Abstract
BackgroundA discrepancy in leg length and femoral offset restoration is the leading cause of patient dissatisfaction in hip replacement surgery and has profound implications on patient quality of life. The aim of this study is to compare biomechanical hip reconstruction in hip resurfacing, large-diameter femoral head hip arthroplasty and conventional total hip replacement.MethodSixty patient's post-operative radiographs were reviewed; 20 patients had a hip resurfacing (HR), 20 patients had a Large Head Metal-on-metal (LHM) hip replacement and 20 patients had a conventional small head Total Hip Replacement (THR). The leg length and femoral offset of the operated and unoperated hips were measured and compared.ResultsHip resurfacing accurately restored hip biomechanics with no statistical difference in leg length (P = 0.07) or femoral offset (P = 0.95) between the operated and non-operative hips. Overall HR was superior for reducing femoral offset discrepancies where it had the smallest bilateral difference (-0.2%, P = 0.9). The traditional total hip replacement was least effective at restoring the hip anatomy.ConclusionThe use of a larger-diameter femoral head in hip resurfacing does not fully account for the superior biomechanical restoration, as LHM did not restore femoral offset as accurately. We conclude that restoration of normal hip biomechanics is best achieved with hip resurfacing.
Highlights
A discrepancy in leg length and femoral offset restoration is the leading cause of patient dissatisfaction in hip replacement surgery and has profound implications on patient quality of life
The conventional small head Total Hip Replacement (THR) restored 80% patients leg lengths to < 10 mm difference and the results showed no statistically significant difference
This study provides further evidence that the more contemporary hip resurfacing is superior for restoring leg MOM Large Head Metal-on-metal (LHM) THR Mean
Summary
A discrepancy in leg length and femoral offset restoration is the leading cause of patient dissatisfaction in hip replacement surgery and has profound implications on patient quality of life. One of the main challenges of hip replacement is to restore leg length and provide optimal femoral offset. A difference in operated and unoperated leg length creates tension in the soft tissue structures and muscles around the operated hip. This causes the pelvis to tilt, creating a sensation that one leg is longer [4]. A leg length discrepancy can lead to low back pain, discomfort, instability, abnormal gait, nerve palsies and patient dissatisfaction [5]. A low femoral offset can lead to wearing of the acetabular cup which is the primary cause of aseptic loosening [6], abnormal gait, joint instability [7] and dislocation [8]
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