Abstract
Background
Larger femoral heads are commonly presumed to improve joint stability and hip biomechanics; some studies have suggested they may hasten recovery of a normal gait. To our knowledge, no gait analysis studies have compared different size head diameters in THA.
Questions/purposes
We compared (1) spatiotemporal gait parameters, (2) kinematic and kinetic gait parameters, and (3) Harris hip scores in patients undergoing THA randomized to receive a 28-, 36-, or ≥ 42-mm bearing couple. We hypothesized a larger femoral head would restore an earlier, more physiologic gait pattern.
Methods
This randomized, blinded study involved 60 patients who received the same cementless THA except for the size of the bearing. Inclusion criteria were primary hip arthritis, female sex, and age between 55 and 70 years. Exclusion criteria were other problems influencing walking ability. The patients were randomized into three groups of 20 each (28- and 36-mm ceramic-on-crosslinked polyethylene, ≥ 42-mm metal-on-metal). All patients underwent the same postoperative rehabilitation protocol. Gait evaluation using an optoelectronic system was performed preoperatively and at 2 and 4 months postoperatively.
Results
With the numbers available, no differences in spatiotemporal gait parameters, kinematic or kinetic gait parameters, or Harris hip scores emerged among the three groups. All variables assessed at 4 months postoperatively showed improvements across all groups, but the differences among them were not significant.
Conclusions
The hypothesis that a larger femoral head results in improved early gait performance was not supported by this study.
Level of Evidence
Level I, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
Similar content being viewed by others
References
Berry DJ, von Knoch M, Schleck CD, Harmsen WS. Effect of femoral head diameter and operative approach on risk of dislocation after primary total hip arthroplasty. J Bone Joint Surg Am. 2005;87:2456–2463.
Charnley J. Total hip replacement by low friction arthroplasty. Clin Orthop Relat Res. 1970;72:7–21.
Davis RB, Õunpuu S, Tybursky D, Gage JR. A gait analysis data collection and reduction technique. Hum Mov Sci. 1991;10:575–587.
Greene WB, Heckman JD. The Clinical Measurement of Joint Motion. Rosemont, IL: American Academy of Orthopaedic Surgeons; 1994.
Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737–755.
Jameson SS, Lees D, James P, Serrano-Pedraza I, Partington PF, Muller SD, Meek RM, Reed MR. Lower rates of dislocations with increased femoral head size after primary total hip replacement: a five-year analysis of NHS patients in England. J Bone Joint Surg Br. 2011;93:876–880.
Lavigne M, Therrien M, Nantel J, Roy A, Prince F, Vendittoli PA. The John Charnley Award. The functional outcome of hip resurfacing and large-head THA is the same: a randomized, double-blind study. Clin Orthop Relat Res. 2010;468:326–336.
Lee JH, Lee BW, Lee BJ, Kim SY. Midterm results of primary total hip arthroplasty using highly cross-linked polyethylene: minimum 7-year follow-up study. J Arthroplasty. 2011;26:1014–1019.
Lindemann U, Becker C, Unnewehr I, Muche R, Aminin K, Dejnabadi H, Nikolaus T, Puhl W, Huch K, Dreinhöfer KE. Gait analysis and WOMAC are complementary in assessing functional outcome in total hip replacement. Clin Rehabil. 2006;20:413–420.
Lombardi AV Jr, Skeels MD, Berend KR, Adams JB, Franchi OJ. Do large heads enhance stability and restore native anatomy in primary total hip arthroplasty? Clin Orthop Relat Res. 2011;469:1547–1553.
Lusty PJ, Tai CC, Sew-Hoy RP, Walter WL, Walter WK, Zicat BA. Third-generation alumina-on-alumina ceramic bearings in cementless total hip arthroplasty. J Bone Joint Surg Am. 2007;89:2676–2683.
McCrory JL, White SC, Lifeso RM. Vertical ground reaction forces: objective measures of gait following hip arthroplasty. Gait Posture. 2001;14:104–109.
Meftah M, Ebrahimpour PB, He C, Ranawat AS, Ranawat CS. Preliminary clinical and radiographic results of large ceramic heads on highly cross-linked polyethylene. Orthopedics. 2011;34:133–137.
Mont MA, Seyler TM, Ragland PS, Starr R, Erhart J, Bhave A. Gait analysis of patients with resurfacing hip arthroplasty compared with hip osteoarthritis and standard total hip arthroplasty. J Arthroplasty. 2007;22:100–108.
Peters CL, McPherson E, Jackson JD, Erickson JA. Reduction in early dislocation rate with large-diameter femoral heads in primary total hip arthroplasty. J Arthroplasty. 2007;22(6 suppl 2):140–144.
Petersen MK, Andersen NT, Mogensen P, Voight M, Søballe K. Gait analysis after total hip replacement with hip resurfacing implant or Mallory-head Exeter prosthesis: a randomised controlled trial. Int Orthop. 2011;35:667–674.
Randelli F, Banci L, D’Anna A, Visentin O, Randelli G. Cementless Metasul metal-on-metal total hip arthroplasties at 13 years. J Arthroplasty. 2012;27:186–192.
Saito S, Ishii T, Mori S, Hosaka K, Ootaki M, Tokuhashi Y. Long-term results of Metasul metal-on-metal total hip arthroplasty. Orthopedics. 2010;11:33.
Shrader MW, Bhowmik-Stoker M, Jacofsky MC, Jacofsky DJ. Gait and stair function in total and resurfacing hip arthroplasty: a pilot study. Clin Orthop Relat Res. 2009;467:1476–1484.
Smith TM, Berend KR, Lombardi AV Jr, Emerson RH Jr, Mallory TH. Metal-on-metal total hip arthroplasty with large heads may prevent early dislocation. Clin Orthop Relat Res. 2005;441:137–142.
Thomas GE, Simpson DJ, Mehmood S, Taylor A, McLardy-Smith P, Gill HS, Murray DW, Glyn-Jones S. The seven-year wear of highly cross-linked polyethylene in total hip arthroplasty: a double blind, randomized controlled trial using radiostereometric analysis. J Bone Joint Surg Am. 2011;93:716–722.
Yeung E, Bott PT, Chana R, Jackson MP, Holloway I, Walter WL, Zicat BA, Walter WK. Mid-term results of third-generation alumina-on-alumina ceramic bearings in cementless total hip arthroplasty: a ten-year minimum follow-up. J Bone Joint Surg Am. 2012;94:138–144.
Acknowledgments
The authors thank Claudio Pagnuzzato MD as orthopaedic surgeon, Michele Corbella MD for his contribution as a member of the surgical team, and Christine Champlon MSEng of the Motion Analysis Laboratory for assistance in gait acquisition and data processing.
Author information
Authors and Affiliations
Corresponding author
Additional information
During the study period, the institution of the authors received funding from Lima Corp (San Daniele del Friuli, Italy). Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
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.
About this article
Cite this article
Zagra, L., Anasetti, F., Bianchi, L. et al. No Difference in Gait Recovery After THA With Different Head Diameters: A Prospective Randomized Study. Clin Orthop Relat Res 471, 3830–3837 (2013). https://doi.org/10.1007/s11999-013-2926-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11999-013-2926-6