Background: A theoretical advantage of resurfacing arthroplasty of
the hip is that a failed femoral component can be safely and successfully
revised to a total hip arthroplasty. To our knowledge, this advantage has not
been demonstrated to date.
Methods: Twenty-one metal-on-metal resurfacing arthroplasties in
twenty patients with an average age of 50.2 years were converted to a
conventional stemmed total hip arthroplasty because of femoral component
failure. In eighteen hips, the acetabular component was retained, and in three
hips both components were revised. The results in the resurfacing conversion
group were compared with those in a group of fifty-eight patients who had
undergone sixty-four primary total hip arthroplasties that had been performed
during the same time-period by the same surgeon. Clinical evaluations (the
Harris hip score, the University of California at Los Angeles pain, walking,
and activity scores and the Short Form-12 score) and radiographic evaluations
were performed. The average duration of follow-up was forty-six months for the
conversion arthroplasty group and fifty-seven months for the primary
conventional total hip arthroplasty group.
Results: There was no significant difference between the conversion
arthroplasty group and the conventional arthroplasty group with regard to
operative time, blood loss, or complication rates. At the time of the most
recent follow-up, with the numbers studied, there were no significant
differences between the two groups with regard to the mean Harris hip score;
the University of California at Los Angeles pain, walking, and activity score;
or the SF-12 score. As assessed radiographically, the quality of component
fixation and the alignment of the reconstruction were equivalent between the
two groups. There had been no instances of aseptic loosening of the femoral or
the acetabular component in either group, and there had been no dislocations
after conversion of a resurfacing arthroplasty.
Conclusions: Conversion of a hip resurfacing with a femoral-side
failure to a total hip arthroplasty appears to be comparable with primary
total hip arthroplasty in terms of surgical effort, safety, and early clinical
Level of Evidence: Therapeutic Level III. See
Instructions to Authors for a complete description of levels of evidence.