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 Adult Hip Reconstruction Test 4: Bearing Surfaces/Alternatives to Conventio...
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The Journal of Bone and Joint Surgery (American) 86:40-46 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.

The Biomechanical Results of Total Hip Resurfacing Arthroplasty

Mauricio Silva, MD1, Kee Haeng Lee, MD1, Christian Heisel, MD1, Mylene A. dela Rosa, BS1 and Thomas P. Schmalzried, MD1

1 Joint Replacement Institute at Orthopaedic Hospital, 2400 South Flower Street, Los Angeles, CA 90007

Investigation performed at the Joint Replacement Institute at Orthopaedic Hospital, Los Angeles, California

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from Wright Medical Technology and the Piedmont Fund of the Los Angeles Orthopaedic Hospital Foundation. In addition, one or more of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity (DePuy, a Johnson and Johnson Company). No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: With the advent of more wear-resistant bearings, there is renewed interest in resurfacing total hip arthroplasty. However, there is a paucity of information on the biomechanical results of this type of arthroplasty compared with those of contemporary total hip arthroplasty.

Methods: Using standardized radiographs, we measured and compared the biomechanical parameters that affect the hip joint reactive forces in fifty hips that had a metal-metal surface replacement with those parameters in forty hips that had a contemporary cementless total hip replacement performed during the same time-period by the same surgeon.

Results: On the average, the arthritic hips that were treated with metal-metal surface replacement had had a more valgus preoperative neck-shaft angle and less horizontal femoral offset than the normal, contralateral hips (p = 0.0003). After both the metal-metal surface replacements and the cementless total hip replacements, the hip center of rotation was medialized by approximately 6 mm. Both procedures were associated with an average increase in limb length of approximately 3 or 4 mm. After the metal-metal surface replacements, the horizontal femoral offset was essentially equal to the preoperative value, but both values averaged about 8 mm less than those on the normal, contralateral side (p < 0.00001). In the hips with a conventional total hip replacement, the horizontal femoral offset increased an average of 9.5 mm compared with the preoperative value and was an average of 5 mm more than that for the normal, contralateral hip (p = 0.001).

Conclusions: The biomechanical results of total hip resurfacing depend on the preoperative anatomy of the proximal part of the femur. Limb lengthening of 1 cm can be achieved, but horizontal femoral offset is essentially unchanged by hip resurfacing. Horizontal femoral offset can be increased reliably with a contemporary total hip replacement. Arthritic hips of limbs that are more than 1 cm shorter than the contralateral limb or that have a comparatively low horizontal femoral offset may be better served by a contemporary total hip replacement. These biomechanical limitations should be considered in the selection of hips for resurfacing.

Level of Evidence: Therapeutic study, Level III-1 (case-control study). See Instructions to Authors for a complete description of levels of evidence.


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