Survival and revision causes of hip resurfacing arthroplasty and the Mitch proximal epiphyseal replacement: results from the Danish Hip Arthroplasty Register

Background and purpose — The Mitch proximal epiphyseal replacement (PER) was developed to preserve proximal femoral bone and minimize femoral neck fracture associated with hip resurfacing arthroplasty (HRA). We studied the survival and risk of revision of HRA compared with cementless metal-on-polyethylene (MoP) total hip arthroplasty (THA) and the survival and risk of revision of the Mitch PER compared with MoP THA.

Patients and methods — Using propensity score, we matched 1,057 HRA to 1,057 MoP THA and 202 Mitch PER to 1,010 MoP THA from the Danish Hip Arthroplasty Register. To estimate the relative risk (RR) of revision, we used regression with the pseudo-value approach and treated death as a competing risk.

Results — The cumulative incidence for any revision of HRA at 10 years’ follow-up was 11% (95% confidence interval [CI] 9.1–13) and 6.4% (CI 5.8–7.0) for MoP THA. The RR of any revision was 1.5 (CI 1.1–2.1) for HRA at 10 years’ follow-up. By excluding the ASR components, the RR of revision at 10 years was 1.2 (CI 0.8–1.7). The cumulative incidence of revision was 9.6% (CI 4.2–18) for Mitch PER and 5.4% (CI 5.1–5.7) for MoP THA at 8 years. The RR of revision was 2.0 (CI 0.9–4.3) for Mitch PER at 8 years’ follow-up.

Interpretation — The HRA had increased risk of revision compared with the MoP THA. When excluding ASR, the HRA group had similar risk of revision compared with MoP THA. The Mitch PER did not have a statistically significant increased risk of revision compared with MoP THA.