Total hip arthroplasty (THA) remains relatively uncommon procedure in patients under the age of 30. Hip resurfacing (HR) is a potential alternative to THA. To our knowledge, no study has compared these two options in patients under 30 years old. Therefore, we conducted a retrospective comparative study of HR versus THA to: 1) assess implant survival, 2) evaluate functional outcomes.

HR provide better survival and superior functional and activity scores compared to THA.

Between 2006 and 2017, 105 patients under 30 years underwent either HR (62 cases) or THA (43 cases). We compared the number of surgical revisions and their causes to determine survival. Clinical outcomes were assessed using the following scores: Merle d’Aubigné, UCLA, Forgotten Joint Score (FJS), Oxford-12, Harris, and Devane. The Minimum Clinically Important Difference (MCID) and the Patient Acceptable Symptom State (PASS) were also analyzed using the Oxford-12 score.

After 8 years of follow-up, implant survival was 89.9% (95%CI: 0.71–0.96) in the THA group versus 98.4% (95%CI: 0.89–0.99) in the HR group. The THA group had three revisions (due to wear, metallosis, and infection), whereas the HR group had one (femoral collapse). Before adjusting for preoperative status, Harris and Devane scores were higher in the THA group: 96.8 (Interquartile Range (IQR): 92–100) vs 91.5 (IQR: 86–97) (p = 0.002) and 4 (IQR: 4–5) vs 4 (IQR: 3–5) (p = 0.003), respectively. After adjustment, THA patients showed significantly greater improvements in activity scores: Devane (0.5 vs. 0 (p = 0.0006)) and UCLA (1.2 vs. 0 (p = 0.0007)). No significant differences were observed between HR and THA regarding MCID or PASS based on Oxford-12.

HR allows for easier revision surgery and demonstrates excellent clinical outcomes, making it a valuable option in very young patients who are likely to require future surgeries. Our data confirm that HR is a viable long-term option for patients under 30 years old when technically feasible.

III; retrospective case-control study.