Patient-reported outcomes among age-matched hip resurfacing and total hip arthroplasty: an analysis of 622 patients with a minimum 2-year follow-up

Abstract

Aim:

The purpose of this study was to investigate differences in patient-reported outcome measures (PROMs) among patients who underwent THA in comparison to Birmingham hip resurfacing (BHR) for the treatment of osteoarthritis.

Methods:

A prospective cohort of 1414 patients who underwent BHR (n = 707) or THA (n = 707) for the treatment of primary osteoarthritis in a single healthcare system between July 2015 and December 2017 were included and propensity score matched on age. Differences between groups in the Hip disability and Osteoarthritis Outcome Score (HOOS) pain subscale, HOOS-Physical Function Shortform (PS), and the University of California at Los Angeles (UCLA) activity score at 2 years follow-up were evaluated. Minimal clinically important differences (MCID) were based on previous studies.

Results:

Of the total 622 patients (THA, n = 311; BHR, n = 311) who completed the 2-year follow-up, BHR patients reported less pain (2-year HOOS pain: BHR, 100; THA, 95; p < 0.001), higher function (2-year HOOS PS: BHR, 95.4; THA, 91.2; p < 0.001), and greater activity levels (2-year UCLA activity: BHR, 7.5; THA, 6; p < 0.001) compared to THA patients. After adjusting for demographic variables, no significant difference in estimated median HOOS pain scores was found between cohorts. BHR patients exhibited significantly higher median HOOS-PS scores (HOOS-PS score difference: 2.5, 95% CI, 0.38–5.4; p = 0.03) and higher median UCLA activity scores (UCLA activity score difference: 0.79, 95% CI, 0.33–1.24; p < 0.001) compared to THA patients. No differences were observed in the proportion of patients achieving MCID thresholds in all PROMs between groups.

Conclusion:

BHR and THA have both been shown to significantly ameliorate pain and enhance functional capacity in patients with end-stage osteoarthritis. Interestingly, at the 2-year postoperative follow-up, BHR patients exhibited higher activity levels and improved physical function compared to those who underwent THA; however, the extent of this improvement may not reach clinical relevance.

Keywords

BHR hip resurfacing hip arthroplasty PROMs THA

Get full access to this article

View all access options for this article.

References

Grits

Emara

Orr

, et al. Preoperative Veteran RAND-12 Mental Composite Score of >60 associated with increased likelihood of patient satisfaction after total hip arthroplasty. J Arthroplasty 2023; 38(Suppl. 2): S258–S264.

Rullán

Deren

Zhou

, et al. The arthroplasty surgeon growth indicator: a tool for monitoring supply and demand trends in the orthopaedic surgeon workforce from 2020 to 2050. J Bone Joint Surg Am 2023; 105: 1038–1045.

Orr

Klika

Emara

, et al. Dissatisfaction after total hip arthroplasty associated with preoperative patient-reported outcome phenotypes. J Arthroplasty 2022; 37: S498–S509.

Bhal

, et al. Results of the First U.S. FDA-approved hip resurfacing device at 10-year follow-up. J Bone Joint Surg Am 2021; 103: 1303–1311.

Palazzuolo

Bensa

Bauer

, et al. Resurfacing hip arthroplasty is a safe and effective alternative to total hip arthroplasty in young patients: a systematic review and meta-analysis. J Clin Med 2023; 12: 2093.

Halawi

Oak

Brigati

, et al. Birmingham hip resurfacing versus cementless total hip arthroplasty in patients 55 years or younger: a minimum five-year follow-up. J Clin Orthop Trauma 2018; 9: 285–288.

Oak

Strnad

O’Rourke

, et al. Mid-term results and predictors of patient-reported outcomes of Birmingham hip resurfacing. J Arthroplasty 2017; 32: 110–118.

Brooks

Samuel

Levin

, et al. Mortality after hip resurfacing versus total hip arthroplasty in young patients: a single surgeon experience. Ann Transl Med 2019; 7: 77.

dela Rosa

Silva

Heisel

, et al. Range of motion after total hip resurfacing. Orthopedics 2007; 30: 352–357.

10.

Nam

Nunley

Ruh

, et al. Short-term results of Birmingham hip resurfacing in the United States. Orthopedics 2015; 38: e715–e721.

11.

Lons

Arnould

Pommepuy

, et al. Excellent short-term results of hip resurfacing in a selected population of young patients. Orthop Traumatol Surg Res 2015; 101: 661–665.

12.

Pasqualini

Piuzzi

NS.

Patient-reported outcome measures: state of the art in patient-reported outcome measure application in lower extremity orthopaedics. J Am Acad Orthop Surg 2023; 31: e883–e889.

13.

Ford

Hellman

Kazarian

, et al. Five to ten-year results of the Birmingham hip resurfacing implant in the U.S.: a single institution’s experience. J Bone Joint Surg Am 2018; 100: 1879–1887.

14.

Cleveland Clinic OME Arthroplasty Group; Bircher

Kamath

, et al. No clinically meaningful difference in 1-year patient-reported outcomes among major approaches for primary total hip arthroplasty. Hip Int 2022; 32: 568–575.

15.

Haddad

Konan

Tahmassebi

A prospective comparative study of cementless total hip arthroplasty and hip resurfacing in patients under the age of 55 years: a ten-year follow-up. Bone Joint J 2015; 97-B: 617–622.

16.

Siqueira

and Cleveland Clinic OME Group. No clinically meaningful differences in 1-year patient-reported outcome measures between hip resurfacing and total hip arthroplasty: an age-matched prospective cohort study. J Hip Surg 2021; 5: 84–90.

17.

Smith

Nichols

Donell

, et al. The clinical and radiological outcomes of hip resurfacing versus total hip arthroplasty: a meta-analysis and systematic review. Acta Orthop 2010; 81: 684–695.

18.

OME Cleveland Clinic Orthopaedics. Value in research: achieving validated outcome measurements while mitigating follow-up cost. J Bone Joint Surg Am 2020; 102: 419–427.

19.

Roth

Anis

Emara

, et al. The potential effects of imposing a body mass index threshold on patient-reported outcomes after total knee arthroplasty. J Arthroplasty 2021; 36: S198–S208.

20.

Anis

Strnad

Klika

, et al. Developing a personalized outcome prediction tool for knee arthroplasty. Bone Joint J 2020; 102-B: 1183–1193.

21.

Cleveland Clinic OME Arthroplasty Group; Arnold

Anis

, et al. Preoperative cut-off values for body mass index deny patients clinically significant improvements in patient-reported outcomes after total hip arthroplasty. Bone Joint J 2020; 102-B: 683–692.

22.

Curtis

Tariq

Brigati

, et al. Validation of a novel surgical data capturing system following total hip arthroplasty. J Arthroplasty 2018; 33: 3479–3483.

23.

Nilsdotter

Bremander

Measures of hip function and symptoms: Harris Hip Score (HHS), Hip Disability and Osteoarthritis Outcome Score (HOOS), Oxford Hip Score (OHS), Lequesne Index of Severity for Osteoarthritis of the Hip (LISOH), and American Academy of Orthopedic Surgeons (AAOS) Hip and Knee Questionnaire. Arthritis Care Res (Hoboken) 2011; 63(Suppl. 11): S200–S207.

24.

Davis

Perruccio

Canizares

, et al. The development of a short measure of physical function for hip OA HOOS-Physical Function Shortform (HOOS-PS): an OARSI/OMERACT initiative. Osteoarthritis Cartilage 2008; 16: 551–559.

25.

Heiberg

Figved

Physical functioning and prediction of physical activity after total hip arthroplasty: five-year followup of a randomized controlled trial. Arthritis Care Res (Hoboken) 2016; 68: 454–462.

26.

Paulsen

Roos

Pedersen

, et al. Minimal clinically important improvement (MCII) and patient-acceptable symptom state (PASS) in total hip arthroplasty (THA) patients 1 year postoperatively. Acta Orthop 2014; 85: 39–48.

27.

Oxblom

Hedlund

Nemes

, et al. Patient-reported outcomes in hip resurfacing versus conventional total hip arthroplasty: a register-based matched cohort study of 726 patients. Acta Orthop 2019; 90: 318–323.

28.

Lingard

Muthumayandi

Holland

JP.

Comparison of patient-reported outcomes between hip resurfacing and total hip replacement. J Bone Joint Surg Br 2009; 91: 1550–1554.

29.

Konan

Waugh

Ohly

, et al. Mid-term results of a prospective randomised controlled trial comparing large-head metal-on-metal hip replacement to hip resurfacing using patient-reported outcome measures and objective functional task-based outcomes. Hip Int 2021; 31: 637–643.

30.

Ortiz-Declet

Iacobelli

Yuen

, et al. Birmingham hip resurfacing vs total hip arthroplasty: a matched-pair comparison of clinical outcomes. J Arthroplasty 2017; 32: 3647–3651.