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The aim of this study was to evaluate the ten-year clinical and functional outcome of hip resurfacing and to compare it with that of cementless hip arthroplasty in patients under the age of 55 years. Between 1999 and 2002, 80 patients were enrolled into the study: 24 were randomised (11 to hip resurfacing, 13 to total hip arthroplasty), 18 refused hip resurfacing and chose cementless total hip arthroplasty with a 32 mm bearing, and 38 insisted on resurfacing. The mean follow-up for all patients was 12.1 years (10 to 14). Patients were assessed clinically and radiologically at one year, five years and ten years. Outcome measures included EuroQol EQ5D, Oxford, Harris hip, University of California Los Angeles and University College Hospital functional scores. No differences were seen between the two groups in the Oxford or Harris hip scores or in the quality of life scores. Despite a similar aspiration to activity pre-operatively, a higher proportion of patients with a hip resurfacing were running and involved in sport and heavy manual labour after ten years. We found significantly higher function scores in patients who had undergone hip resurfacing than in those with a cementless hip arthroplasty at ten years. This suggests a functional advantage for hip resurfacing. There were no other attendant problems. Cite this article: Bone Joint J 2015; 97-B:617-22.

Resumen
El objetivo de este estudio fue evaluar el resultado de diez años clínica y funcional de recubrimiento de cadera y compararla con la de la artroplastia de cadera no cementada en pacientes menores de 55 años. Entre 1999 y 2002, 80 pacientes fueron incluidos en el estudio: 24 fueron asignados al azar (11 de recubrimiento de cadera, 13 para la artroplastia total de cadera), 18 se negaron recubrimiento de cadera no cementada y eligió la artroplastia total de cadera con un cojinete de 32 mm y 38 insistieron en repavimentación . La media de seguimiento para todos los pacientes fue de 12,1 años (10 a 14). Los pacientes fueron evaluados clínicamente y radiológicamente en un año, cinco años y diez años. Las medidas de resultado incluyeron EuroQol EQ5D, Oxford, Harris de cadera, de la Universidad de California en Los Angeles y University College Hospital puntuaciones funcionales. No se observaron diferencias entre los dos grupos en las puntuaciones de cadera Oxford o Harris o en el de calidad de vida. A pesar de una aspiración similar a la actividad antes de la cirugía, una mayor proporción de pacientes con un recubrimiento de cadera estaban corriendo e involucrado en el deporte y el trabajo manual pesado después de diez años. Encontramos puntuaciones de la función significativamente mayores en los pacientes que se habían sometido a recubrimiento de cadera que en aquellos con una artroplastia de cadera no cementada a los diez años. Esto sugiere una ventaja funcional para el recubrimiento de cadera

©2015 The British Editorial Society of Bone & Joint Surgery.

Adverse reaction to metal debris (ARMD) involving the hip joint has emerged as an important reason for failure and revision among patients with metal-on-metal (MOM) hip arthroplasty. To the authors’ knowledge, there are no reports of adverse radiographic sequelae in the greater trochanter subsequent to revision for ARMD. The authors describe clinical and radiographic findings in 2 patients who developed greater trochanteric fragmentation 1 to 2 years after conversion of their failed MOM hips to polyethylene bearings. Both patients had solid pseudotumors with tissue necrosis. Several reports describe various clinical features of ARMD. Although poor outcomes have been demonstrated after some MOM revisions, to the authors’ knowledge, no reports document greater trochanter fragmentation in ARMD. The current patients highlight the fact that tissue damage occurring with MOM bearing hips can involve bone in addition to soft tissue even after a pseudotumor has been removed and serum metal levels have decreased to normal levels after revision. Unlike the greater trochanteric fractures historically associated with polyethylene wear and osteolysis, no evidence of bone cysts or lesions was found prior to the fractures and neither fracture healed with conservative treatment. For these 2 patients, the authors believe the tissue necrosis included both soft tissue and bone. The necrotic bone resorbed gradually after removal of the MOM bearing, resulting in bone fragmentation with ongoing symptoms. These patients emphasize and remind us that damage is not only limited to soft tissues, but also includes bone. Surgeons should be aware of this radiographic finding and the associated clinical symptoms. [Orthopedics. 2015; 38(5):e447-e451.].

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