Abstract
Background
Proposed benefits of total hip resurfacing arthroplasty over total hip arthroplasty (THA) include better proprioception, but this has not been rigorously tested or validated.
Questions/purposes
Our purpose was to apply an advanced testing device that objectively quantifies dynamic postural stability to determine if total hip resurfacing is associated with improved proprioception compared with standard or large-head THA.
Methods
Three groups of 25 patients (total hip resurfacing, THA femoral head > 32 mm, THA femoral head ≤ 32 mm) and a matched control group were recruited. All participants had UCLA scores ≥ 5 and Harris hip scores ≥ 90 at the time of testing. Testing was conducted using a commercially available device that uses a multidirectional, powered platform to measure deviations of the center of mass and consisted of trials with both double- and single-limb support.
Results
Double-limb testing showed no differences between groups. In single-limb testing, the operative side performed better in patients who had undergone total hip resurfacing versus THA, but this difference disappeared when the operative side was normalized to the nonoperative side. When compared with control subjects who had not had arthroplasty, both operative and nonoperative sides showed significantly worse proprioception for all arthroplasty cohorts, suggesting that decreased proprioception is associated with arthritis of the hip in young adults.
Conclusions
Total hip resurfacing arthroplasty did not result in improved proprioception compared with THA. These results tend to refute the concept that improved proprioception is a rationale for selecting total hip resurfacing over THA in young patients.
Level of Evidence
Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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The institution of one or more of the authors has received funding from Biomet Inc (Warsaw, IN, USA) (RMN, RLB), Stryker Orthopaedics (Mahwah, NJ, USA) (RMN, RLB), Smith & Nephew, Inc (Memphis, TN, USA) (RMN, RLB), EOS Imaging Inc (Cambridge, MA, USA) (RLB), Medical Compression Systems, Inc (West Hills, CA, USA) (RLB), Wright Medical Technology, Inc (Arlington, TN, USA) (RMN, JCC, RLB), Zimmer Inc (Warsaw, IN, USA) (JCC), DePuy Orthopaedics, Inc (Warsaw, IN, USA) (RMN), and the National Institutes of Health (RLB). Aided by a grant from the Orthopaedic Research and Education Foundation. One of the authors certifies that he (RMN) has 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). One of the authors certifies that he (JCC) has 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, Inc (Sunnyvale, CA, USA). One of the authors certifies that he (RLB) has 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.
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 prior to 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.
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Larkin, B., Nyazee, H., Motley, J. et al. Hip Resurfacing Does Not Improve Proprioception Compared With THA. Clin Orthop Relat Res 472, 555–561 (2014). https://doi.org/10.1007/s11999-013-3082-8
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DOI: https://doi.org/10.1007/s11999-013-3082-8