Conclusions Revisions and reoperations are more frequent and occur earlier with metal-on-metal hip resurfacing , except when discontinued devices are removed from the analyses .
Background Metal-on-metal hip resurfacing was developed for younger , active patients as an alternative to THA , but it remains controversial .
Study heterogeneity , inconsistent outcome definitions , and unst and ardized outcome measures challenge our ability to compare arthroplasty outcomes studies .
Questions / purpose sWe asked how early revisions or reoperations ( within 5 years of surgery ) and overall revisions , adverse events , and postoperative component malalignment compare among studies of metal-on-metal hip resurfacing with THA  among patients with hip osteoarthritis .
Secondarily , we compared the revision frequency identified in the systematic review with revisions reported in four major joint replacement registries .
Second-Generation Cementless Total Hip Arthroplasty: Eight to Eleven-Year Results
Background : Second-generation cementless femoral components were design ed to provide more reliable ingrowth and to limit distal osteolysis by incorporating circumferential proximal ingrowth surfaces . We examined the eight to eleven-year results of total hip arthroplasty with a cementless , anatomically design ed femoral component and a cementless hemispheric acetabular component . Methods : Ninety-two consecutive primary total hip arthroplasties with implantation of a femoral component with a circumferential proximal porous coating ( Anatomic Hip ) and a cementless hemispheric porous-coated acetabular component ( Harris-Galante II ) were performed in eighty-five patients . These patients were prospect ively followed clinical ly and radiographically . Six patients ( seven hips ) died and five patients ( seven hips ) were lost to follow-up , leaving seventy-four patients ( seventy-eight hips ) who had been followed for a mean of ten years ( range , eight to eleven years ) . The mean age at the time of the arthroplasty was fifty-two years . Results : The mean preoperative Harris hip score of 51 points improved to 94 points at the time of final follow-up ; 86 % of the hips had a good or excellent result . Thigh pain was reported as mild to severe after seven hip arthroplasties . No femoral component was revised for any reason , and none were loose radiographically at the time of the last follow-up . Two hips underwent acetabular revision ( one because of dislocation and one because of loosening ) . Kaplan-Meier survivorship analysis was performed with revision or loosening of any component as the end point . The ten-year survival rate was 96.4 % ± 2.1 % for the total hip prosthesis , 100 % for the femoral component , and 96.4 % ± 2.1 % for the acetabular component . Radiolucencies adjacent to the nonporous portion of the femoral component were seen in sixty-eight ( 93 % ) of the -seventy-three hips with complete radiographic follow-up . Femoral osteolysis proximal to the lesser trochanter was noted in four hips ( 5 % ) . No osteolysis was identified distal to the lesser trochanter . Periacetabular osteolysis was identified in twelve hips ( 16 % ) . Five patients underwent exchange of the acetabular liner because of polyethylene wear . Conclusions : This second-generation cementless , anatomically design ed femoral component provided excellent clinical and radiographic results with a 100 % survival rate at ten years . The circumferential porous coating of this implant improved ingrowth and prevented distal osteolysis at a mean of ten years after the arthroplasty
Conclusions Revisions and reoperations are more frequent and occur earlier with metal-on-metal hip resurfacing , except when discontinued devices are removed from the analyses .
Background Metal-on-metal hip resurfacing was developed for younger , active patients as an alternative to THA , but it remains controversial .
Study heterogeneity , inconsistent outcome definitions , and unst and ardized outcome measures challenge our ability to compare arthroplasty outcomes studies .
Questions / purpose sWe asked how early revisions or reoperations ( within 5 years of surgery ) and overall revisions , adverse events , and postoperative component malalignment compare among studies of metal-on-metal hip resurfacing with THA  among patients with hip osteoarthritis .
Secondarily , we compared the revision frequency identified in the systematic review with revisions reported in four major joint replacement registries .