Hip resurfacing or stemmed arthroplasty for young active patients?

Hip replacement surgery is one of the most cost effective and clinically effective medical interventions.1 It can vastly improve quality of life for patients who have end stage degenerative joint disease. Increased function and longevity of implants is needed for younger patients, and this has led surgeons and implant manufacturers to continue to improve techniques, implant designs, and bearing surfaces. In a linked randomised controlled trial (doi:10.1136/bmj.e2147), Costa and colleagues compare function 12 months after resurfacing arthroplasty or conventional stemmed total hip arthroplasty in younger patients.2

Stemmed conventional total hip arthroplasty has reproducibly good results. However, for young people who may have a life expectancy of a further 50 years, the longevity of the prosthesis does not match that of the patient, and revision surgery may be inevitable. The quest for a prosthetic hip that will last for the lifetime of a young patient is the driver for innovation. Resurfacing arthroplasty was marketed as a good choice for younger patients in terms of function and longevity.