Canadian researchers have determined that when it comes to hip replacement choices, a partial replacement may be a better choice than a total hip replacement. More specifically, they found no difference in terms of outcomes between a total and a partial hip replacement, and evidence that the former may result in greater harm than the latter.

Purpose of the Study

The study, carried out at McMaster University in Ontario and published in the New England Journal of Medicine, randomly assigned approximately 1500 hip fracture patients over the age of 50 either a total or a partial hip replacement.

The objective was to find out which patients were more likely to require revision surgery within 24 months, based on the hip replacement choices that were made and which group wound up with a better quality of life and fewer complications.

The Conclusions

In most respects, there appeared to be little difference between the two groups. In on respect, however, the difference was significant. This was a rate of serious complications; 42 percent of total hip replacement patients experienced adverse effects, as opposed to 37 percent of those who underwent a partial hip replacement.

Dr. Mohit Bhandari, the lead author of the study, acknowledged that the hip replacement choices in these cases may not necessarily have been the main factor in the complications that patients experienced. However, he notes that more complex surgeries also mean a higher risk of such complications.

Criticism

Noting that the study “only looks at outcomes two years out,” a spokesperson for the American Academy of Orthopedic Surgeons says the main reason for revision surgery has less to do with whether it is total or partial hip replacement and more to do with the metal construction of many prostheses used today.

“A metal ball sitting in a native socket doesn’t feel good after a while,” orthopedic surgeon Dr. Claudette Lajam explains in U.S. News and World Report. Over a period of time, the patient’s own natural cartilage starts to wear away as it is in moving contact with the metal component.

Metal hip replacements have been associated with numerous complications, and not just because of the cartilage issue. Some products, which are made of metal-on-metal (MoM) construction, are also known to shed microscopic bits of their metal material into patients’ tissues and bloodstream, resulting in a condition known as metallosis. The consequences can be metal toxicity, tissue necrosis, and prosthesis failure.

Which of These Hip Replacement Choices is Better?

According to Bhandari, such choices come down to factors such as the patient’s age how much longer they expect to live. He says, “Someone who’s 51 may believe strongly they don’t mind the potential of earlier risk for longer-term gain. But patients who are 90 may want to see less risk with similar earlier benefits.” It also depends largely on the patient; hip replacement surgery is not a “one-size-fits-all” proposition.

In regards to the dangers of metal-on-metal hip replacements, ceramic products may offer a better alternative, as these are less prone to shedding and the materials are not toxic to humans.