Conversion of hip resurfacing to total hip arthroplasty: is the outcome closer to primary or revision total hip arthroplasty?

Background: Along with the advent of newer bearings, hip resurfacing (HR) is gaining renewed interest as a bone sparing alternative to conventional total hip arthroplasty (THA) in young patients. However, the outcome of conversion of failed HR to THA (HRc) remains sparsely described. This study aimed to compare the outcomes and complication rates of HRc to those of primary (pTHA) and revision THA (rTHA) to find out to which group HRc is most comparable.

Hypothesis: The study hypothesis was that the outcomes and complications rates of HRc were closer to those of pTHA than rTHA.

Materials and methods: Between 2001 and 2011, a continuous series of 207 HR were prospectively included in our institutional registry and retrospectively analyzed. Out of them, 17 HR (8%) were converted to THA. Propensity scores were used to match patients in the HRc group to the pTHA and the rTHA groups using a greedy 1:3 matching procedure (51 pTHA and 51 rTHA). Clinical and radiographic outcomes, perioperative data and complications were analyzed and compared between the three groups.

Results: No significant difference between HRc and pTHA was observed in terms of clinical and functional outcomes, duration of surgery, acetabular component diameter and length of hospital stay (p = 0.13 to 0.94). Perioperative blood loss was significantly lower for pTHA than for HRc (p = 0.01). HRc demonstrated significantly higher HHS and HOOS scores than for rTHA at one year (p = 0.03 and p < 0.01, respectively). Duration of surgery was significantly lower in HRc compared to rTHA (p = 0.02) while length of hospital stay was similar (p = 0.84). Complication rate was significantly higher in the rTHA group, compared to HRc and pTHA groups (37.3 vs. 29.4 vs. 11.8%, p = 0.01).

Conclusion: This study demonstrated that the clinical and functional outcomes of HRc were closer to those of pTHA than those of rTHA, though complication rate was higher than for pTHA.

Level of evidence: III; Retrospective comparative study.