Gait Analysis of Patients with Resurfacing Hip Arthroplasty Compared with Hip Osteoarthritis and Standard Total Hip Arthroplasty

doi:10.1016/j.arth.2006.03.010

The Journal of Arthroplasty

Volume 22, Issue 1, January 2007, Pages 100-108

https://doi.org/10.1016/j.arth.2006.03.010 Get rights and content

Abstract

Patients with standard total hip arthroplasties may have reduced hip abduction and extension moments when compared with normal nonosteoarthritic hips. In comparison, patients after resurfacing total hip arthroplasty appear to have a near-normal gait. The authors evaluated temporal-spatial parameters, hip kinematics, and kinetics in hip resurfacing patients compared with patients with unilateral osteoarthritic hips and unilateral standard total hip arthroplasties. Patients with resurfacing walked faster (average 1.26 m/s) and were comparable with normals. There were no significant differences in hip abductor and extensor moments of patients with resurfacing compared with patients in the standard hip arthroplasty group. This study showed more normal hip kinematics and functionality in resurfacing hip arthroplasty, which may be due to the large femoral head.

Section snippets

Materials and Methods

Fifteen metal-on-metal unilateral total hip resurfacing patients (Conserve Plus, Wright Medical, Arlington, Tenn) and 15 patients who underwent unilateral stemmed total hip arthroplasty with a small femoral head were compared with a cohort of 10 patients with unilateral osteoarthritis of the hip (as determined by clinical and radiographic evaluation). Demographic parameters were similar and can be found in Table 1. The mean age for the resurfacing group was slightly lower than the other 2

Results

Patients with hip resurfacing walked significantly faster and were comparable with normal walking speed (1.2-1.3 m/s) (Table 2A). Mean walking speed for resurfacing patients was 1.26 m/s, which was statistically higher than patients with osteoarthritis and standard total hip arthroplasties (Table 2B) (P < .001 for both comparisons). These latter 2 groups of patients walked with speeds of 0.96 m/s and 0.99 m/s, respectively (Table 2A).

The resurfacing group had closer to normal gait parameters

Discussion

This study has demonstrated closer to normal hip kinematics and kinetics when total hip resurfacing arthroplasties were compared with standard total hip arthroplasties and osteoarthritic hips. Our findings are in line with a study by Gore et al [30], who found that resurfacing patients maintained their muscle strength and walking velocity. However, in their study, preoperatively, resurfacing patients were younger, had less pain, and walked faster than patients having a standard total hip

Acknowledgments

Funding for this research was received from Wright Medical, Arlington, Tenn. The authors thank Colleen Kazmarek for outstanding assistance in preparing this manuscript.

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Cited by (159)

Revision Total Hip Arthroplasty for Aseptically Failed Metal-On-Metal Hip Resurfacing Arthroplasty
2022, Journal of Arthroplasty
While common, studies assessing outcomes of failed metal-on-metal (MoM) resurfacings converted to total hip arthroplasties (THAs) are limited. We determined the outcomes following revision THA of aseptic MoM hip resurfacings.
Between 2000 and 2019, we identified 52 revision THAs for failed MoM hip resurfacings through our total joint registry. Mean age was 55 years, 42% were women, and mean body mass index was 28 kg/m². Adverse local tissue response led to THA in 67% of the cases. The most common revision articulation was metal-on-cross-linked or ceramic-on-cross-linked polyethylene (71%). Median head size was 36 mm. The acetabular component was retained in 21% and 28% used dual-mobility constructs. The mean follow-up was 6 years (range, 2-12 years).
The 5-year survivorships free of any re-revision or reoperation were 89% and 85%, respectively. The primary cause of re-revision (6) was dislocation (4). The 5-year cumulative probability of dislocation was 19% and was 13% in those patients treated with dual-mobility constructs versus 22% in those treated with standard articulations (P = .58). No dislocations occurred in THAs with retained acetabular components and dual-mobility constructs versus a 5-year cumulative probability of dislocation of 25% in those with revised acetabular components and standard articulations (P = .24).
Revision THAs for aseptically failed MoM hip resurfacings yielded a 5-year survivorship free of re-revision of 89%. The main reason for failure was dislocation, which was reduced, but not statistically significantly, when a dual-mobility construct was used, especially if the acetabular component was retained.
IV.
Hueter Anterior Approach for Metal-on-Metal Hip Resurfacing Arthroplasty: 555 Cases at a Minimum Five-Year Follow-Up
2021, Journal of Arthroplasty
Purpose of this study was to determine implant survivorship and resultant outcomes, including modes of failure, for metal-on-metal hip resurfacing through the Hueter anterior approach (HAA).
Retrospective review of cases from 2006 to 2015, resulted in 555 metal-on-metal hip resurfacing via HAA, mean age 49.4 ± 6.9 years and mean BMI 28.1 ± 5.3. Kaplan-Meier curves were used to assess implant survivorship. Evaluation of technique was based on radiographic assessment of component position at 6 weeks. Patient-reported outcome measures were assessed using 12-Item Short Form Survey 12, University of California Los Angeles activity, Western Ontario and McMaster Universities Osteoarthritis Index, and hip disability osteoarthritis outcome scores.
At a mean follow-up of 9.18 years, survivorship was 95.0% at 5 years (95% CI: 93.2-96.8 years) and 92.5% at 10 years (95% CI: 90.0-95.0 years); men at 96.1% (95% CI: 94.3-97.9) and 93.8% (95% CI: 91.1-96.5), and women at 88.8% (95% CI: 81.9-95.7) and 85.6% (95% CI: 77.6-93.6), 5 and 10 years, respectively (P = .033). There were 37 revisions to total hips (7%) at a mean time of 3.3 years (SD 2.7). Indications for revision were aseptic loosening of acetabular (n = 12) and femoral component (n = 7) and pseudotumor (n = 6). Radiographic parameters were respectable and consistent, median acetabular inclination angle 41.2° and femoral stem shaft angle 137.7°. Patient-reported outcome measure scores significantly improved and remained stable at 2 and 5 years postoperatively.
Although choice of surgical approach should always be based on surgeon’s technical expertise, this study has shown that HAA is safe and effective for hip resurfacing. Mindful attention to long-term metal ion exposure must still be considered.
High-level judo practice after hip resurfacing
2020, Revue de Chirurgie Orthopedique et Traumatologique
La pratique sportive après arthroplastie de hanche est une demande fonctionnelle de plus en plus fréquente. Certains sports comme le judo sont mal évalués en termes de possibilité après prothèse et considérés comme à risque important de luxation, descellement et révision. Le but de ce travail était d’évaluer le retour au judo après resurfaçage de hanche (RTH) en termes de délai et de niveau de pratique chez une population experte et de déterminer le taux de complication chirurgicale.
Il s’agit d’une étude observationnelle rétrospective incluant tous les judokas licenciés avec un niveau expert (≥ ceinture noire 3^e Dan) opérés d’un RTH. Tous les patients ont répondu à un questionnaire dédié détaillant leur niveau de pratique du judo (international, national, régional, loisir), le type de pratique (enseignement, loisir technique, loisir compétition), le grade précis (dan), le volume horaire hebdomadaire et le délai postopératoire de reprise du judo. Les caractéristiques de la reprise ont été analysées (judo technique, au sol, combat).
Soixante-sept RTH chez 60 patients ont été réalisé chez judokas internationaux pour 11 cas, nationaux pour 3, régionaux pour 8 et loisir pour 38. Concernant les grades, la série était constituée de 18 cas 3^e Dan, 18 cas 4^e Dan, 7 cas 5^e Dan et 17 cas hauts gradés (6^e et 7^e Dan, 5 et 12 cas respectivement). Le recul moyen était de 65,3 mois (9,9–111,9). Tous les scores cliniques mettaient en évidence une amélioration cliniquement et statistiquement significative. Sur les 60 patients, 53 avaient repris le judo au dernier recul (89,5 %) au délai moyen de 4 mois (2–7) postopératoire pour le judo technique, 6 mois (3–10) pour le judo au sol et 7 mois (3–12) pour les combats. Les motifs d’absence de reprise du judo étaient : pour 3 patients un changement volontaire de sport, pour 2 patients une appréhension psychologique et pour 2 patients une douleur inguinale résiduelle. Le volume horaire hebdomadaire était : de 0,9 heures par semaine (0–5) en préopératoire à 5 heures (2–18) (p < 0,001) en postopératoire.
Le RTH dans une population de judokas de haut niveau technique permet un retour au sport sans complications de type fracture, luxation ou descellement à court terme.
III.
High-level judo practice after hip resurfacing
2020, Orthopaedics and Traumatology: Surgery and Research
The ability to participate in sports after hip arthroplasty is increasingly being requested by patients. The possibilities of participating in sports such as judo after hip arthroplasty have not been explored sufficiently even though these sports are associated with a high risk of loosening, dislocation or revision. The aim of this study was to evaluate the return to judo after hip resurfacing arthroplasty (HRA) in terms of time and level of practice in an expert population and to determine the surgical complication rate.
This was a retrospective observational study of all licensed judo practitioners at an expert level (≥ black belt 3rd Dan) who underwent HRA. Patients filled out a sport-specific questionnaire that captured their level of judo practice (international, national, regional, recreational), type of practice (teaching, technical recreational, competitive recreational), dan grade, weekly volume of practice and time elapsed after surgery before resuming judo. The features of the return to judo were analyzed (technical, ground, combat).
Sixty-seven HRA were implanted in 60 patients: 11 were international judokas, 3 were national, 8 were regional and 38 were recreational. The case series consisted of 18 patients who were 3rd Dan, 18 were 4th Dan, 7 were 5th Dan, 5 were 6th Dan and 12 were 7th Dan. The average follow-up was 65.3 months (range 9.9–11.9). All the clinical scores pointed to clinically and statistically significant improvement. Of the 60 patients, 53 had resumed judo at the final assessment (90%) after a mean of 4 months (2–7) for technical judo, 6 months (3–10) for ground judo and 7 months (3–12) for combat judo. Of those who did not resume their judo practice, 3 patients voluntarily changed sports, 2 had psychological apprehension and 2 had residual groin pain. The weekly volume of practice preoperatively was 0.9 hours (0–5) and postoperatively it reached 5 hours (2–18) (P < 0.001).
HRA in a population of high-level judokas allows for return to sport practice without short-term complications such as fracture, dislocation or loosening.
III.
A discrete element model to predict anatomy of the psoas muscle and path of the tendon: Design implications for total hip arthroplasty
2019, Clinical Biomechanics
The accurate estimation of a muscle's line of action is a fundamental requirement in computational modelling. We present a novel anatomical muscle wrapping technique and demonstrate its clinical use on the evaluation of the Psoas muscle mechanics in hip arthroplasty.
A volume preserving, spring model to parameterize muscle anatomy changes during motion is presented. Validation was performed by a CT scan of a cadaver model in multiple positions. The predicted psoas musculotendinous path was compared with the actual imaging findings. In a second stage, psoas kinetics were compared between a conventional versus a resurfacing hip arthroplasty during gait.
Anatomy prediction error was found to be 2.12 mm on average (SD 1.34 mm). When applied to psoas mechanics during walking, the muscle was found to wrap predominantly around the femoral head providing a biomechanically efficient and nearly constant moment arm for flexion during the entire gait cycle. However, this advantage was found to be lost in small diameter hip arthroplasty designs resulting in an important mechanical disadvantage. The moment arm for flexion, was on average 36% (SD 0.03%) lower in the small diameter conventional hip arthroplasty as compared to the large diameter head of the hip resurfacing and this difference was highly significant. (p < 0.001).
Despite the shortcomings of an “in silico” and cadaveric study, our findings are in accordance with previous clinical and gait studies. Furthermore, the findings are strongly in favour of large diameter implant designs, warranting their further development and optimisation.
No difference in gait kinematics or kinetics between limbs in bilateral total hip replacement patients at long-term follow-up
2019, Clinical Biomechanics
Previous studies report that gait parameters of patients following total hip replacement improve from pre-operative levels, although in most cases do not reach those of normal subjects. However, studies are generally of unilateral total hip replacement patients at short-term follow-up. There have been no reports of 3D gait kinematics and kinetics in patients with bilateral total hip replacements at long-term follow-up. The aim of this study was to compare temporospatial parameters and 3D lower limb gait kinematics and kinetics at long-term follow-up between limbs and against controls for patients who have undergone staged bilateral total hip replacement.
3D gait analysis was performed on 13 patients who had undergone bilateral total hip replacement, at an average follow-up of 10.1 (first hip) and 9.3 years (second hip), and a normal elderly control group comprising 10 subjects.
Knee flexion/extension range of motion was marginally greater in Hip 2 (p = 0.049) compared to Hip 1 by 3.2°. There were no other significant differences in temporospatial parameters or a range of lower limb kinematics or kinetics between the first and second operated hip. Multiple gait parameters were significantly worse for both hips compared to age-matched normal individuals.
Although symmetrical biomechanical recovery was achieved, significant gait deficiencies remain in both hips compared to normal controls. These deficits may provide targets for enhanced rehabilitation programs.

View all citing articles on Scopus

: Benefits or funds were received in partial or total support of the research material described in this article. These benefits or support were received from the following sources: Wright Medical Technology, Inc, 5677 Airline Road, Arlington, TN 38002.

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Original ArticleGait Analysis of Patients with Resurfacing Hip Arthroplasty Compared with Hip Osteoarthritis and Standard Total Hip Arthroplasty

Abstract

Section snippets

Materials and Methods

Results

Discussion

Acknowledgments

Orthop Clin North Am

J Arthroplasty

J Arthroplasty

J Arthroplasty

Gait Posture

J Arthroplasty

Clin Biomech

Clin Biomech (Bristol, Avon)

Tharies resurfacing arthroplasty: evolution and long-term results

Clin Orthop

Total articular resurfacing arthroplasty: analysis of component failure in sixty-seven hips

J Bone Joint Surg Am

Total articular replacement arthroplasty. A three- to ten-year case-controlled study

Clin Orthop

Metal on metal total hip replacement workshop consensus document

Clin Orthop

The influence of shape and sliding distance of femoral head movement loci on the wear of acetabular cups in total hip arthroplasty

Proc Inst Mech Eng

Rate of wear in total hip replacement

Clin Orthop

Friction and wear properties of polymer, metal, and ceramic prosthetic joint materials evaluated on a multichannel screening device

J Biomed Mater Res

The benefits of metal-on-metal total hip replacements

Clin Orthop

Dislocation after total hip arthroplasty

J Bone Joint Surg Am

Dislocation after total hip arthroplasty. Treatment with an above knee hip spica cast

Clin Orthop

Temporal feature estimation during walking using miniature accelerometers: an analysis of gait improvement after hip arthroplasty

Med Biol Eng Comput

Original Article
Gait Analysis of Patients with Resurfacing Hip Arthroplasty Compared with Hip Osteoarthritis and Standard Total Hip Arthroplasty