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Do Young, Active Patients Perceive Advantages After Surface Replacement Compared to Cementless Total Hip Arthroplasty?

  • Symposium: 2012 International Hip Society Proceedings
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Potential advantages suggested but not confirmed for surface replacement arthroplasty (SRA) over THA include lower frequency of limp, less thigh pain, less limb length discrepancy, and higher activity.

Questions/purposes

We therefore determined whether patients having SRA had a limp, thigh pain, or limb length discrepancy less frequently or had activity levels higher than patients having THA.

Methods

In a multicenter study, we surveyed 806 patients aged 18 to 60 years with a premorbid UCLA activity score of 6 or more who underwent hip arthroplasty for noninflammatory arthritis at one of five orthopaedic centers. Patients had either a cementless THA with an advanced bearing surface (n = 682) or an SRA (n = 124). The patients were demographically comparable. Specific telephone survey instruments were designed to assess limp, thigh pain, perception of limb length, and activity levels. Minimum followup was 1 year (mean, 2.3 years; range, 1.1–3.9 years).

Results

When controlled for age, sex, and premorbid activity level, patients with SRA had a higher incidence of complete absence of any limp, lower incidence of thigh pain, lower incidence of perception of limb length discrepancy, greater ability to walk continuously for more than 60 minutes, higher percentage of patients who ran after surgery, greater distance run, and higher percentage of patients who returned to their most favored recreational activity.

Conclusions

When interviewed by an independent third party, patients with SRA reported higher levels of function with fewer symptoms and less perception of limb length discrepancy compared to a similar cohort of young, active patients with THA.

Level of Evidence

Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank the UWSC, especially John Stevenson BA and Bob Cradock MS for all their help completing this project and Angel Poucher AAS for her assistance with preparing the manuscript.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, 11300 West Pavilion, Campus Box 8233, St Louis, MO, 63110, USA

    Robert L. Barrack MD, Erin L. Ruh MS, John C. Clohisy MD & Ryan M. Nunley MD

  2. The Center for Hip and Knee Surgery—JRSI Foundation, Inc, Mooresville, IN, USA

    Michael E. Berend MD

  3. Midwest Orthopaedics at Rush, Chicago, IL, USA

    Craig J. Della Valle MD

  4. Anderson Orthopaedic Clinic, Arlington, VA, USA

    C. Anderson Engh Jr MD

  5. Rothman Institute of Orthopedics, Thomas Jefferson University, Philadelphia, PA, USA

    Javad Parvizi MD, FRCS

Authors
  1. Robert L. Barrack MD
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  2. Erin L. Ruh MS
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  3. Michael E. Berend MD
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  4. Craig J. Della Valle MD
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  5. C. Anderson Engh Jr MD
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  6. Javad Parvizi MD, FRCS
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  7. John C. Clohisy MD
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  8. Ryan M. Nunley MD
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Corresponding author

Correspondence to Robert L. Barrack MD.

Additional information

The institution of one or more of the authors has received, during the study period, funding from Biomet Inc (Warsaw, IN, USA) (RLB, MEB, RMN), EOS Imaging Inc (Cambridge, MA, USA) (RLB, RMN), Medical Compression Systems, Inc (West Hills, CA, USA) (RLB, RMN), NIH (Bethesda, MD, USA) (RLB, JP), Smith & Nephew, Inc (Memphis, TN, USA) (RLB, CDV, CAE, JP, RMN), Stryker Orthopaedics (Mahwah, NJ, USA) (RLB, MEB, CDV, JP, RMN), Wright Medical Technology, Inc (Arlington, TN, USA) (RLB, JCC, RMN), Johnson & Johnson (New Brunswick, NJ, USA) (MEB), DePuy Orthopaedics Inc, a Johnson & Johnson company (Warsaw, IN, USA) (JP, CAE), 3 M (St Paul, MN, USA) (JP), Baxter Healthcare Corp (Deerfield, IL, USA) (JP), Musculoskeletal Transplant Foundation (Edison, NJ, USA) (JP), Zimmer Inc (Warsaw, IN, USA) (JP, JCC), and Inova Health Care Services (Falls Church, VA, USA) (CAE). The institutions of the authors have received, during the study period, funding from Smith & Nephew in support of this study.

One of the authors certifies that he (RLB) has received or may receive payments or benefits, during the study period, an amount of more than USD 1,000,001 from Smith & Nephew, Inc, and an amount of more than USD 1,000,001 from Stryker Orthopaedics.

One of the authors certifies that he (MEB) has received or may receive payments or benefits, during the study period, an amount of USD 100,001 to 1,000,000 from Biomet Inc.

One of the authors certifies that he (CDV) has received or may receive payments or benefits, during the study period, an amount of USD 10,000 to 100,000 from Biomet Inc, an amount of USD 10,000 to 100,000 from Smith & Nephew, Inc, an amount of less than USD 10,000 from ConvaTec (Skillman, NJ, USA), and an amount of less than USD 10,000 from CD Diagnostics (Wynnewood, PA, USA).

One of the authors certifies that he (CAE), or a member of his immediate family, has received or may receive payments or benefits, during the study period, an amount of more than USD 1,000,001 from DePuy Orthopaedics Inc, a Johnson & Johnson company.

One of the authors certifies that he (JP) has received or may receive payments or benefits, during the study period, an amount of USD 10,000 to 100,000 from Smith & Nephew, Inc, an amount of USD 10,000 to 100,000 from 3 M, an amount of USD 10,000 to 100,000 from Cadence Pharmaceuticals, Inc (San Diego, CA, USA), an amount of USD 10,000 to 100,000 from CeramTec (Laurens, SC, USA), an amount of USD 10,000 to 100,000 from Pfizer (New York, NY, USA), an amount of USD 10,000 to 100,000 from Salient Surgical (Minneapolis, MN, USA), an amount of USD 10,000 to 100,000 from TissueGene (Rockville, MD, USA), and an amount of USD 10,000 to 100,000 from Zimmer Inc.

One of the authors certifies that he (JCC) has received or may receive payments or benefits, during the study period, an amount of less than USD 10,000 from Biomet Inc, and an amount of less than USD 10,000 from Pivot Medical (Sunnyvale, CA, USA).

One of the authors certifies that he (RMN) has received or may receive payments or benefits, during the study period, an amount of less than USD 10,000 from Smith & Nephew, Inc, an amount of less than USD 10,000 from Wright Medical Technology, Inc, an amount of less than USD 10,000 from Medtronic (Minneapolis, MN, USA), an amount of less than USD 10,000 from CardioMEMS (Atlanta, GA, USA), and an amount of less than USD 10,000 from Integra LifeSciences (Plainsboro, NJ, USA).

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Washington University School of Medicine (St Louis, MO, USA), The Center for Hip and Knee Surgery (Mooresville, IN, USA), Midwest Orthopaedics at Rush (Chicago, IL, USA), Anderson Orthopaedic Clinic (Arlington, VA, USA), and Rothman Institute of Orthopedics (Philadelphia, PA, USA).

Appendices

Appendix 1: Screening Section: Premorbid UCLA Score

  1. 1.

    In the year before your (left/right) hip became painful, did you ever participate in impact sports such as jogging, tennis, skiing, acrobatics, ballet, heavy labor, or backpacking?

    • Yes = Go to Question 2

    • No = Go to Question 3

  2. 2.

    In the year before your (left/right) hip became painful, did you participate in impact sports less than once per week or at least once per week?

    • At least once per week = UCLA 10

    • Less than once per week = UCLA 9

    • No = Go to Question 3

  3. 3.

    In the year before your (left/right) hip became painful, did you participate in very active events, such as golf or bowling, at least once per week?

    • Yes = UCLA 8

    • No = Go to Question 4

  4. 4.

    In the year before your (left/right) hip became painful, did you participate in active events, such as bicycling, at least once per week?

    • Yes = UCLA 7

    • No = Go to Question 5

  5. 5.

    In the year before your (left/right) hip became painful, did you participate in moderate activities, such as swimming, unlimited housework, or shopping, at least once per week?

    • Yes = UCLA 6

    • No = End survey

Appendix 2: Questions Suggested as Potential Differences Between Surface Replacement Arthroplasty and THA

  1. 1.

    In the last 30 days, how often have you limped while walking?

    • Never, rarely, sometimes, very often, or extremely often

  2. 2.

    In the last 30 days, how long have you been able to walk continuously?

    • 0 to 15 minutes, 16 to 30 minutes, 31 to 60 minutes, 61 minutes to 2 hours, or more than 2 hours

  3. 3.

    Since your hip was operated on, have you tried to run, even for just a few steps?

    • If “yes”: Since your hip operation, what is the farthest distance you have run?

    A few steps only, more than a few steps up to a quarter of a mile, more than a quarter of a mile up to 1 mile, more than 1 mile up to 5 miles, or more than 5 miles

  4. 4.

    Do you ever feel a difference in the length of your legs?

    • If “yes”: Does the length of the leg on your (left/right) side where you had your hip operation feel longer or shorter than your other leg?

  5. 5.

    Do you ever feel pain in your (left/right) thigh on the side where you had your hip operation?

    • If “yes”: In the last 30 days, about how often did you experience pain in your (left/right) thigh?

    Never, rarely, sometimes, very often, or extremely often

  6. 6.

    In the last 30 days, about how often did you experience grinding or popping or hear clicking or other noises in your (left/right) hip?

    • Never, rarely, sometimes, often, or extremely often

  7. 7.

    During the last 30 days, how often did you do/play/etc Activity 1 (most preferred activity)?

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Barrack, R.L., Ruh, E.L., Berend, M.E. et al. Do Young, Active Patients Perceive Advantages After Surface Replacement Compared to Cementless Total Hip Arthroplasty?. Clin Orthop Relat Res 471, 3803–3813 (2013). https://doi.org/10.1007/s11999-013-2915-9

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  • DOI: https://doi.org/10.1007/s11999-013-2915-9

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