The Effect of Hip Arthroplasty on Gait Function: Comparison of Ceramic-On-Ceramic Hip Resurfacing, Metal-On-Metal Hip Resurfacing, and Total Hip Arthroplasty.

Abstract

Ceramic-on-ceramic hip resurfacing arthroplasty (CoC-HRA) has been developed to eliminate metal ion concerns which have been associated with metal-on-metal hip resurfacing arthroplasty (MoM-HRA) while maintaining similar functionality. The aim of the study was to examine gait function pre- and postoperatively between CoC-HRA, MoM-HRA, and THA using subjective and objective measures with comparison to a healthy control group. Nineteen unilateral CoC-HRA, 19 unilateral MoM-HRA, and 18 unilateral THA gender, age, and BMI matched participants completed patient-reported outcome measures (PROMs) (Oxford hip score [OHS] and metabolic equivalence of task score [MET]) and underwent gait analysis on an instrumented treadmill, preoperatively (2-8 weeks) and then postoperatively (40-52 weeks). Spatiotemporal measures and vertical ground reaction forces (GRF) were recorded. Statistical parametric mapping was used to detect differences in GRF between affected and nonaffected leg and to healthy controls. Preoperatively, there were no differences between groups in PROMs or objective measures. All groups showed an improved OHS postoperatively with only CoC-HRA and MoM-HRA demonstrating significant increase in MET. Postoperatively, TWS in both HRA groups improved with no difference to CON while THA was unable to demonstrate improvements. Postoperatively, at 6.5 km/h, THA demonstrated an asymmetric GRF profile, whereas CoC-HRA and MoM-HRA showed no differences between legs. In comparison of the affected leg GRF, THA demonstrated a weaker push off when compared to both resurfacing groups and CON. CoC-HRA and MoM-HRA showed no significant differences to CON. CoC-HRA emerges as a potential alternative to MoM-HRA, effectively addressing metal ion release concerns while retaining similar functional benefits.