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Research

Total hip arthroplasty versus resurfacing arthroplasty in the treatment of patients with arthritis of the hip joint: single centre, parallel group, assessor blinded, randomised controlled trial

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e2147 (Published 19 April 2012) Cite this as: BMJ 2012;344:e2147
  1. Matthew L Costa, professor of trauma and orthopaedic surgery1,
  2. Juul Achten, senior research fellow2,
  3. Nicholas R Parsons, trial statistician2,
  4. Richard P Edlin, senior lecturer in health economics3,
  5. Pedro Foguet, consultant orthopaedic surgeon4,
  6. Udai Prakash, consultant orthopaedic surgeon4,
  7. Damian R Griffin, professor of trauma and orthopaedic surgery2
  8. Young Adult Hip Arthroplasty team
  1. 1Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry CV4 7AL, UK
  2. 2Division of Health Sciences, Warwick Medical School, University of Warwick
  3. 3Health Systems, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
  4. 4University Hospitals Coventry and Warwickshire NHS trust, Coventry
  1. Correspondence to: M L Costa Matthew.Costa{at}warwick.ac.uk
  • Accepted 2 March 2012

Abstract

Objectives To compare the clinical and cost effectiveness of total hip arthroplasty with resurfacing arthroplasty in patients with severe arthritis of the hip.

Design Single centre, two arm, parallel group, assessor blinded, randomised controlled trial with 1:1 treatment allocation.

Setting One large teaching hospital in the United Kingdom.

Participants 126 patients older than 18 years with severe arthritis of the hip joint, suitable for resurfacing arthroplasty of the hip. Patients were excluded if they were considered to be unable to adhere to trial procedures or complete questionnaires.

Interventions Total hip arthroplasty (replacement of entire femoral head and neck); hip resurfacing arthroplasty (replacement of the articular surface of femoral head only, femoral neck remains intact). Both procedures replaced the articular surface of the acetabulum.

Main outcome measures Hip function at 12 months after surgery, assessed using the Oxford hip score and Harris hip score. Secondary outcomes were quality of life, disability rating, physical activity level, complications, and cost effectiveness.

Results 60 patients were randomly assigned to hip resurfacing arthroplasty and 66 to total hip arthroplasty. Intention to treat analysis showed no evidence for a difference in hip function between treatment groups at 12 months (t test, P=0.242 and P=0.070 for Oxford hip score and Harris hip score, respectively); 95% of follow-up data was available for analysis. Mean Oxford hip score was 40.4 (95% confidence interval 37.9 to 42.9) in the resurfacing group and 38.2 (35.3 to 41.0) in the total arthroplasty group (estimated treatment effect size 2.23 (−1.52 to 5.98)). Mean Harris hip score was 88.4 (84.4 to 92.4) in the resurfacing group and 82.3 (77.2 to 87.5) in the total arthroplasty group (6.04 (−0.51 to 12.58)). Although we saw no evidence of a difference, we cannot definitively exclude clinically meaningful differences in hip function in the short term. Overall complication rates did not differ between treatment groups (P=0.291). However, we saw more wound complications in the total arthroplasty group (P=0.056) and more thromboembolic events in the resurfacing group (P=0.049).

Conclusions No evidence of a difference in hip function was seen in patients with severe arthritis of the hip, one year after receiving a total hip arthroplasty versus resurfacing arthroplasty. The long term effects of these interventions remain uncertain.

Trial registration Current Controlled Trials ISRCTN33354155, UKCRN 4093.

Footnotes

  • We thank Becky Kearney, Katie McGuinness, Helen Richmond, Phil Jones, Kate Dennison, Zoe Buckingham, Troy Douglin, and Catherine Richmond for their assistance in recruitment and data collection during the trial; Chris McCarthy, Chris Bridle, Ceri Jones, Tim Friede, and Steve Krikler for their clinical, trials, and regulatory expertise in the trial steering committee and data monitoring committee for this trial; and all the patients for their time and effort in participating in this trial.

  • This trial was conducted on behalf of the Young Adult Hip Arthroplasty team at the University Hospitals Coventry and Warwickshire NHS trust: Matthew Costa, Pedro Foguet, Udai Prakash, Damian Griffin, Richard King, Steve Krikler, and Gavin Pereira.

  • Contributors: MLC, JA, and NRP designed the study and analysed and interpreted the trial data. MLC, PF, UP, DRG managed the recruitment and follow-up of the patients. RE was responsible for the health economics analysis of the trial. MLC, JA, and NRP planned and wrote the first draft of the paper, which was subsequently revised by all authors. All authors read and approved the final manuscript. MLC is guarantor.

  • Funding: This study was funded by the Research for Patient Benefit scheme of the National Institute of Health Research. This trial was cosponsored by the University of Warwick and University Hospitals Coventry and Warwickshire NHS trust. This manuscript presents independent research commissioned by the National Institute of Health Research. The views expressed are those of the authors and not necessarily those of the NHS, the National Institute of Health Research, or the Department of Health.

  • Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: funding from the National Institute of Health Research, University of Warwick, and University Hospitals Coventry and Warwickshire NHS trust; consultant surgeons at the University Hospitals Coventry and Warwickshire NHS trust have received research project funding and provided paid educational support to meetings sponsored by manufacturers of both total hip arthroplasty and resurfacing arthroplasty implants, but not in relation to this study.

  • Ethical approval: This study was approved by the Coventry research ethics committee (no 07/Q2802/26) on 9 May 2007. Further approval was obtained from the research and development department of the University Hospitals Coventry and Warwickshire NHS trust. This research complies with the Helsinki Declaration.

  • Data sharing: no additional data available.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

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