title: Have cementless and resurfacing components improved the medium-term results of hip replacement for patients under 60 years of age?
abstract: OBJECTIVE
  The optimal hip replacement for young patients remains unknown. We compared patient-reported outcome measures (PROMs), revision risk, and implant costs over a range of hip replacements.
  
  
  METHODS
  We included hip replacements for osteoarthritis in patients under 60 years of age performed between 2003 and 2010 using the commonest brand of cemented, cementless, hybrid, or resurfacing prosthesis (11,622 women and 13,087 men). The reference implant comprised a cemented stem with a conventional polyethylene cemented cup and a standard-sized head (28- or 32-mm). Differences in implant survival were assessed using competing-risks models, adjusted for known prognostic influences. Analysis of covariance was used to assess improvement in PROMs (Oxford hip score (OHS) and EQ5D index) in 2014 linked procedures.
  
  
  RESULTS
  In males, PROMs and implant survival were similar across all types of implants. In females, revision was statistically significantly higher in hard-bearing and/or small-stem cementless implants (hazard ratio (HR) = 4) and resurfacings (small head sizes (< 48 mm): HR = 6; large head sizes (≥ 48 mm): HR = 5) when compared to the reference cemented implant. In component combinations with equivalent survival, women reported significantly greater improvements in OHS with hybrid implants (22, p = 0.006) and cementless implants (21, p = 0.03) (reference, 18), but similar EQ5D index. For men and women, National Health Service (NHS) costs were lowest with the reference implant and highest with a hard-bearing cementless replacement.
  
  
  CONCLUSIONS
  In young women, hybrids offer a balance of good early functional improvement and low revision risk. Fully cementless and resurfacing components are more costly and do not provide any additional benefit for younger patients.
authors.affiliation: School of Medicine, Pharmacy and Health , Durham University, Queen's Campus, University Boulevard, Stockton-on-Tees , UK .
authors.forename: Simon S
authors.initials: SS
authors.lastname: Jameson
authors.forename: James
authors.initials: J
authors.lastname: Mason
authors.forename: Paul
authors.initials: P
authors.lastname: Baker
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Gregg
authors.forename: Martyn
authors.initials: M
authors.lastname: Porter
authors.forename: David J
authors.initials: DJ
authors.lastname: Deehan
authors.forename: Mike R
authors.initials: MR
authors.lastname: Reed
mesh_terms: D000293:Adolescent; D000328:Adult; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D002484:Cementation / Q000379:methods*; D015331:Cohort Studies; D004739:England; D005260:Female; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000601:surgery*; D063868:Patient Outcome Assessment; D016016:Proportional Hazards Models; D012042:Registries; D012086:Reoperation / Q000706:statistics & numerical data; D012737:Sex Factors; D016896:Treatment Outcome; D014852:Wales; D055815:Young Adult