Work

Revision outcomes after failed hip resurfacing arthroplasty vary by failure indication and component strategy: A systematic review

Year: 2026

Type: review

Abstract: Purpose: Hip resurfacing arthroplasty (HRA) is a bone-conserving procedure indicated for end-stage osteoarthritis in younger, active patients. The widespread failure of metal-on-metal (MoM) bearings due to adverse reactions to metal debris has generated a large and complex revision cohort. The recent regulatory approval of ceramic-on-ceramic (CoC) resurfacing devices necessitates an updated synthesis of HRA revision outcomes. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search of MEDLINE, EMBASE, CINAHL, Cochrane Library and HMIC was conducted. Studies reporting outcomes of primary HRA revision with a minimum of 12 months of follow-up and extractable re-revision or functional outcome data were included. Studies reporting primary HRA survivorship only were excluded. Data were extracted on revision strategy, indications, serum metal ion levels, patient-reported outcome measures and re-revision rates. Results: Twenty-three studies were included, encompassing 2320 reported HRA revision procedures. Across 1705 hips with longitudinal data, 157 re-revisions or major reoperations occurred (9.2%). Both-component revision had the lowest crude strategy-specific rate (59/828; 7.1%), followed by femoral-only revision (63/486; 13.0%) and isolated acetabular revision (10/52; 19.2%). Strategy was indication-dependent: femoral-only revision predominated for fracture (239/325; 73.5%), whereas both-component revision predominated for metal-related pathology (245/368; 66.6%) and loosening/osteolysis (268/416; 64.4%). Post-revision, cobalt and chromium concentrations decreased in both studies reporting paired data; HHS improved from 64.4 to 92.5. Instability/dislocation/intraprosthetic dislocation was the commonest complication (32/118; 27.1%), followed by periprosthetic joint infection (24/118; 20.3%). Primary CoC resurfacing had 98.0% 5-year survivorship, with predominantly mechanical failures and no re-revision data. Conclusions: HRA revision can provide functional recovery and metal ion reduction, but outcomes depend on indication, component status and construct. Both-component revision had the lowest crude observed re-revision proportion. Femoral-only revision may be considered when the shell is fixed, well-oriented, undamaged, and biologically uninvolved. Retained-cup dual mobility is a component-preserving option but carries risks of intraprosthetic dislocation and uncertain long-term polyethylene wear. Level of Evidence: Level IV.

Source: Journal of Experimental Orthopaedics

DOI: 10.1002/jeo2.70965

Authors: Srikar Reddy Namireddy, Hariharan Subbiah Ponniah, Milos Brjklac, Justin Cobb, Kartik Logishetty

Institutions: Imperial College London, Cleveland Clinic London, University College London Hospitals NHS Foundation Trust, University College London

Language: English

Topic: Orthopaedic implants and arthroplasty

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,850