Hip resurfacing generates a more physiological gait than total hip replacement: A case-control study

Abstract

Background: Restoration of the constitutional joint anatomy after hip replacement favours physiological peri-articular soft-tissue tension and kinematics, and is likely to be functionally beneficial. Hip resurfacing (HR) and conventional total hip replacement (THR) are two different options for replacing degenerated hips, and are likely to result in different anatomical reconstruction. We initiated this study to investigate the differences in gait performance between these two prosthetic options, and aimed to answer the following questions: (1) does HR result in better restoration of the frontal hip anatomical parameters, (2) and generate a more physiological gait compared to THR? (3) Does the quality of the anatomical restoration after THR influence gait performance?

Hypotheses: Our hypothesis was that a better anatomical restoration using HR versus THR would produce more physiological (symmetric) gait.

Methods: We retrospectively reviewed 52 patients who had unilateral primary osteoarthritis successfully treated by replacement (40 THRs and 12 HRs). Hip anatomical parameters were measured on standing pelvic radiographs on both the prosthetic and the contralateral healthy hips. Patients undertook gait assessment under both normal and stress conditions at a mean follow-up of 14 months (7 to 16 months). Gait performances were compared between HR and THR, and the relationship between gait performances and quality of frontal anatomical restoration (estimated on radiograph) were assessed.

Results: Compared to the native contralateral side, the HR procedure tended to decrease all independent anatomical radiographic parameters with the exception of the vertical centre of rotation offset, whilst the THR procedure tended to increase them; the difference between HR and THR was only statistically significant for femoral offset and global horizontal offset (increased after THR while reduced after HR). Only 50% of THR and 25% of HR procedures closely anatomically (±15%) recreated both global horizontal offset and global vertical offset. Under normal conditions (normal walking speed and flat ramp), the gait was fairly symmetric for both the HR and the THR patients with a symmetry index of 0.62% and 3.14% respectively. At high walking speed (stress conditions), the symmetry index degraded for both groups, but the gait remained more symmetric in the HR group (2.09%), compared to the THR group (5.74%); nevertheless, the difference remained not statistically significant (p=0.159). We were unable to detect any significant relationship between gait performances and radiographically measured hip frontal anatomical parameters.

Discussion/conclusions: HR procedure is more consistent than conventional THR in generating a more physiological gait under stress conditions. Radiographic estimation of the quality of the frontal anatomical hip restoration is of poor value to predict gait performances of THR patients.

Level of evidence: III - retrospective case-control study with prospective data collection.

Keywords: Gait analysis; Hip replacement; Hip resurfacing; Kinematic alignment; Symmetry index.