者在1年和最终随访时的髋关节残疾和骨关节炎结局评分关节置换以及下肢活动量表评分显著更高。在最终随访时，HRA组患者的视觉模拟量表疼痛评分更低，改良Harris髋关节评分更高。HRA组未报告翻修情况，而THA组有1例因感染进行了翻修。
在精心挑选的65岁及以上患者中，HRA可提供与THA相当或更好的结果。然而，HRA和THA之间的决策应个体化，需考虑患者因素和潜在风险。
