The effectiveness of metal on metal hip resurfacing: a systematic review of the available evidence published before 2002

A systematic review was carried out to identify the relevant literature on MoM published before 2002. As watchful waiting and total hip replacement are alternative methods commonly used to alleviate the symptoms of degenerative joint disease of the hip, we compared MoM with these.The data on the effectiveness of MoM are scarce, as it is a relatively new technique and at present only short-term results are available.It is not possible to make any firm conclusions about the effectiveness of MoM based on these early results. While the short-term results are promising, it is unclear if such results would be replicated in more rigorous studies, and what the long-term performance might be. Further research is needed which ideally should involve long-term randomised comparisons of MoM with alternative approaches to the clinical management of hip disease.The treatment of younger people with disease of the hip joint presents a difficult clinical problem. Conventional total hip replacement (THR) may be felt to carry too high a risk of failure over a patient's lifetime. Overall, long-term results of THR in younger patients with a variety of underlying conditions indicate that 25–30% may require revision by 15 years [1], compared with less than five percent at ten years for older patients, and less than ten percent at ten or more years for all patients [2]. Specific subgroups of young active patients, such as those with osteoarthritis, may experience a revision rate of 50% [3]. In 1999/00 in the NHS in England 18% (8,389) of THRs were performed on people aged between 15 and 59, 46% (21,440) in people aged 60 to 74, and 36% (27,965) in people aged 75 and over [4]. Data on the number of revisions performed was not so readily available. A previous report suggested that out of approximately 2700 THRs per year, 2100 (78%) are primary THRs and 600 (22%) are revisions [5]. More recent data on revisions of THRs as a percentage of the total number of THR procedures suggest that in 1998/