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 .
Introduction of total hip arthroplasty in Lithuania: Results from the first 10 years
Background Hip replacement as a routine procedure was introduced in Lithuania in 1991 . At Klaipeda Hospital , one of the 2 hospitals at which this was begun , the arthroplasties were followed prospect ively from the start . This study concerns the 10-year results from a country with no previous experience of hip replacement . The results are compared with those from a hospital with considerable experience of total hip replacement . Methods We compared the revision rate for the first 658 primary ScanHip arthroplasties inserted at Klaipeda to that for the first 939 ScanHip primary arthroplasties inserted at Lund University Hospital , Sweden . Only patients with osteoarthritis were included , and the endpoint was revision for aseptic loosening with exchange of one or both components . Results We found that patients operated at Klaipeda Hospital had a significantly higher risk of revision ( 12 % ) than those operated in Lund ( 6 % ) . Interpretation Although we could not identify any specific reason for the Swedish results being better than the Lithuanian results , it is probable that previous surgical inexperience of hip replacement in Lithuania played a role . We believe that the findings will stimulate surgeons in Lithuania to analyze their failures and improve the results
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 .