Posteroinferior relevant scapular neck offset in reverse shoulder arthroplasty: key player for motion and friction-type impingement in a computer model.

BACKGROUND: Range of motion (ROM) and prevention of notching remain a challenge for reverse shoulder arthroplasty (RSA). Both may be affected by the morphology of the scapula. The purpose of this study was to define anteroinferior (a) and posteroinferior (p) relevant scapular neck offset (RSNO) and to examine the hypothesis that pRSNO is significantly smaller than aRSNO, and influences rigid body motion (RBM). Adapting glenosphere implantation strategies may therefore be of value. MATERIAL AND METHODS: In this computer model study, we used deidentified computed tomographic scans of 22 patients (11 male and 11 female; mean age: 72.9 years) with massive cuff tears without joint space narrowing. Eight RSA glenoid configurations were tested with a constant neck-shaft angle (145°). Two baseplate types (25 mm; 25 + 3 mm lateralized) and 4 glenospheres (GS) (36 mm; 36 +2 mm of eccentricity; 39 mm; 39 + 3 mm) were used. RSNO was defined as the standardized measurement of the horizontal distance from the inferior extent of the GS to the bony margin of the scapula after baseplate positioning (flush to inferior glenoid extent; neutral position: 0° inclination and 0° version-both software computed). RESULTS: There was a highly significant difference between pRSNO and aRSNO for both genders (P < .001). pRSNO was always smaller than aRSNO. pRSNO was strongly correlated with external rotation (ERO: 0.84) and extension (EXT: 0.74) and moderately correlated with global ROM (GROM: 0.68). There was a moderately strong correlation between aRSNO and internal rotation (IRO: 0.69). pRSNO was strongly correlated with aRSNO, EXT, ERO, IRO, adduction (ADD) and GROM (0.82, 0.72, 0,8, 0.71, 0.82, 0.76) in female patients and with EXT and ERO (0.82, 0.89) in male patients. The median pRSNO allowing for at least 45° ERO and 40° EXT was 14.2 mm for men and 13.8 mm for women. For all patients and models, pRSNO ≥14 mm increased EXT, ERO, and GROM significantly compared with pRSNO <14 mm (P < .001). The combination of lateralization and inferior overhang (eccentricity) led to the most significant increase of pRSNO for each GS size (P < .001). CONCLUSION: This is one of the first RSA modeling studies evaluating nonarthritic glenoids of both genders. The lateral scapular extent to glenoid relationship is asymmetric. pRSNO is always smaller than aRSNO for both genders and was a critical variable for EXT and ERO, demonstrating additional strong correlation with aRSNO, IRO, ADD, and GROM in female patients. pRSNO ≥14 mm was a safe value to prevent friction-type impingement. Combining increased glenosphere size, lateralization, and inferior overhang gives the best results in this computer-simulated setting.

Editorial Commentary: Proximal Hamstring Tendon Injuries: Is the Research Hamstrung by the Use of Poor Outcome Measures?

Proximal hamstring tendon injuries are uncommon injuries, and there are few high-quality studies of surgical procedures in the literature. Increasing standardization of outcome measures with the use of validated, injury-specific, patient-reported outcome measures will improve research in this area. This will allow better assessment of novel surgical techniques.

Arthrogenic muscle inhibition after ACL reconstruction: a scoping review of the efficacy of interventions.

OBJECTIVE: To determine whether reported therapeutic interventions for arthrogenic muscle inhibition (AMI) in patients with ACL injuries, following ACL reconstruction, or in laboratory studies of AMI, are effective in improving quadriceps activation failure when compared with standard therapy in control groups. DESIGN: A scoping review of the efficacy of interventions was conducted in accordance with the methodological framework of Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Search terms included 'arthrogenic muscle inhibition', 'quadriceps activation following knee injuries', 'anterior cruciate' or 'knee' combined with 'quadriceps activation', 'quadriceps inhibition', 'corticomotor', 'arthrogenic', 'brain activation' and 'neuroplasticity'. Articles were evaluated for risk of bias using the PEDro (Physiotherapy Evidence Database) criteria. The overall quality of evidence for each intervention was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). DATA SOURCES: PubMed, EMBASE and Cumulative Index to Nursing and Allied Health Literature databases. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Isolated case reports and articles reporting outcomes in patients with chronic disease or major trauma were excluded. All other original research articles were included. RESULTS: 780 potential articles were identified. 20 met the inclusion criteria. These studies provided a moderate quality of evidence to support the efficacy of cryotherapy and physical exercises in the management of AMI. There was low-quality evidence for efficacy of neuromuscular electrical stimulation and transcutaneous electrical nerve stimulation, and very low-quality evidence for efficacy of ultrasound and vibration. CONCLUSIONS: This scoping review demonstrated moderate-quality evidence for the efficacy of cryotherapy and physical exercises in improving quadriceps activation failure after ACL injury and reconstruction. These therapeutic modalities are therefore recommended in the management of AMI.

Joint Perception After Total Hip Arthroplasty and the Forgotten Joint.

BACKGROUND: Assessing patients' functional outcomes following total hip arthroplasty with traditional scoring systems is limited by their ceiling effects. The Forgotten Joint Score (FJS) has been suggested as a more discriminating option. The actual score in the FJS which constitutes a "forgotten joint," however, has not been defined. The emerging concept of joint perception led to the development of the Patient's Joint Perception question (PJP) to assess the patient's opinion of their prosthetic joint. METHODS: Two hundred fifty-seven total hip arthroplasties were assessed at a mean of 68 months of follow-up (range 57-79). Outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), FJS, and PJP. Correlation of the scores as well as the ceiling effects were analyzed. RESULTS: The mean FJS was 88.5 (range 27.1-100). PJP was correlated with the FJS and WOMAC (Spearman's rho -0.510 and 0.465, respectively). Fifty-two percent of the patients felt their hip as a natural joint (FJS: 95% confidence interval [CI] 93.3-96.0), 24.1% as an artificial joint with no restriction (FJS: 95% CI 83.1-90.5), and 23.3% as an artificial joint with minor restrictions (FJS: 95% CI 73.8-82.2). Only 0.8% had major restrictions and none reported a non-functional joint. The ceiling effect was high with both the WOMAC and FJS, with 27.2% and 31.9%. In addition, 28.6% of the patients had a WOMAC >10 and 23.4% an FJS <90 while reporting having a natural hip. Furthermore, 21.5% with a perfect WOMAC or 21.9% with a perfect FJS reported having an artificial joint with or without limitation. CONCLUSION: A forgotten hip perception corresponds to an FJS >93. In 20%-30% of the cases, the WOMAC and FJS failed to identify the forgotten joint, or reached the maximum score when the patients did not feel their hip was natural. The PJP is a simple and reliable tool that enables identification of patients who feel replaced hip is natural.

Clinical Outcomes of Single Anteromedial Bundle Biologic Augmentation Technique for Anterior Cruciate Ligament Reconstruction With Consideration of Tibial Remnant Size.

PURPOSE: The primary aim of this study was to evaluate the functional outcomes, knee stability, complications, and reoperations associated with anatomic anterior cruciate ligament (ACL) reconstruction using the single anteromedial bundle biological augmentation (SAMBBA) technique in a consecutive series of 128 patients with a minimum follow-up of 24 months. A secondary aim was to compare larger preserved ACL remnants with smaller preserved remnants. METHODS: Patients who underwent primary anatomic ACL reconstruction using the SAMBBA technique from July 2013 to October 2014 were analyzed. Exclusion criteria were (1) age <16 years, (2) revision cases, (3) multiple ligament injuries, (4) chondral lesions greater than grade 2 according to the Outerbridge classification, (5) additional injuries to the collateral ligaments greater than grade 2, or (6) a history of a contralateral ACL injury. Clinical assessment including evaluation of side-to-side difference and functional outcome measures with the International Knee Documentation Committee (IKDC) subjective score and the Tegner Activity Scale were used to evaluate outcomes before surgery and at the last follow-up. Any subsequent surgical procedures were systematically recorded during the study period. The patients were also divided in 2 groups according to their ACL remnant size, ≥50% or <50%, and compared. RESULTS: Of the 135 patients who underwent primary SAMBBA technique, 128 patients returned to final follow-up, with a mean follow-up of 31.7 months (range, 24-44.3). At last follow-up, the IKDC score significantly improved from 54.1 ± 15.1 to 92.5 ± 11.4 (P < .001); the Tegner activity score (6.4 ± 1.2) was similar (P = .3) to the preinjury score (6.5 ± 1.2). Side-to-side laxity significantly improved from 6.7 ± 1.2 mm to 0.7 ± 1 mm (P < .001). Twenty-four subsequent surgeries (18.7%) were performed including 10 meniscal procedures, 7 ACL revisions, 5 arthroscopies for cyclops lesions, one microfracture, and one manipulation under anaesthesia. The side-to-side laxity (P = .30) and rates of reoperation (P = .65), graft failure (P = .45), and cyclops lesions (P = .67) were not significantly different between ≥50% or <50% ACL remnant groups. CONCLUSIONS: The results of this study demonstrate that primary anatomic ACL reconstruction using the SAMBBA technique significantly improved clinical and functional outcomes between baseline and follow-up at a minimum of 24 months. A low rate of complications was observed with this technique. No significant differences between large and moderate size ACL remnants were detected for all outcome measures. LEVEL OF EVIDENCE: Level IV case series with subgroup analysis.

The popliteus tendon provides a safe and reliable location for all-inside meniscal repair device placement.

PURPOSE: Repairs of the posterior horn of the lateral meniscus can be technically challenging. In contrast to medial meniscus repairs, the capsule around the posterior segment attachment of the lateral meniscus is quite thin. This study evaluates the clinical results of an arthroscopic all-inside repair technique for unstable, vertical, lateral meniscus tears, using a suture repair placed directly into the popliteus tendon. METHODS: A retrospective analysis of prospectively collected data from the SANTI database was performed. All patients who had undergone combined ACL reconstruction with lateral meniscus all-inside repair, using sutures placed in the popliteus tendon, between 2011 and 2015, were included. Patients were reviewed clinically at 1 and 2 years' follow-up. At final follow-up, all patients were contacted to identify if they underwent further surgery or had knee pain, locking or effusion. Symptomatic patients were recalled for clinical evaluation by a physician and Magnetic Resonance Imaging of the knee. Operative notes for those undergoing further surgery were reviewed and rates and type of re-operation, including for failed lateral meniscal repair were recorded. RESULTS: Two hundred patients (mean age 28.6 ± 10.2 years) with a mean follow-up of 45.5 ± 12.8 months (range 24.7-75.2) were included. The mean Subjective International Knee Documentation Committee (IKDC) at final follow-up was 85.0 ± 11.3. The post-operative mean side-to-side laxity measured at 1 year was 0.6 ± 1.0 mm. Twenty-six patients underwent re-operation (13%) at a mean follow-up of 14.8 ± 7.8 months. The ACL graft rupture rate was 5.0%. Other causes for re-operation included medial meniscus tear (2.5%), cyclops lesion (1.5%) and septic arthritis (0.5%). The lateral meniscus repair failure rate was 3.5%. No specific complications relating to placement of sutures in the popliteus tendon were identified. CONCLUSION: Arthroscopic all-inside repair of unstable, vertical, lateral meniscus tears using a suture placed in the popliteus tendon is a safe technique. It is associated with a very low failure rate with no specific complications. LEVEL OF EVIDENCE: Level IV.

Proximal hamstring tendon avulsion surgery: evaluation of the Perth Hamstring Assessment Tool.

PURPOSE: The purpose of the present study was to validate a new scoring system for proximal hamstring injury-the Perth Hamstring Assessment Tool (PHAT). METHODS: This is a prospective series of 74 consecutive proximal hamstring surgical repairs in 72 patients, with a median age of 50.5 years (range 16-74). Patients completed the PHAT, SF12 Health Survey and Lower Extremity Functional Scale (LEFS). The scoring system was validated by calculating its internal consistency, reproducibility, reliability and sensitivity to change. Construct validity was evaluated using Pearson's correlation analysis to examine the strength of association between the PHAT, LEFS and SF-12 scores. RESULTS: The PHAT showed high completion rate (100 %), high internal consistency (Cronbach's alpha 0.80), high reproducibility (ICC 0.84) and high sensitivity to change. There was moderate correlation with the LEFS and low correlation with the Physical Component Score of the SF-12. CONCLUSION: This study has validated the PHAT as an assessment tool for proximal hamstring tendon injuries. The new questionnaire provides a measure of outcome that is reliable and sensitive to clinically important change. This simple questionnaire provides the clinician with a quick and practical tool for assessing patients with proximal hamstring injuries: to assess pre-operative disability and monitor recovery post-operatively. LEVEL OF EVIDENCE: II.

A prospective evaluation of proximal hamstring tendon avulsions: improved functional outcomes following surgical repair.

PURPOSE: Avulsion of the proximal hamstring tendons is an uncommon injury. To date, few studies have prospectively evaluated outcomes of surgical repair. The aim of the present study is to review the functional outcomes of surgical repair of proximal hamstring tendon avulsions. METHODS: This is a prospective series of 96 consecutive proximal hamstring surgical repairs in 94 patients, with a median age of 50 years and median follow-up of 33 months (range 12-58). Functional outcomes were assessed using the Perth Hamstring Assessment Tool (PHAT)-a validated scoring system for proximal hamstring injuries. RESULTS: Significant improvements in functional outcomes were seen across all patients at 1-year follow-up. There was a mean PHAT score improvement of 34.7 points at the 1-year follow-up (p < 0.001, 95% CI 29.9-39.5). The SF-12 PCS scores showed a significant improvement at 1-year follow-up of 13.8 points (p < 0.001, 95% CI 10.7-16.9). These were maintained at final follow-up. Acute repairs had significantly higher improvement in PHAT score with acute patients improving a mean of 38.6 points (p < 0.001, 95% CI 32.0-44.3) and chronic patients only improving by a mean of 25.3 points (p < 0.001, 95% CI 18.2-33.3) at final follow-up. CONCLUSION: This study establishes that surgical repair of proximal hamstring tendon ruptures leads to improved patient outcomes, in both acute and chronic repairs. Early surgical repair, however, achieves superior outcomes to late repair. These results suggest that surgeons should be operating on proximal hamstring avulsions, and preferably in the acute stage. LEVEL OF EVIDENCE: II.

Ventriculoperitoneal Shunt Fracture Following Application of Halo-Gravity Traction: A Case Report.

BACKGROUND: Ventriculoperitoneal (VP) shunt malfunctions are very common, and shunt fracture is one of the most common causes. Shunt fractures are often a result of calcification and tethering, which predispose the tubing to fracture when mechanical stresses are applied. This case report describes a case of shunt fracture following application of halo-gravity traction for correction of spinal deformity. METHODS: Chart and imaging data for a single case were reviewed and reported in this retrospective case study. RESULTS: A 10-year-old female, being treated for syndromic scoliosis, underwent posterior surgical release and application of halo-gravity traction. Increasing weight of traction was applied over a period of 6 weeks, for gradual deformity correction. It was noted on the 6-week cervical spine radiograph that the VP shunt had fractured at the base of the neck. The patient was taken to the operating room and intraoperative findings confirmed shunt fracture. This was repaired without complications. CONCLUSIONS: This case, to our best knowledge, is the first reported occurrence of shunt fracture following application of halo-gravity traction. It demonstrates the importance of careful monitoring of patients with VP shunts, when they are undergoing traction for correction of spinal deformity. LEVEL OF EVIDENCE: Level IV.

Cluster hole versus solid cup in total hip arthroplasty: a randomized control trial.

Acetabular osteolysis has been linked to polyethylene debris that is generated in the hip migrating through screw holes in the acetabular component. Solid-backed acetabular components were designed to decrease this osteolysis. This prospective trial randomized 100 patients undergoing total hip arthroplasty to either a solid-backed or a cluster-hole acetabular component-all without screws. At 5years post-surgery, 34.4% of all patients had osteolytic lesions that were visible on CT. There was no significant difference in either presence or volume of the osteolytic lesions, cup migration or functional outcomes (OHS) between the groups. There may no longer be a detriment to using cluster-hole cups instead of solid cups in all hips. This would then give the surgeon the option to use screws for stability as required.

Selective Genicular Artery Embolization in the Management of Osteoarthritic Knee Pain-A Narrative Review.

Many people with pain from osteoarthritis (OA) of the knee are either not ready for surgery or may never be surgical candidates. Genicular artery embolization (GAE) is a new proposed management for those with pain despite maximum medical management. It has historically been used to manage recurrent spontaneous haemarthrosis following total knee replacement, but newer studies are showing a positive effect in managing pre-arthroplasty knee OA. The goal of this review is to summarise current and relevant literature from searches of computerised databases and relevant journals, and analyse their results. Studies included show that GAE has promising outcomes in managing mild to moderate OA knee pain in those who have exhausted at least 3 months of conservative therapy. Most studies show improvements in VAS pain and PROM scores (including KOOS, and/or WOMAC). Minimal adverse effects have been associated in up to two years of follow up, the majority of which are self-resolving. The article précises a concise general procedural technique for performing GAE, as well as comparing and contrasting different embolic agents that may be utilised. GAE shows promising outcomes in management of mild to moderate OA knee pain. In the future, there will need to be higher volume studies to determine effectiveness, suitable candidates, and other potential adverse effects.

Biomechanical and Histological Study of Retrieved LARS Synthetic Ligaments.

BACKGROUND: Synthetic grafts have been used for a number of years in anterior cruciate ligament (ACL) reconstruction surgery. One of the more recent additions to the stable of synthetic ligaments is the Ligament Augmentation and Reconstruction System (LARS) ligament. PURPOSE: To analyze the biomechanics and histology of LARS grafts retrieved due to failure of the device. STUDY DESIGN: Descriptive laboratory study. METHODS: A total of 22 LARS ligament grafts that were explanted from patients were sent for analysis. Five new, unused samples of the standard LARS ACL graft were also analyzed. Biomechanical testing was performed: ultimate tensile force, force versus displacement, and stress versus strain were recorded. Histopathological examination was performed looking for degree of fibrous tissue ingrowth as well as the presence of a foreign body reaction. RESULTS: Of the 22 grafts retrieved, 14 were used for ACL grafts, 1 for a lateral collateral ligament graft, 2 for medial collateral ligament grafts, 4 for gluteal tendon augmentation, and 1 for a supraspinatus augmentation. A severe foreign body reaction was found in 86% of the grafts (18/22) and a mild foreign body reaction in the remaining 14% (4/22). Tissue ingrowth was minimal in the majority of ACL grafts; the other grafts showed moderate tissue ingrowth. Maximal tensile force was significantly higher for the new ACL grafts (mean ± SD, 1667 ± 845 N) compared with the retrieved grafts (897 ± 395 N; P < .05). CONCLUSION: This study demonstrated that the vast majority of retrieved LARS artificial ligaments had a florid foreign body reaction. There was minimal tissue ingrowth in ACL grafts and moderate ingrowth in other grafts. Retrieved grafts had a decreased ultimate tensile force, which increased their risk of rupture. CLINICAL RELEVANCE: Surgeons should be cautious in choosing to use these grafts in reconstructive surgery for patients.

Humeral head size predicts baseplate lateralization in reverse shoulder arthroplasty: a comparative computer model study.

Background: In reverse shoulder arthroplasty (RSA), the ideal combination of baseplate lateralization (BL), glenosphere size (GS), and glenosphere overhang (GOH) with a commonly used 145° neck shaft angle (NSA) is unclear. This is the first study evaluating correlations of body height (BH), humeral head size (HS), glenoid height (GH), and association of gender with best glenoid configurations for range of motion (ROM) maintaining anatomic lateralization (aLAT) for optimized muscle length in 145° and less distalized 135° RSA. Methods: In this computer model study, 22 computed tomographies without joint narrowing were analyzed (11 male/female). A standardized semi-inlay 145° platform stem was combined with 20 glenoid configurations (baseplate [B] 25, 25 + 3/+6 lateralized [l], 29, 29 + 3/6l combined with glenosphere 36, 36 + 2 eccentric [e], 36 + 3l, 39, 39 + 3e, 39 + 3l , 42, 42 + 4e). Abduction-adduction, flexion-extension, external rotation-internal rotation, total ROM (TROM), and total notching relevant (TNR) ROM were computed, best TROM models respecting aLAT (-1 mm to +1 mm) and HS/GH recorded. Second, the 145° models (Ascend Flex stem; Stryker, Kalamazoo, MI, USA) were converted and compared to a 135° inlay RSA (New Perform stem; Stryker, Kalamazoo, MI, USA) maintaining GOH (6.5-7 mm) and aLAT. Results: Best 145° models had eccentric glenospheres (mean BL: 3.5 mm, GOH 8.8 mm, GS 38.1 mm, distalization 23 mm). The 135° models had concentric glenospheres, mean BL 3.8 mm, GOH 6.9 mm, GS 39.7 mm, and distalization 14.1 mm. HS showed the strongest positive correlation with BL in 145° and 135° models (0.65/0.79). Despite reduced GOH in smaller females with a 135° NSA, adduction, external rotation, extension, TNR ROM, and TROM were significantly increased (P = .02, P = .005, P = .005, P = .004, P = .003), abduction however reduced (P = .02). The same trends were seen for males. Conclusion: HS is a practical measure in surgery or preoperatively, and the strong positive correlation with BL is a useful planning aid. Despite reduction of GOH, conversion to a less distalized 135° NSAinlay design is powerful to maintain and even significantly increase all components of TNR ROM (extension/external rotation/adduction) in small females with the drawback of reduced abduction which may however be compensated by scapula motion. Lateralization with a less distalized 135° RSA optimizes muscle length, may facilitate subscapularis repair, and maintains highest rigid body motion.

Advances in Hip Replacement Surgery.

Total hip arthroplasty (THA) is one of the most successful types of surgical operation, with some considering it "the operation of the century" [...].

Evolution of Concepts: Can Personalized Hip Arthroplasty Improve Joint Stability?

Hip arthroplasty procedures are successful and reproducible. However, within the first two post-operative years, hip dislocations are the most common cause for revisions. This is despite the majority of the dislocations having the acetabular component within what is described as the 'safe zone'. The limitations of such boundaries do not take into account the variability of individual hip anatomy and functional pelvic orientation that exist. An alternative concept to address hip instability and improve overall outcomes is functional acetabular orientation. In this review article, we discuss the evolution of concepts, particularly the kinematic alignment technique for hip arthroplasty and the use of large-diameter heads to understand why total hip arthroplasty dislocations occur and how to prevent them.

Current concepts in chronic traumatic anterior shoulder instability.

Chronic traumatic anterior shoulder instability can be defined as recurrent trauma-associated shoulder instability requiring the assessment of three anatomic lesions: a capsuloligamentous and/or labral lesion; anterior glenoid bone loss and a Hill-Sachs lesion. Surgical treatment is generally indicated. It remains controversial how risk factors should be evaluated to decide between a soft-tissue, free bone-block or Latarjet-type procedure. Patient risk factors for recurrence are age; hyperlaxity; competitive, contact and overhead sports. Trauma-related factors are soft tissue lesions and most importantly bone loss with implications for treatment. Different treatment options are discussed and compared for complications, return to sports parameters, short- and long-term outcomes and osteoarthritis. Arthroscopic Bankart and open Latarjet procedures have a serious learning curve. Osteoarthritis is associated with the number of previous dislocations as well as surgical techniques. Latarjet-type procedures have the lowest rate of dislocation recurrence and if performed correctly, do not seem to increase the risk of osteoarthritis.

Challenges for Optimization of Reverse Shoulder Arthroplasty Part II: Subacromial Space, Scapular Posture, Moment Arms and Muscle Tensioning.

In part II of this comprehensive review on the optimization of reverse shoulder arthroplasty (RSA), we focus on three other challenges: 1. "Conservation of sufficient subacromial and coracohumeral space"; 2. "Scapular posture"; and 3. "Moment arms and muscle tensioning". This paper follows a detailed review of the basic science and clinical literature of the challenges in part I: 1. "External rotation and extension" and 2. "Internal rotation". "Conservation of sufficient subacromial and coracohumeral space" and "Scapular posture" may have a significant impact on the passive and active function of RSA. Understanding the implications of "Moment arms and muscle tensioning" is essential to optimize active force generation and RSA performance. An awareness and understanding of the challenges of the optimization of RSA help surgeons prevent complications and improve RSA function and raise further research questions for ongoing study.

Resurfacing Hip Arthroplasty Is a Safe and Effective Alternative to Total Hip Arthroplasty in Young Patients: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed at comparing resurfacing hip arthroplasty (RHA) and total hip arthroplasty (THA) in terms of rate of complications, revisions, functional outcomes, blood loss, operative time and metal ions levels. The search was conducted on three databases (PubMed, Cochrane and Web of Science) updated until 13 October 2022. The inclusion criteria were RCTs) written in the English language, with no time limitation, comparing RHA and THA. Among the retrieved 4748 articles, 18 RCTs were eligible for a total of 776 patients (mean age 53.1 ± 5.0). A meta-analysis was performed. RHA reported significantly lower blood loss compared to THA (p < 0.001) but with longer operative time (p < 0.001). No statistically significant difference was found between RHA and THA in terms of complications (12.08% and 16.24%, respectively) and revisions (6.32% and 6.14%, respectively). Both RHA and THA provide excellent clinical results in a population of young and active patients. Functional outcomes were not significantly different between the groups. Moreover, no significant difference in metal ion levels was found. These findings provide evidence concerning the safety and clinical effectiveness of RHA. Because of its bone-preserving properties, the lack of drawbacks and good outcomes, RHA appears to be a valid alternative to THA in young and active patients.