Skip to main content
SpringerLink
Log in

The John Charnley Award: The Functional Outcome of Hip Resurfacing and Large-head THA Is the Same: A Randomized, Double-blind Study

  • Symposium: Papers Presented at the Hip Society Meetings 2009
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Better functional outcome is believed by some to occur after hip resurfacing (HR) than conventional 28-mm total hip arthroplasty (THA) in young and active patients with hip osteoarthritis. However, the postulated superior outcome of HR over THA may simply be the result of a bias in patient selection or the use of a larger femoral head. We therefore asked whether HR would demonstrate superior functional outcome when compared with a THA with a large-diameter femoral head in a randomized, double-blind study. Gait speed and postural balance evaluations, functional tests, and clinical data were analyzed preoperatively and at 3, 6, and 12 months after surgery. Gait speed was used as the primary outcome measure. Forty-eight patients were randomized in the study and a third group of 14 healthy subjects served as controls. The gait speed and postural balance evaluations, the performance at most functional tests, and clinical scores were similar in HR and large-head THA groups at each followup period. The operated patients reached most control group values at 3 months postoperatively. By these measures, HR did not provide better clinical function over large-head THA.

Level of Evidence: Level I, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Amstutz HC, Ball ST, Le Duff MJ, Dorey FJ. Resurfacing THA for patients younger than 50 years: results of 2- to 9-year followup. Clin Orthop Relat Res. 2007;460:159–164.

    PubMed  Google Scholar 

  2. Amstutz HC, Beaulé PE, Dorey FJ, Le Duff MJ, Campbell PA, Gruen TA. Metal-on metal hybrid surface arthroplasty: two to six-year follow-up study. J Bone Joint Surg Am. 2004;86:28–39.

    PubMed  Google Scholar 

  3. Ball ST, Le Duff MJ, Amstutz HC. Early results of conversion of a failed femoral component in hip resurfacing arthroplasty. J Bone Joint Surg Am. 2007;89:735–741.

    Article  PubMed  Google Scholar 

  4. Baratto L, Morasso PG, Re C, Spada G. A new look at posturographic analysis in the clinical context: sway-density versus other parameterization techniques. Motor Control. 2002;6:246–270.

    PubMed  Google Scholar 

  5. Bassey EJ, Fentem PH, MacDonald IC, Scriven PM. Self-paced walking as a method for exercise testing in elderly and young men. Clin Sci Mol Med Suppl. 1976;51:609–612.

    CAS  PubMed  Google Scholar 

  6. Beaule PE, Dorey FJ, Hoke R, Leduff M, Amstutz HC. The value of patient activity level in the outcome of total hip arthroplasty. J Arthroplasty. 2006;21:547–552.

    Article  PubMed  Google Scholar 

  7. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15:1833–1840.

    CAS  PubMed  Google Scholar 

  8. Bergmann G, Deuretzbacher G, Heller M, Graichen F, Rohlmann A, Strauss J, Duda GN. Hip contact forces and gait patterns from routine activities. J Biomech. 2001;34:859–871.

    Article  CAS  PubMed  Google Scholar 

  9. Berman AT, Quinn RH, Zarro VJ. Quantitative gait analysis in unilateral and bilateral total hip replacements. Arch Phys Med Rehabil. 1991;72:190–194.

    CAS  PubMed  Google Scholar 

  10. Bhave A, Marker DR, Seyler TM, Ulrich SD, Plate JF, Mont MA. Functional problems and treatment solutions after total hip arthroplasty. J Arthroplasty. 2007;22(Suppl 2):116–124.

    Article  PubMed  Google Scholar 

  11. Bohannon RW. Intertester reliability of hand-held dynamometry: a concise summary of published research. Percept Mot Skills. 1999;88:899–902.

    Article  CAS  PubMed  Google Scholar 

  12. Dagnelie P. Theoretical and Applied Statistics. Volume 2, Statistical Inference in One and Two Dimensions. 2nd Ed [in French]. Bruxelles, Belgium: De Boeck et Larcier; 2006.

    Google Scholar 

  13. Daniel J, Pynsent PB, McMinn DJ. Metal-on-metal resurfacing of the hip in patients under the age of 55 years with osteoarthritis. J Bone Joint Surg Br. 2004;86:177–184.

    Article  CAS  PubMed  Google Scholar 

  14. Duncan PW, Weiner DK, Chandler J, Studenski S. Functional reach: a new clinical measure of balance. J Gerontol. 1990;45:M192–M197.

    CAS  PubMed  Google Scholar 

  15. Foucher KC, Hurwitz DE, Wimmer MA. Preoperative gait adaptations persist one year after surgery in clinically well-functioning total hip replacement patients. J Biomech. 2007;40:3432–3437.

    Article  PubMed  Google Scholar 

  16. Gage WH, Winter DA, Frank JS, Adkin AL. Kinematic and kinetic validity of the inverted pendulum model in quiet standing. Gait Posture. 2004;19:124–132.

    Article  PubMed  Google Scholar 

  17. Garbuz DS, Xu M, Sayre EC. Patients’ outcome after total hip arthroplasty: a comparison between the Western Ontario and McMaster Universities index and the Oxford 12-item hip score. J Arthroplasty. 2006;21:998–1004.

    Article  PubMed  Google Scholar 

  18. Garellick G, Malchau H, Herberts P. Specific or general health outcome measures in the evaluation of total hip replacement. A comparison between the Harris hip score and the Nottingham Health Profile. J Bone Joint Surg Br. 1998;80:600–606.

    Article  CAS  PubMed  Google Scholar 

  19. Girard J, Lavigne M, Vendittoli PA, Roy AG. Biomechanical reconstruction of the hip: a randomised study comparing total hip resurfacing and total hip arthroplasty. J Bone Joint Surg Br. 2006;88:721–726.

    CAS  PubMed  Google Scholar 

  20. Girard J, Touraine D, Soenen M, Massin P, Laffargue P, Migaud H. Measurement of head penetration on digitalized radiographs: reproducibility and accuracy [in French]. Rev Chir Orthop Reparatrice Appar Mot. 2005;91:137–142.

    CAS  PubMed  Google Scholar 

  21. Gore DR, Murray MP, Gardner GM, Sepic SB. Hip function after total vs surface replacement. Acta Orthop Scand. 1985;56:386–390.

    Article  CAS  PubMed  Google Scholar 

  22. Hing CB, Back DL, Bailey M, Young DA, Dalziel RE, Shimmin AJ. The results of primary Birmingham hip resurfacings at a mean of five years. An independent prospective review of the first 230 hips. J Bone Joint Surg Br. 2007;89:1431–1438.

    Article  CAS  PubMed  Google Scholar 

  23. Kelln BM, McKeon PO, Gontkof LM, Hertel J. Hand-held dynamometry: reliability of lower extremity muscle testing in healthy, physically active, young adults. J Sport Rehabil. 2008;17:160–170.

    PubMed  Google Scholar 

  24. Kennedy D, Stratford PW, Pagura SM, Walsh M, Woodhouse LJ. Comparison of gender and group differences in self-report and physical performance measures in total hip and knee arthroplasty candidates. J Arthroplasty. 2002;17:70–77.

    Article  PubMed  Google Scholar 

  25. Kishida Y, Sugano N, Nishii T, Miki H, Yamaguchi K, Yoshikawa H. Preservation of the bone mineral density of the femur after surface replacement of the hip. J Bone Joint Surg Br. 2004;86:185–189.

    Article  CAS  PubMed  Google Scholar 

  26. Kotzar GM, Davy DT, Berilla J, Goldberg VM. Torsional loads in the early postoperative period following total hip replacement. J Orthop Res. 1995;13:945–955.

    Article  CAS  PubMed  Google Scholar 

  27. Kotzar GM, Davy DT, Goldberg VM, Heiple KG, Berilla J, Heiple KG Jr, Brown RH, Burstein AH. Telemeterized in vivo hip joint force data: a report on two patients after total hip surgery. J Orthop Res. 1991;9:621–633.

    Article  CAS  PubMed  Google Scholar 

  28. Kyriazis V, Rigas C. Temporal gait analysis of hip osteoarthritic patients operated with cementless hip replacement. Clin Biomech (Bristol, Avon). 2002;17:318–321.

    Article  CAS  Google Scholar 

  29. Laughman RK, Askew LJ, Bleimeyer RR, Chao EY. Objective clinical evaluation of function. Gait analysis. Phys Ther. 1984;64:1839–1845.

    CAS  PubMed  Google Scholar 

  30. Lavigne M, Masse V, Girard J, Roy AG, Vendittoli PA. Return to sport after hip resurfacing or total hip arthroplasty: a randomized study [in French]. Rev Chir Orthop Reparatrice Appar Mot. 2008;94:361–367.

    CAS  PubMed  Google Scholar 

  31. Lindemann U, Becker C, Unnewehr I, Muche R, Aminin K, Dejnabadi H, Nikolaus T, Puhl W, Huch K, Dreinhofer KE. Gait analysis and WOMAC are complementary in assessing functional outcome in total hip replacement. Clin Rehabil. 2006;20:413–420.

    Article  CAS  PubMed  Google Scholar 

  32. Long WT, Dorr LD, Healy B, Perry J. Functional recovery of noncemented total hip arthroplasty. Clin Orthop Relat Res. 1993;288:73–77.

    PubMed  Google Scholar 

  33. McHorney CA, Ware JE Jr, Raczek AE. The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care. 1993;31:247–263.

    Article  CAS  PubMed  Google Scholar 

  34. McLaughlin JR, Lee KR. Total hip arthroplasty with an uncemented tapered femoral component. J Bone Joint Surg Am. 2008;90:1290–1296.

    Article  PubMed  Google Scholar 

  35. Merle D’Aubigné R. Numerical classification of the function of the hip. 1970 [in French]. Rev Chir Orthop Reparatrice Appar Mot. 1990;76:371–374.

    PubMed  Google Scholar 

  36. Miki H, Sugano N, Hagio K, Nishii T, Kawakami H, Kakimoto A, Nakamura N, Yoshikawa H. Recovery of walking speed and symmetrical movement of the pelvis and lower extremity joints after unilateral THA. J Biomech. 2004;37:443–455.

    Article  PubMed  Google Scholar 

  37. 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.

    Article  PubMed  Google Scholar 

  38. Nantel J, Termoz N, Centomo H, Lavigne M, Vendittoli PA, Prince F. Postural balance during quiet standing in patients with total hip arthroplasty and surface replacement arthroplasty. Clin Biomech (Bristol, Avon). 2008;23:402–407.

    Google Scholar 

  39. Nantel J, Termoz N, Vendittoli PA, Lavigne M, Prince F. Gait patterns following total hip arthroplasty and surface replacement arthroplasty. Arch Phys Med Rehabil. 2009;90:463–469.

    Article  PubMed  Google Scholar 

  40. Perron M, Malouin F, Moffet H, McFadyen BJ. Three-dimensional gait analysis in women with a total hip arthroplasty. Clin Biomech (Bristol, Avon). 2000;15:504–515.

    Article  CAS  Google Scholar 

  41. Podsiadlo D, Richardson S. The timed ‘Up & Go’: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39:142–148.

    CAS  PubMed  Google Scholar 

  42. Pollard TC, Baker RP, Eastaugh-Waring SJ, Bannister GC. Treatment of the young active patient with osteoarthritis of the hip. A five- to seven-year comparison of hybrid total hip arthroplasty and metal-on-metal resurfacing. J Bone Joint Surg Br. 2006;88:592–600.

    Article  CAS  PubMed  Google Scholar 

  43. Redelmeier DA, Bayoumi AM, Goldstein RS, Guyatt GH. Interpreting small differences in functional status: the Six Minute Walk test in chronic lung disease patients. Am J Respir Crit Care Med. 1997;155:1278–1282.

    CAS  PubMed  Google Scholar 

  44. Sherrington C, Lord SR. Reliability of simple portable tests of physical performance in older people after hip fracture. Clin Rehabil. 2005;19:496–504.

    Article  PubMed  Google Scholar 

  45. Skutek M, Bourne RB, Rorabeck CH, Burns A, Kearns S, Krishna G. The twenty to twenty-five-year outcomes of the Harris design-2 matte-finished cemented total hip replacement. A concise follow-up of a previous report. J Bone Joint Surg Am. 2007;89:814–818.

    Article  PubMed  Google Scholar 

  46. Steffen RT, Pandit HP, Palan J, Beard DJ, Gundle R, McLardy-Smith P, Murray DW, Gill HS. The five-year results of the Birmingham Hip Resurfacing arthroplasty: an independent series. J Bone Joint Surg Br. 2008;90:436–441.

    Article  CAS  PubMed  Google Scholar 

  47. Trudelle-Jackson E, Emerson R, Smith S. Outcomes of total hip arthroplasty: a study of patients one year postsurgery. J Orthop Sports Phys Ther. 2002;32:260–267.

    PubMed  Google Scholar 

  48. Vail TP, Mina CA, Yergler JD, Pietrobon R. Metal-on-metal hip resurfacing compares favorably with THA at 2 years followup. Clin Orthop Relat Res. 2006;453:123–131.

    Article  PubMed  Google Scholar 

  49. van den Akker-Scheek I, Stevens M, Bulstra SK, Groothoff JW, van Horn JR, Zijlstra W. Recovery of gait after short-stay total hip arthroplasty. Arch Phys Med Rehabil. 2007;88:361–367.

    Article  PubMed  Google Scholar 

  50. Vendittoli PA, Lavigne M, Girard J, Roy AG. A randomised study comparing resection of acetabular bone at resurfacing and total hip replacement. J Bone Joint Surg Br. 2006;88:997–1002.

    Article  PubMed  Google Scholar 

  51. Winter DA. ABC (Anatomy, Biomechanics and Control) of Balance During Standing and Walking. Waterloo, Canada: Waterloo Biomechanics; 1995.

    Google Scholar 

Download references

Acknowledgments

We thank Muthu Ganapathi, MD, for help with radiographic data collection and analysis and Daniel Lusignan for clinical data collection and study coordination. We also thank Guillaume Carrier Eng and Vicky Bouffard, BSc, for their help with functional data collection and analysis.

Author information

Authors and Affiliations

  1. Maisonneuve-Rosemont Hospital, 5415 Assomption Boulevard, Montreal, Quebec, H1T 2M4, Canada

    Martin Lavigne MD, MSc, Alain Roy MD & Pascal-André Vendittoli MD, MSc

  2. Department of Surgery, University of Montreal, Montreal, Quebec, Canada

    Martin Lavigne MD, MSc, Alain Roy MD, François Prince PhD & Pascal-André Vendittoli MD, MSc

  3. Gait and Posture Laboratory, Marie Enfant Rehabilitation Center (CHU-Sainte-Justine), Montreal, Quebec, Canada

    Marc Therrien MSc, Julie Nantel MSc & François Prince PhD

  4. Department of Kinesiology, University of Montreal, Montreal, Quebec, Canada

    Julie Nantel MSc & François Prince PhD

Authors
  1. Martin Lavigne MD, MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marc Therrien MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Julie Nantel MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alain Roy MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. François Prince PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Pascal-André Vendittoli MD, MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Martin Lavigne MD, MSc.

Additional information

One or more of the authors (ML) have received funding from Zimmer, Warsaw, IN.

Each author certifies that his or her institution has 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 Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada.

About this article

Cite this article

Lavigne, M., Therrien, M., Nantel, J. et al. 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 468, 326–336 (2010). https://doi.org/10.1007/s11999-009-0938-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-009-0938-z

Keywords

Search

Navigation