Total Hip Arthroplasty, Total Hip Resurfacing and Femoroacetabular Impingement

Principal Investigators: Robert T. Trousdale, M.D., Rafael J. Sierra, M.D., Mark W. Pagnano, M.D., Daniel J. Berry, M.D. and Kenton R. Kaufman, Ph.D.
Project Coordinators: Kathie Bernhardt — bernhardt.kathie@mayo.edu and Christine Huyber — huyber.christine@mayo.edu

Our investigations into hip pathology focus on addressing the functional outcomes of corrective surgical procedures for osteoarthritis and femoracetabular impingement. Each of the studies is concerned with hip range of motion (ROM) before and after surgery and its correlation to physical examination and patient satisfaction surveys.

To correct for hip osteoarthritis, there are two common surgical procedures: total hip arthroplasty (THA) and total hip resurfacing (THR). THR is a bone-conserving alternative to standard THA for treating young patients with hip osteoarthritis. We have developed multiple protocols to characterize hip ROM for each procedure and to compare functional outcomes between the two procedures. Two prospective, randomized, double blind, controlled trials were developed to compare between THA and THR. One study compares procedures between subjects with unilateral hip disease and the other compares subjects with bilateral hip disease. Currently, there remains only personal bias for choosing one surgical procedure over another. These studies were designed to address the major short-term, clinically important issues between the two types of procedures with special emphasis on functional outcome.

Femoroacetabular impingement is a condition where there is abnormal contact between the femur and the acetabulum in the normal hip range of motion required for daily living activities or at extremes of motion. The impingement can cause hip pain and lead to early osteoarthritis in young and active adults. The impingement is corrected with surgery, but very little is known about hip ROM after surgical treatment. To address this deficiency, we developed a prospective clinical trial to compare active and passive hip range of motion before and after treatment. This study will attempt to show objective differences in hip ROM and confirm if these differences correlate with patient satisfaction and increased function reported in clinical questionnaires.

Common to all the studies described above is examination of the patient preoperatively and postoperatively at 2-3 months and 1 year. During examination hip ROM is measured passively and with motion analysis, and patients complete a set of questions that address hip function and patient satisfaction. The unilateral and bilateral THA and THR studies also involve strength testing of the hip muscles as well as hip x-rays. The findings from this work will be treated as valuable information to guide clinical practice.