Range of motion of large head total hip arthroplasty is greater than 28 mm total hip arthroplasty or hip resurfacing.

BACKGROUND Reduced range of motion of the hip has a detrimental influence on lower limb function. Large diameter head total hip arthroplasty may theoretically have a greater potential for restoring normal hip range of motion due to greater head-neck diameter ratio, and hence provide better function compared to conventional or hip resurfacing arthroplasty. METHOD At minimum one year follow-up, range of motion of the operated and contra lateral hips was clinically assessed using digital photographs and bony landmarks in a clinical comparative study. We assessed if 1) large diameter head total hip arthroplasty (55 patients) restores better hip range of motion compared to 28 mm total hip arthroplasty (50 patients) or hip resurfacing (60 patients) 2) large diameter head total hip arthroplasty achieves same hip range of motion as contra lateral normal hips and 3) hip range of motion correlates with the WOMAC score. FINDINGS The large diameter head total hip arthroplasty group had significantly greater total arcs of motion (approximately 20°), mostly due to an increase of hip flexion and external rotation, but did not reach normal hip motion. The hip range of motion showed significant correlation with the WOMAC score, especially the flexion arc. INTERPRETATION The better hip range of motion of large diameter head total hip arthroplasty is likely due to the greater head to neck diameter ratio and hence seems to be the best option to optimize range of hip motion and improve function after hip arthroplasty.

[1]  Yasuharu Nakashima,et al.  Effects of the femoral offset and the head size on the safe range of motion in total hip arthroplasty. , 2009, The Journal of arthroplasty.

[2]  R. Bader,et al.  Limited range of motion of hip resurfacing arthroplasty due to unfavorable ratio of prosthetic head size and femoral neck diameter , 2008, Acta orthopaedica.

[3]  R A Oostendorp,et al.  Range of joint motion and disability in patients with osteoarthritis of the knee or hip. , 2000, Rheumatology.

[4]  U P Wyss,et al.  Activities of daily living in non-Western cultures: range of motion requirements for hip and knee joint implants , 2001, International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation.

[5]  M. Lavigne,et al.  Painful impingement of the hip joint after total hip resurfacing: a report of two cases. , 2008, The Journal of arthroplasty.

[6]  M. Royle,et al.  Metal-on-metal hip resurfacing: the effect of cup position and component size on range of motion to impingement. , 2009, The Journal of arthroplasty.

[7]  Natalia Nuño,et al.  Factors affecting hip range of motion in surface replacement arthroplasty. , 2007, Clinical biomechanics.

[8]  R. Pietrobon,et al.  Metal-on-Metal Hip Resurfacing Compares Favorably with THA at 2 Years Followup , 2006, Clinical orthopaedics and related research.

[9]  W. Maloney,et al.  Time-related improvement in the range of motion of the hip after total replacement. , 1985, The Journal of bone and joint surgery. American volume.

[10]  D. D’Lima,et al.  The Effect of the Orientation of the Acetabular and Femoral Components on the Range of Motion of the Hip at Different Head-Neck Ratios* , 2000, The Journal of bone and joint surgery. American volume.

[11]  K. Harms-Ringdahl,et al.  Examination of passive ROM and capsular patterns in the hip. , 2003, Physiotherapy research international : the journal for researchers and clinicians in physical therapy.

[12]  M. Lavigne,et al.  Biomechanical reconstruction of the hip: a randomised study comparing total hip resurfacing and total hip arthroplasty. , 2006, The Journal of bone and joint surgery. British volume.

[13]  Clarke Ic.  Symposium on Surface Replacement Arthroplasty of the Hip. Biomechanics: mutifactorial design choices--an essential compromise? , 1982 .

[14]  Johnston Rc,et al.  Hip motion measurements for selected activities of daily living. , 1970 .

[15]  A. Hofman,et al.  The association of abnormalities on physical examination of the hip and knee with locomotor disability in the Rotterdam Study. , 1996, British journal of rheumatology.

[16]  W. Hutton,et al.  Impingement after total hip arthroplasty related to prosthetic component selection and range of motion. , 1997, Journal of the Southern Orthopaedic Association.

[17]  R. Mollan,et al.  A statistical analysis of hip scores. , 1993, The Journal of bone and joint surgery. British volume.

[18]  E. Ebramzadeh,et al.  Less range of motion with resurfacing arthroplasty than with total hip arthroplasty: In vitro examination of 8 designs , 2008, Acta orthopaedica.

[19]  Toshiaki Takahashi,et al.  The relationship between increased hip range of motion, wear, and locking mechanism failure in the Harris-Galante acetabular component. , 2009, The Journal of arthroplasty.

[20]  C. Goldsmith,et al.  Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. , 1988, The Journal of rheumatology.

[21]  T. K. Kim,et al.  Correlation of maximum flexion with clinical outcome after total knee replacement in Asian patients. , 2007, The Journal of bone and joint surgery. British volume.

[22]  W. Harris,et al.  Correlation of measured range of hip motion following total hip arthroplasty and responses to a questionnaire. , 1996, The Journal of arthroplasty.

[23]  Shantanu Patil,et al.  Bony impingement affects range of motion after total hip arthroplasty: A subject‐specific approach , 2008, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[24]  D J Schurman,et al.  Range of motion studies for total hip replacements. A comparative study with a new experimental apparatus. , 1975, Clinical orthopaedics and related research.

[25]  W. Harris,et al.  Range of motion and stability in total hip arthroplasty with 28-, 32-, 38-, and 44-mm femoral head sizes. , 2005, The Journal of arthroplasty.

[26]  M. Ritter,et al.  The Importance of Range of Motion after Total Hip Arthroplasty , 2007, Clinical orthopaedics and related research.

[27]  B F Morrey,et al.  Dislocations after total hip arthroplasty. , 1982, The Journal of bone and joint surgery. American volume.

[28]  M. Lavigne,et al.  A randomised study comparing resection of acetabular bone at resurfacing and total hip replacement. , 2006, The Journal of bone and joint surgery. British volume.

[29]  I C Clarke,et al.  Prosthetic hip range of motion and impingement. The effects of head and neck geometry. , 1982, Clinical orthopaedics and related research.

[30]  M. Ritter,et al.  Effect of range of motion on the success of a total knee arthroplasty. , 1987, The Journal of arthroplasty.

[31]  K. Widmer,et al.  The impact of the CCD-angle on range of motion and cup positioning in total hip arthroplasty. , 2005, Clinical biomechanics.

[32]  S. Hasson,et al.  Mobility and perceived function after total knee arthroplasty. , 2006, The Journal of arthroplasty.

[33]  J. J. Gerhardt,et al.  Range-of-motion measurements. , 1995, The Journal of bone and joint surgery. American volume.

[34]  M J Lichtenstein,et al.  Determinants of hip and knee flexion range: results from the San Antonio Longitudinal Study of Aging. , 1999, Arthritis care and research : the official journal of the Arthritis Health Professions Association.

[35]  M. L. Le Duff,et al.  Range of motion after stemmed total hip arthroplasty and hip resurfacing - a clinical study. , 2009, Bulletin of the NYU hospital for joint diseases.

[36]  S. H. Weeden,et al.  A randomized, prospective study of primary total knee components designed for increased flexion. , 2007, The Journal of arthroplasty.