title: Patient activity after total hip arthroplasty: a comparison of three different bearing surfaces.
abstract: Patients who receive hip arthroplasty today desire prostheses that not only have great longevity, but are also suitable for a very active lifestyle. Advances in metallurgy, tribologic behavior, surgical technique, as well as improvements in strength and microstructure, have made ceramic-on-ceramic and metal-on-metal bearings available for young patients requiring a great deal of mobility. The purpose of this study was to assess if the bearing surface had an effect, if any, on postoperative activity levels and clinical outcomes in patients receiving three different types of hip arthroplasty. This study includes three groups of 30 patients who had each received conventional metal-on-polyethylene total hip arthroplasty (THA), ceramic-on-ceramic THA, or hip resurfacing arthroplasty. All groups were matched by men to women ratio, age, body mass index, diagnosis, preoperative activity levels, and length of follow-up. Clinical outcomes evaluated included weighted postoperative activity levels, Harris hip scores, patient satisfaction scores, revision rates, and complication rates. Patients who had received a metal-on-metal resurfacing had achieved significantly higher activity scores (mean 10.5 points; range, 1-28 points) compared to patients who had received ceramic-on-ceramic (mean 6.9 points; range, 0-34 points) or metal-on-polyethylene bearings (mean 5.6 points; range, 1-18 points). The mean postoperative Harris hip scores (94 vs 92 vs 91 points), patient satisfaction scores (9 vs 8.4 vs 8.3 points), aseptic revision (3% vs 0% vs 0%), and complication rates (3% vs 3% vs 3%) were similar between resurfacing, ceramic-on-ceramic, and metal-on-polyethylene bearing groups, respectively. This study showed that in cohorts of similarly matched arthroplasty patients in multiple demographics factors and preoperative activity levels, metal-on-metal resurfacing arthroplasty may offer higher postoperative activity levels. For patients with higher activity levels, resurfacing arthroplasty may be advantageous compared to other types of bearings.
authors.affiliation: Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157-1070; Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Heidelberg, Schlierbacher Landstrasse 20.
authors.forename: Johannes F
authors.initials: JF
authors.lastname: Plate
authors.affiliation: Seton Hall University, School of Health and Medical Sciences, Department of Orthopaedic Surgery, South Orange Village, NJ.
authors.forename: Kimona
authors.initials: K
authors.lastname: Issa
authors.affiliation: Seton Hall University, School of Health and Medical Sciences, Department of Orthopaedic Surgery, South Orange Village, NJ.
authors.forename: Craig
authors.initials: C
authors.lastname: Wright
authors.affiliation: Seton Hall University, School of Health and Medical Sciences, Department of Orthopaedic Surgery, South Orange Village, NJ.
authors.forename: Bartlomiej W
authors.initials: BW
authors.lastname: Szczech
authors.affiliation: Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Reconstruction, Sinai Hospital of Baltimore, Baltimore, Maryland; Family Orthopaedic Center, St. Margaret's Hospital, Spring Valley, Illinois.
authors.forename: Bhaveen H
authors.initials: BH
authors.lastname: Kapadia
authors.affiliation: Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD.
authors.forename: Samik
authors.initials: S
authors.lastname: Banerjee
authors.affiliation: Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Reconstruction, Sinai Hospital of Baltimore, Baltimore, Maryland.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Mont
mesh_terms: D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D005260:Female; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D017060:Patient Satisfaction; D011183:Postoperative Complications; D011474:Prosthesis Design