Clinical Orthopaedics and Related Research®

, Volume 471, Issue 12, pp 3803–3813 | Cite as

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

  • Robert L. Barrack
  • Erin L. Ruh
  • Michael E. Berend
  • Craig J. Della Valle
  • C. Anderson EnghJr
  • Javad Parvizi
  • John C. Clohisy
  • Ryan M. Nunley
Symposium: 2012 International Hip Society Proceedings



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.


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.


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).


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.


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.



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.


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Copyright information

© The Association of Bone and Joint Surgeons® 2013

Authors and Affiliations

  • Robert L. Barrack
    • 1
  • Erin L. Ruh
    • 1
  • Michael E. Berend
    • 2
  • Craig J. Della Valle
    • 3
  • C. Anderson EnghJr
    • 4
  • Javad Parvizi
    • 5
  • John C. Clohisy
    • 1
  • Ryan M. Nunley
    • 1
  1. 1.Department of Orthopaedic SurgeryWashington University School of Medicine/Barnes-Jewish Hospital, Washington University School of MedicineSt LouisUSA
  2. 2.The Center for Hip and Knee Surgery—JRSI Foundation, IncMooresvilleUSA
  3. 3.Midwest Orthopaedics at RushChicagoUSA
  4. 4.Anderson Orthopaedic ClinicArlingtonUSA
  5. 5.Rothman Institute of OrthopedicsThomas Jefferson UniversityPhiladelphiaUSA

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