Total Hip Arthroplasty vs Hip Resurfacing in Patients Over 65: A Propensity ScoreeMatched Comparison of Patient-Reported Outcomes

Background: Hip-resurfacing arthroplasty (HRA) has grown in popularity as an alternative to total hip arthroplasty (THA) but is primarily utilized and indicated in younger patients with sufficient bone stock and aspirations of returning to higher level of physical activity. While the mechanical structure of HRA implants allows for sparing of the femoral neck and more anatomical weight-bearing distribution, questions surround its viability in older patients, specifically those aged 65 years or older. We undertook this study to compare the results of HRA vs THA in a population of older patients, with specific focus on patient-reported outcome measures. Methods: A retrospective, propensity-matched study was conducted on patients aged 65 years or older who underwent either HRA or THA via posterior approach. Patients were matched in a 1:1 ratio based on age, body mass index, and race. Patient-reported outcome measures, including Hip Disability and Osteoarthritis Outcome Score Joint Replacement, Lower Extremity Activity Scale, Visual Analog Scale pain scores, and modified Harris Hip Score were compared at preoperative, 6-week, 1-year, and minimum 2year follow-ups. Results: Seventy patients in each group were included. HRA patients demonstrated significantly higher Hip Disability and Osteoarthritis Outcome Score Joint Replacement and Lower Extremity Activity Scale scores at 1-year and final follow-ups. Visual Analog Scale pain scores were lower, and modified Harris Hip Score was higher for HRA patients at the final follow-up. No revisions were reported in the HRA group while one revision due to infection occurred in the THA group. Conclusions: In carefully selected patients aged 65 years or older, HRA can provide comparable or superior outcomes to THA. However, the decision between HRA and THA should be individualized, considering patient factors and potential risks. (c) 2025 The Authors. Published by Elsevier Inc. on behalf of The American Association of Hip and Knee Surgeons. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).