No Difference in Gait Recovery After THA With Different Head Diameters: A Prospective Randomized Study

Abstract

Background Larger femoral heads are commonly presumed to improve joint stability and hip biomechanics; some studies have suggested they may hasten recovery of a normal gait. To our knowledge, no gait analysis studies have compared different size head diameters in THA. Questions/purposes We compared (1) spatiotemporal gait parameters, (2) kinematic and kinetic gait parameters, and (3) Harris hip scores in patients undergoing THA randomized to receive a 28-, 36-, or C 42-mm bearing couple. We hypothesized a larger femoral head would restore an earlier, more physiologic gait pattern. Methods This randomized, blinded study involved 60 patients who received the same cementless THA except for the size of the bearing. Inclusion criteria were primary hip arthritis, female sex, and age between 55 and 70 years. Exclusion criteria were other problems influencing walking ability. The patients were randomized into three groups of 20 each (28-and 36-mm ceramic-on-crosslinked polyethylene, C 42-mm metal-on-metal). All patients underwent the same postoperative rehabilitation protocol. Gait evaluation using an optoelectronic system was performed preoperatively and at 2 and 4 months postoperatively.

Preoperative factors associated with postoperative gait kinematics and kinetics after total hip arthroplasty

“…Postoperative joint geometry reconstruction can be an important contributor to hip joint loading during gait 48 , hip abductor strength 49,50 , and has recently been linked to clinical outcomes 29 . The influence of femoral head size on gait has also been investigated 51 . Unfortunately radiographs were not available for all subjects, so we could not evaluate the influence of these factors on gait in this study.…”

In Vivo Damage of the Head-Neck Junction in Hard-on-Hard Total Hip Replacements: Effect of Femoral Head Size, Metal Combination, and 12/14 Taper Design

“…In the 2000s, prosthetic designs evolved toward larger diameter heads in order to simulate native joint dimensions more closely. Larger diameter heads increase joint stability and range of motion [ 27 ], and seem to assure more normal hip kinematics and functionality [ 28 , 29 , 30 , 31 ]. However, following the introduction of large-diameter hard bearings, HNJ damage has become a cause of failure of THAs [ 32 , 33 , 34 ].…”

Increased Mortality in Metal-on-Metal versus Non-Metal-on-Metal Primary Total Hip Arthroplasty at 10 Years and Longer Follow-Up: A Systematic Review and Meta-Analysis

“…There were 26 RCTs (30 papers), all of second generation MOM THA, that reported revisions [ 14 – 17 , 25 – 40 , 42 , 49 – 52 ]. These studies comprised 1,546 MOM THA (49 revisions) and 1,746 non-MOM THA (24 revisions).…”