1-stage bilateral total hip arthroplasty operation in 22 patients with use of short and standard stem length on either side: gait analysis 1 and 2 years after bilateral THA

Abstract

Background:

According to previous gait analyses, insertion of a total hip arthroplasty (THA) will improve the range of hip flexion-extension but not to normal. Use of short stems could have a potential to improve the motion by preservation of more bone and muscular attachments. We evaluated whether a short femoral stem resulted in improved hip motion compared to a conventional stem in patients who underwent 1-stage bilateral THA. The most painful hip was randomised to either design and the 2^nd hip was operated with the design not used on the 1^st side.

Methods:

Gait analysis was performed with an optical tracking system in 22 patients. The follow-up was performed 1 and 2 years after the operation. The mean age was 59 (SD 7.7) years and body mass index was 27.7 (SD 4.3). 66 subjects without hip pathology served as controls.

Results:

Minimal differences were observed, between or within the 2 different stem designs during gait at the 2 follow-up occasions. Comparison between each of the 2 stem designs and controls at 2 years revealed reduced stride length (p = 0.009), cadence, hip extension (p<0.001) and hip extension-flexion range (p = 0.021) for both designs. Furthermore, the range of hip adduction-abduction (p = 0.046) and hip abduction moment for both designs in the frontal plane was also reduced bilaterally (p<0.001).

Conclusions:

We found no difference in gait parameters between the short and the conventional stem after 1-stage bilateral THA. Although both hip joints were operated at the same time motions and moments did not normalise after bilateral 1-stage operations.

Keywords

Arthroplasty gait hip imaging replacement three-dimensional

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References

Cereatti

Camomilla

Vannozzi

Cappozzo

Propagation of the hip joint centre location error to the estimate of femur vs pelvis orientation using a constrained or an unconstrained approach. J Biomech. 2007; 40(6): 1228–1234.

Ferrari

Benedetti

Pavan

et al . Quantitative comparison of five current protocols in gait analysis. Gait Posture. 2008; 28(2): 207–216.

Krych

Pagnano

Wood

Meneghini

Kaufmann

No benefit of the two-incision THA over mini-posterior THA: a pilot study of strength and gait. Clin Orthop Relat Res. 2010; 468(2): 565–570.

McGinley

Baker

Wolfe

Morris

ME.

The reliability of three-dimensional kinematic gait measurements: a systematic review. Gait Posture. 2009; 29(3): 360–369.

Peters

Galna

Sangeux

Morris

Baker

Quantification of soft tissue artifact in lower limb human motion analysis: a systematic review. Gait Posture. 2010; 31(1): 1–8.

Stagni

Fantozzi

Cappello

Leardini

Quantification of soft tissue artefact in motion analysis by combining 3D fluoroscopy and stereophotogrammetry: a study on two subjects. Clin Biomech (Bristol, Avon). 2005; 20(3): 320–329.

Tranberg

Zügner

Kärrholm

Improvements in hip- and pelvic motion for patients with osseointegrated trans-femoral prostheses. Gait Posture. 2011; 33(2): 165–168.

Zugner

Tranberg

Lisovskaja

Shareghi

Karrholm

Validation of gait analysis with dynamic radiostereometric analysis (RSA) in patients operated with total hip arthroplasty. J Orthop Res. 2017: 35(7); 1515–1522.

Beaulieu

Lamontagne

Beaulé

PE.

Lower limb biomechanics during gait do not return to normal following total hip arthroplasty. Gait Posture. 2010; 32(2): 269–273.

10.

Ewen

Stewart

St Clair Gibson

Kashyap

Caplan

Post-operative gait analysis in total hip replacement patients-a review of current literature and meta-analysis. Gait Posture. 2012; 36(1): 1–6.

11.

Foucher

KC.

Identifying clinically meaningful benchmarks for gait improvement after total hip arthroplasty. J Orthop Res. 2016; 34(1): 88–96.

12.

Lindemann

Becker

Unnewehr

et al . Gait analysis and WOMAC are complementary in assessing functional outcome in total hip replacement. Clin Rehabil. 2006; 20(5): 413–420.

13.

Morrey

BF.

Short-stemmed uncemented femoral component for primary hip arthroplasty. Clin Orthop Relat Res. 1989; (249): 169–175.

14.

Weidow

Tranberg

Saari

Kärrholm

Hip and knee joint rotations differ between patients with medial and lateral knee osteoarthritis: gait analysis of 30 patients and 15 controls. J -Orthop Res. 2006; 24(9): 1890–1899.

15.

Bell

Pedersen

Brand

RA.

A comparison of the accuracy of several hip center location prediction methods. J Biomech. 1990; 23(6): 617–621.

16.

Bell

Brand

RA.

Roentgenographic changes in proximal femoral dimensions due to hip rotation. Clin Orthop Relat Res. 1989; (240): 194–199.

17.

Brooker

Bowerman

Robinson

Riley

Jr.

Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am. 1973; 55(8): 1629–1632.

18.

Gruen

McNeice

Amstutz

HC.

Modes of failure of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res. 1979; (141): 17–27.

19.

Kim

Park

Kim

JS.

Ultrashort versus Conventional Anatomic Cementless Femoral Stems in the Same Patients Younger Than 55 Years. Clin Orthop Relat Res. 2016; 474(9): 2008–2017.

20.

Liu

Jia

Zhang

A comparison of a short versus a conventional femoral cementless stem in total hip arthroplasty in patients 70 years and older. J Orthop Surg. 2016; 11(1): 33.

21.

Schmidutz

Beirer

Weber

Mazoochian

Fottner

-Jansson

Biomechanical reconstruction of the hip: comparison between modular short-stem hip arthroplasty and conventional total hip arthroplasty. Int Orthop. 2012; 36(7): 1341–1347.

22.

Schmidutz

Graf

Mazoochian

Fottner

Bauer-Melnyk

Jansson

Migration analysis of a metaphyseal anchored short-stem hip prosthesis. Acta Orthop. 2012; 83(4): 360–365.

23.

Harris

WH.

Osteolysis and particle disease in hip replacement. A review. Acta Orthop Scand. 1994; 65(1): 113–123.

24.

Restrepo

Parvizi

Pour

Hozack

WJ.

Prospective randomized study of two surgical approaches for total hip arthroplasty. J Arthroplasty. 2010; 25(5): 671–679. e1.

25.

Lindgren

Wretenberg

Karrholm

Garellick

Rolfson

Patient-reported outcome is influenced by surgical approach in total hip replacement: a study of the Swedish Hip Arthroplasty Register including 42,233 patients. Bone Joint J. 2014; 96(5): 590–596.

26.

Masonis

Bourne

RB.

Surgical approach, abductor function, and total hip arthroplasty dislocation. Clin Orthop Relat Res. 2002; 405: 46–53.

27.

Downing

Clark

Hutchinson

Colclough

Howard

PW.

Hip abductor strength following total hip arthroplasty: a prospective comparison of the posterior and lateral approach in 100 patients. Acta Orthop Scand. 2001;72(3):215-220.

28.

Mayr

Nogler

Benedetti

et al . A prospective randomized assessment of earlier functional recovery in THA patients treated by minimally invasive direct anterior approach: a gait analysis study. Clin Biomech (Bristol, Avon). 2009; 24(10): 812–818.

29.

Barrett

Turner

Leopold

JP.

Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty. J Arthroplasty. 2013; 28(9): 1634–1638.

30.

Kamada

Naito

Nakamura

Kiyama

Hip abductor muscle strength after total hip arthroplasty with short stems. Arch Orthop Trauma Surg. 2011; 131(12): 1723–1729.

31.

Salemyr

Muren

Ahl

et al . Lower periprosthetic bone loss and good fixation of an ultra-short stem compared to a conventional stem in uncemented total hip arthroplasty. Acta Orthop. 2015; 86(6): 659–666.