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 .
What Works Best, a Cemented or Cementless Primary Total Hip Arthroplasty?: Minimum 17-year Followup of a Randomized Controlled Trial
Background  Total hip arthroplasty ( THA )  has been associated with high survival rates , but debate remains concerning the best fixation mode of THA . Questions / purpose sWe conducted a r and omized controlled trial ( RCT ) with 250 patients with a mean age of 64 years between October 1987 and January 1992 to compare the results of cementless and cemented fixation . Patients and Methods Patients were evaluated for revision of either of the components . One hundred twenty-seven patients had died ( 51 % ) and 12 ( 4.8 % ) were lost to followup . The minimum 17-year followup data ( mean , 20 years ; range , 17–21 years ) for 52 patients of the cementless group and 41 patients of the cemented group were available for evaluation . Results Kaplan-Meier survivorship analysis at 20 years revealed lower survival rates of cemented compared with cementless THA . The cementless tapered stem was associated with a survivorship of 99 % . Age younger than 65 years and male gender were predictors of revision surgery . Conclusions The efficacy of future RCTs can be enhanced by r and omizing patients in specific patient cohorts stratified to age and gender in multicenter RCTs . Including only younger patients might improve the efficacy of a future RCT with smaller sample sizes being required . A minimum 10-year followup should be anticipated , but this can be expected to be longer if the difference in level of quality between the compared implants is smaller . Level of Evidence Level I , therapeutic study . See Guidelines for Authors for a complete description of levels of evidence
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 .