Top

Journal of Orthopaedics and Traumatology

Published in:

Open Access 01-12-2018 | Original article

The loading patterns of a short femoral stem in total hip arthroplasty: gait analysis at increasing walking speeds and inclines

Authors: Anatole V. Wiik, Mads Brevadt, Hardeep Johal, Kartik Logishetty, Oliver Boughton, Adeel Aqil, Justin P. Cobb

Published in: Journal of Orthopaedics and Traumatology | Issue 1/2018

Abstract

Background

The purpose of this study was to examine the gait pattern of total hip arthroplasty (THA) patients with a new short femoral stem at different speeds and inclinations.

Materials and methods

A total of 40 unilateral THA patients were tested on an instrumented treadmill. They comprised two groups (shorter stemmed THA n = 20, longer stemmed THA n = 20), both which had the same surgical posterior approach. The shorter femoral stemmed patients were taken from an ongoing hip trial with minimum 12 months postop. The comparative longer THR group with similar disease and severity were taken from a gait database along with a demographically similar group of healthy controls (n = 35). All subjects were tested through their entire range of gait speeds and inclines with ground reaction forces collected. Body weight scaling was applied and a symmetry index to compare the implanted hip to the contralateral normal hip. An analysis of variance with significance set at α = 0.05 was used.

Results

The experimental groups were matched demographically and implant groups for patient reported outcome measures and radiological disease. Both THA groups walked slower than controls, but symmetry at all intervals for all groups were not significantly different. Push-off loading was less favourable for both the shorter and longer stemmed THR groups (p < 0.05) depending on speed.

Conclusions

Irrespective of femoral stem length, symmetry for ground reaction forces for both THA groups were returned to a normal range when compared to controls. However individual implant performance showed inferior (p < 0.05) push-off forces and normalised step length in both THR groups when compared to controls.

Level of evidence

III.

Patel A, Pavlou G, Mujica-Mota RE, Toms AD (2015) The epidemiology of revision total knee and hip arthroplasty in England and Wales: a comparative analysis with projections for the United States. A study using the National Joint Registry dataset. Bone Joint J 97-B(8):1076–1081. https://doi.org/10.1302/0301-620x.97b8.35170 CrossRefPubMed

Boyle C, Kim IY (2011) Comparison of different hip prosthesis shapes considering micro-level bone remodeling and stress-shielding criteria using three-dimensional design space topology optimization. J Biomech 44(9):1722–1728. https://doi.org/10.1016/j.jbiomech.2011.03.038 CrossRefPubMed

Arno S, Fetto J, Nguyen NQ, Kinariwala N, Takemoto R, Oh C, Walker PS (2012) Evaluation of femoral strains with cementless proximal-fill femoral implants of varied stem length. Clin Biomech 27(7):680–685. https://doi.org/10.1016/j.clinbiomech.2012.03.006 CrossRef

Gustke K (2012) Short stems for total hip arthroplasty: initial experience with the Fitmore stem. J Bone Joint Surg Br 94(11 Suppl A):47–51. https://doi.org/10.1302/0301-620x.94b11.30677 CrossRefPubMed

Renkawitz T, Santori FS, Grifka J, Valverde C, Morlock MM, Learmonth ID (2008) A new short uncemented, proximally fixed anatomic femoral implant with a prominent lateral flare: design rationals and study design of an international clinical trial. BMC Musculoskelet Disord 9:147. https://doi.org/10.1186/1471-2474-9-147 CrossRefPubMedPubMedCentral

Molli RG, Lombardi AV Jr, Berend KR, Adams JB, Sneller MA (2012) A short tapered stem reduces intraoperative complications in primary total hip arthroplasty. Clin Orthop Relat Res 470(2):450–461. https://doi.org/10.1007/s11999-011-2068-7 CrossRefPubMed

Wiles P (1958) The surgery of the osteoarthritic hip. Br J Surg 45(193):488–497CrossRefPubMed

Pipino F, Molfetta L (1993) Femoral neck preservation in total hip replacement. Ital J Orthop Traumatol 19(1):5–12PubMed

McTighe T, Stulberg SD, Keppler L, Keggi J, Kennon R, Aram T, McPherson E (2013) A classification system for short stem uncemented total hip arthroplasty. Bone Joint J Orthop Proc Suppl 95-B(SUPP 15):260

10.

Feyen H, Shimmin AJ (2014) Is the length of the femoral component important in primary total hip replacement? Bone Joint J 96-B(4):442–448. https://doi.org/10.1302/0301-620x.96b4.33036 CrossRefPubMed

11.

Santori FS, Santori N (2010) Mid-term results of a custom-made short proximal loading femoral component. J Bone Joint Surg Br 92(9):1231–1237. https://doi.org/10.1302/0301-620X.92B9.24605 CrossRefPubMed

12.

Hutt J, Harb Z, Gill I, Kashif F, Miller J, Dodd M (2014) Ten year results of the collum femoris preserving total hip replacement: a prospective cohort study of seventy five patients. Int Orthop 38(5):917–922. https://doi.org/10.1007/s00264-013-2212-y CrossRefPubMed

13.

Campbell D, Mercer G, Nilsson KG, Wells V, Field JR, Callary SA (2011) Early migration characteristics of a hydroxyapatite-coated femoral stem: an RSA study. Int Orthop 35(4):483–488. https://doi.org/10.1007/s00264-009-0913-z CrossRefPubMed

14.

Hossain F, Konan S, Volpin A, Haddad FS (2017) Early performance-based and patient-reported outcomes of a contemporary taper fit bone-conserving short stem femoral component in total hip arthroplasty. Bone Joint J. 99-B(4 Supple B):49–55. https://doi.org/10.1302/0301-620x.99b4.bjj-2016-1291.r1 CrossRefPubMed

15.

Shrader MW, Bhowmik-Stoker M, Jacofsky MC, Jacofsky DJ (2009) Gait and stair function in total and resurfacing hip arthroplasty: a pilot study. Clin Orthop Relat Res 467(6):1476–1484. https://doi.org/10.1007/s11999-009-0791-0 CrossRefPubMedPubMedCentral

16.

Aqil A, Drabu R, Bergmann JH, Masjedi M, Manning V, Andrews B, Muirhead-Allwood SK, Cobb JP (2013) The gait of patients with one resurfacing and one replacement hip: a single blinded controlled study. Int Orthop 37(5):795–801. https://doi.org/10.1007/s00264-013-1819-3 CrossRefPubMedPubMedCentral

17.

ClinicalTrials.gov Furlong Evolution^R Hip Trial. https://clinicaltrials.gov/ct2/show/NCT01721278. Assessed 20 Jul 2017

18.

Slack R, Tindall A, Shetty AA, James KD, Rand C (2006) 15-year follow-up results of the hydroxyapatite ceramic-coated femoral stem. J Orthop Surg (Hong Kong) 14(2):151–154. https://doi.org/10.1177/230949900601400209 CrossRef

19.

Ahlback SO (1971) Classification of hip joint arthosis. Nord Med 85(5):157–158PubMed

20.

Renkawitz T, Weber T, Dullien S, Woerner M, Dendorfer S, Grifka J, Weber M (2016) Leg length and offset differences above 5 mm after total hip arthroplasty are associated with altered gait kinematics. Gait Posture 49:196–201. https://doi.org/10.1016/j.gaitpost.2016.07.011 CrossRefPubMed

21.

Dawson J, Fitzpatrick R, Carr A, Murray D (1996) Questionnaire on the perceptions of patients about total hip replacement. J Bone Joint Surg Br 78(2):185–190CrossRefPubMed

22.

Brooks R (1996) EuroQol: the current state of play. Health Policy 37(1):53–72CrossRefPubMed

23.

McCrory JL, White SC, Lifeso RM (2001) Vertical ground reaction forces: objective measures of gait following hip arthroplasty. Gait Posture 14(2):104–109CrossRefPubMed

24.

Herzog W, Nigg BM, Read LJ, Olsson E (1989) Asymmetries in ground reaction force patterns in normal human gait. Med Sci Sports Exerc 21(1):110–114CrossRefPubMed

25.

Hof AL (1996) Scaling gait data to body size. Gait Posture 3:222–223CrossRef

26.

Lavigne M, Therrien M, Nantel J, Roy A, Prince F, Vendittoli PA (2010) 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(2):326–336. https://doi.org/10.1007/s11999-009-0938-z CrossRefPubMed

27.

Studenski S, Perera S, Patel K, Rosano C, Faulkner K, Inzitari M, Brach J, Chandler J, Cawthon P, Connor EB, Nevitt M, Visser M, Kritchevsky S, Badinelli S, Harris T, Newman AB, Cauley J, Ferrucci L, Guralnik J (2011) Gait speed and survival in older adults. JAMA 305(1):50–58. https://doi.org/10.1001/jama.2010.1923 CrossRefPubMedPubMedCentral

28.

Hall DP, Srikantharajah D, Anakwe RE, Gaston P, Howie CR (2009) Patient-reported outcome following metal-on-metal resurfacing of the hip and total hip replacement. Hip Int 19(3):245–250CrossRefPubMed

29.

Wiik AV, Aqil A, Tankard S, Amis AA, Cobb JP (2015) Downhill walking gait pattern discriminates between types of knee arthroplasty: improved physiological knee functionality in UKA versus TKA. Knee surgery, sports traumatology, arthroscopy: official journal of the ESSKA 23(6):1748–1755. https://doi.org/10.1007/s00167-014-3240-x CrossRef

30.

Haddad FS, Konan S, Tahmassebi J (2015) A prospective comparative study of cementless total hip arthroplasty and hip resurfacing in patients under the age of 55 years: a 10-year follow-up. Bone Joint J. 97-B(5):617–622. https://doi.org/10.1302/0301-620x.97b5.34537 CrossRefPubMed

31.

Jakubowitz E, Seeger JB, Lee C, Heisel C, Kretzer JP, Thomsen MN (2009) Do short-stemmed-prostheses induce periprosthetic fractures earlier than standard hip stems? A biomechanical ex vivo study of two different stem designs. Arch Orthop Trauma Surg 129(6):849–855. https://doi.org/10.1007/s00402-008-0676-9 CrossRefPubMed

Title: The loading patterns of a short femoral stem in total hip arthroplasty: gait analysis at increasing walking speeds and inclines
Authors: Anatole V. Wiik
Mads Brevadt
Hardeep Johal
Kartik Logishetty
Oliver Boughton
Adeel Aqil
Justin P. Cobb
Publication date: 01-12-2018
Publisher: Springer International Publishing
Published in: Journal of Orthopaedics and Traumatology / Issue 1/2018
Print ISSN: 1590-9921
Electronic ISSN: 1590-9999
DOI: https://doi.org/10.1186/s10195-018-0504-0

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The loading patterns of a short femoral stem in total hip arthroplasty: gait analysis at increasing walking speeds and inclines

Abstract

Background

Materials and methods

Results

Conclusions

Level of evidence

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Materials and methods

Results

Conclusions

Level of evidence

Please log in to get access to this content

Other articles of this Issue 1/2018

Are clinical outcomes affected by type of plate used for management of mid-shaft clavicle fractures?

How to prevent dislocation after revision total hip arthroplasty: a systematic review of the risk factors and a focus on treatment options

Cross-cultural adaptation and validation of the Italian versions of the Kujala, Larsen, Lysholm and Fulkerson scores in patients with patellofemoral disorders

Alleged malpractice in orthopaedics. Analysis of a series of medmal insurance claims

Development and validation of a guide for the continuity of care in perioperative medication management

Assessing the real benefits of surgery for degenerative lumbar spinal stenosis without instability and spondylolisthesis: a single surgeon experience with a mean 8-year follow-up