The John Charnley Award: Metal-on-metal hip resurfacing versus large-diameter head metal-on-metal total hip arthroplasty: a randomized clinical trial.
Resurfacing arthroplasty has become an attractive option for young patients who want to maintain a high activity level. One recent study reported modestly increased activity levels for patients with resurfacing compared to standard total hip arthroplasty (THA). We conducted a prospective randomized clinical trial to compare clinical outcomes of resurfacing versus large-head metal-on-metal total hip arthroplasty. We randomized 107 patients deemed eligible for resurfacing arthroplasty to have either resurfacing or standard THA. Patients were assessed for quality-of-life outcomes using the PAT-5D index, WOMAC, SF-36, and UCLA activity score. The minimum followup was 0.8 years (mean, 1.1 years; range, 0.8-2.2 years). Of the 73 patients followed at least one year, both groups reported improvement in quality of life on all outcome measures. There was no difference in quality of life between the two arms in the study. Serum levels of cobalt and chromium were measured in a subset of 30 patients. In both groups cobalt and chromium was elevated compared to baseline. Patients receiving a large-head metal-on-metal total hip had elevated ion levels compared to the resurfacing arm of the study. At 1 year, the median serum cobalt increased 46-fold from baseline in patients in the large-head total hip group, while the median serum chromium increased 10-fold. At 1 year, serum cobalt was 10-fold higher and serum chromium 2.6-fold higher than in the resurfacing arm. Due to these excessively high metal ion levels, the authors recommend against further use of this particular large-head total hip arthroplasty.


METHODS
Level I, randomized clinical trial. See Guidelines for Authors for a complete description of levels of evidence.
Garbuz
Donald S
DS
Division of Lower Limb Reconstruction and Oncology, Department of Orthopaedics, University of British Columbia, Room 3114, 910 West 10th Avenue, Vancouver, BC, V5Z 4E3, Canada. garbuz@shaw.ca
Tanzer
Michael
M
Greidanus
Nelson V
NV
Masri
Bassam A
BA
Duncan
Clive P
CP
D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000295:instrumentation*; D001363:Awards and Prizes; D015415:Biomarkers / Q000097:blood; D002857:Chromium / Q000097:blood; D003035:Cobalt / Q000097:blood; D005260:Female; D006621:Hip Joint / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007592:Joint Diseases / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011788:Quality of Life; D020127:Recovery of Function; D013314:Stress, Mechanical; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation
D015415:Biomarkers; D002857:Chromium; D003035:Cobalt
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