Meta-analysis was used to evaluate the clinical efficacy and safety of hip resurfacing and total hip arthroplasty in the treatment of patients with end-stage hip joint disease less than 60 years old.

Retrieve clinical controlled studies on hip resurfacing and total hip arthroplasty that have been published from October 2010 to October 2020.The databases searched include Pubmed, Embase, Cochrane Library, Wanfang Database, CNKI, et al. The keywords searched in Chinese were surface replacement and total hip replacement; the keywords searched in English are hip resurfacing, total hip replacement, total hip arthroplasty. After extracting the data, the Review Manager 5.3 software was used for data analysis to compare the effect of hip resurfacing and total hip arthroplasty in the treatment of middle-aged patients under 60.

A total of 20 literatures were finally included, including 3, 020 cases of hip resurfacing and 2, 407 cases of total hip arthroplasty. Meta-analysis showed that the HHS score of hip resurfacing [MD=2.49, 95% CI(0.66, 4.32),P<0.001] and UCLA activity score [MD=0.64, 95% CI(0.11, 1.17), P=0.02] were higher than total hip arthroplasty, and the differences between two group were statistically significant. There were no statistically significant difference in the VAS pain score [MD=0.19, 95% CI (-0.30, 0.69), P=0.44] between two groups. Cobalt ion concentration of hip resurfacing [MD=-0.72, 95% CI (-1.42, -0.02), P=0.04] and chromium ion concentration [MD=-0.28, 95% CI (-0.39, -0.17), P<0.001] were lower than total hip arthroplasty, and the differences between two group were statistically significant. The revision rate of hip resurfacing [OR=0.45, 95% CI(0.25, 0.80), P=0.007] and the complication rate [OR=0.35, 95% CI(0.12, 0.98), P<0.05] were lower than total hip arthroplasty, and the differences between these two group were statistically significant. The operation time of hip resurfacing [MD=17.58, 95% CI (11.81, 23.35), P<0.001] were higher than total hip arthroplasty, and the intraoperative blood loss [MD=-41.05, 95% CI(-59.87, - 22.24), P<0.001] were lower than total hip arthroplasty, the difference between two group were statistically significant.

For patients under 60 years old with end-stage hip disease, compared with total hip arthroplasty, hip resurfacing has better HHS and UCLA activity scores, reducing intraoperative blood loss, serum metal ion concentration, postoperative the revision rate and complication rate, and improved the quality of life of patients.