Hip Resurfacing is Associated with Significantly Shorter Length of Stay and Increased Postoperative Mobilization than Total Hip Arthroplasty

Abstract

Metal-on-metal hip resurfacing (HRA) is performed as an alternative for total hip arthroplasty (THA) for symptomatic hip osteoarthritis in young, active male patients. This article seeks to determine if there is a difference in postoperative pain, mobilization, and opioid consumption between HRA and THA. A single-institution total joint arthroplasty database was utilized to identify adult patients who underwent elective HRA or THA between 2016 and 2019. Baseline demographic data along with operative time and Charlson Comorbidity Index (CCI) were collected. Patients were matched by age, sex, race, smoking status, body mass index (BMI), and CCI. Morphine milligram equivalents (MME) and visual analog scale scores were collected. Activity Measure for Post-Acute Care (AM-PAC) was used to determine physical therapy progress. A total of 7,387 cases were identified: 96.59% THA (7,135) and 3.41% HRA (252). HRA patients were significantly younger (52.52 vs. 64.04 years; p < 0.001), had higher BMI (30.03 vs. 29.40; p = 0.029), and were almost exclusively male as compared with the THA cohort (98.8% vs. 42.2%; p < 0.001). HRA patients had lower CCI scores (0.36 vs. 1.14; p < 0.001). Surgical time was greater for HRA (124.81 vs. 103.82 minutes; p < 0.001). HRA patients had significantly shorter length of stay (LOS) than THA patients (1.17 vs. 1.48 days; p < 0.001) and had significantly better AM-PAC scores (21.52 vs. 20.65; p = 0.032). HRA patients exhibited a trend toward home discharge (0.4% vs. 2.4%; p = 0.057). Aggregate opioid consumption (23.63 vs. 27.89 MME; p = 0.321) and pain scores (3.47 vs. 3.28; p = 0.438) were not different between matched cohorts. HRA patients are younger, almost exclusively male, and have lower CCI scores at time of surgery. HRA is associated with significantly shorter LOS and greater mobilization measures. They tended to have a higher rate of home discharge. Both groups had similar pain scores and opioid consumption.

Level III Retrospective Cohort Study.

Keywords

hip resurfacing - total hip arthroplasty - length of stay - mobilization - pain score

Publication History

Received: 10 October 2022

Accepted: 25 April 2023

Article published online:
19 May 2023

• References

• 1 Murray DW, Grammatopoulos G, Pandit H, Gundle R, Gill HS, McLardy-Smith P. The ten-year survival of the Birmingham hip resurfacing: an independent series. J Bone Joint Surg Br 2012; 94 (09) 1180-1186
• 2 Amstutz HC, Le Duff MJ, Campbell PA, Gruen TA, Wisk LE. Clinical and radiographic results of metal-on-metal hip resurfacing with a minimum ten-year follow-up. J Bone Joint Surg Am 2010; 92 (16) 2663-2671
• 3 Van Der Straeten C, Gross TP, Amstutz H. et al; and the International Hip Resurfacing Group. Hip resurfacing arthroplasty in young patients: international high-volume centres' report on the outcome of 11,382 metal-on-metal hip resurfacing arthroplasties in patients >50 years at surgery. Hip Int 2022; 32 (03) 353-362
• 4 Daniel J, Pynsent PB, McMinn DJW. Metal-on-metal resurfacing of the hip in patients under the age of 55 years with osteoarthritis. J Bone Joint Surg Br 2004; 86 (02) 177-184
• 5 Mont MA, Ragland PS, Etienne G, Seyler TM, Schmalzried TP. Hip resurfacing arthroplasty. J Am Acad Orthop Surg 2006; 14 (08) 454-463
• 6 Amstutz HC, Le Duff MJ. Hip resurfacing: history, current status, and future. Hip Int 2015; 25 (04) 330-338
• 7 Annual Report 2015 - Shoulder Arthroplasty Annual Report 2015 - Hip and Knee Arthroplasty Annual Report 2015 - 2015 - AOANJRR. Accessed June 3, 2022, at: https://aoanjrr.sahmri.com/annual-reports-2015
• 8 Marker DR, Seyler TM, Jinnah RH, Delanois RE, Ulrich SD, Mont MA. Femoral neck fractures after metal-on-metal total hip resurfacing: a prospective cohort study. J Arthroplasty 2007; 22 (7, Suppl 3): 66-71
• 9 Langton DJ, Joyce TJ, Jameson SS. et al. Adverse reaction to metal debris following hip resurfacing: the influence of component type, orientation and volumetric wear. J Bone Joint Surg Br 2011; 93 (02) 164-171
• 10 Marshall DA, Pykerman K, Werle J. et al. Hip resurfacing versus total hip arthroplasty: a systematic review comparing standardized outcomes. Clin Orthop Relat Res 2014; 472 (07) 2217-2230
• 11 Menendez ME, Schumacher CS, Ring D, Freiberg AA, Rubash HE, Kwon YM. Does “6-Clicks” day 1 postoperative mobility score predict discharge disposition after total hip and knee arthroplasties?. J Arthroplasty 2016; 31 (09) 1916-1920
• 12 Keswani A, Tasi MC, Fields A, Lovy AJ, Moucha CS, Bozic KJ. Discharge destination after total joint arthroplasty: an analysis of postdischarge outcomes, placement risk factors, and recent trends. J Arthroplasty 2016; 31 (06) 1155-1162
• 13 Bozic KJ, Ward L, Vail TP, Maze M. Bundled payments in total joint arthroplasty: targeting opportunities for quality improvement and cost reduction. Clin Orthop Relat Res 2014; 472 (01) 188-193
• 14 Mayer MA, Pirruccio K, Sloan M, Sheth NP. Discharge home is associated with decreased early complications following primary total joint arthroplasty. J Arthroplasty 2019; 34 (11) 2586-2593
• 15 Lee N, Thompson NR, Passek S, Stilphen M, Katzan IL. Minimally clinically important change in the Activity Measure for Post-Acute Care (AM-PAC), a generic patient-reported outcome tool, in people with low back pain. Phys Ther 2017; 97 (11) 1094-1102
• 16 Kugelman DN, Teo G, Huang S, Doran MG, Singh V, Long WJ. A novel machine learning predictive tool assessing outpatient or inpatient designation for Medicare patients undergoing total hip arthroplasty. Arthroplast Today 2021; 8: 194-199
• 17 Haas DA, Zhang X, Davis III CM, Iorio R, Barnes CL. The financial implications of the removal of total knee arthroplasty from the Medicare inpatient-only list. J Arthroplasty 2020; 35 (6S): S33-S36
• 18 Peres-da-Silva A, Kleeman LT, Wellman SS. et al. what factors drive inpatient satisfaction after knee arthroplasty?. J Arthroplasty 2017; 32 (06) 1769-1772
• 19 Mistry JB, Chughtai M, Elmallah RK. et al. What influences how patients rate their hospital after total hip arthroplasty?. J Arthroplasty 2016; 31 (11) 2422-2425
• 20 Benito J, Stafford J, Judd H, Ng M, Corces A, Roche MW. Length of stay increases 90-day readmission rates in patients undergoing primary total joint arthroplasty. J Am Acad Orthop Surg Glob Res Rev 2022; 6 (03) e21.00271
• 21 Yoon RS, Geller JA, Nyce JD, Morrison TA, Macaulay W. Hip resurfacing is less painful at 24 hours than hip replacement. Orthop Clin North Am 2012; 43 (05) e8-e13