Postural balance during quiet standing in patients with total hip arthroplasty and surface replacement arthroplasty

Primary total hip arthroplasty leads to better functional capacities but a general weakness of abductor muscles often persists. A larger head component may improve the postural balance in the medial-lateral direction. The aims of this study are (1) to compare postural stability in patients after total hip and surface replacement arthroplasties and (2) to evaluate the effect of the biomechanical reconstruction on postural stability.

Six months post-surgery, three groups of ten subjects (total hip and surface replacement arthroplasties and control) performed quiet standing tasks in both dual and one leg stance and a hip abductor muscles strength test. The root-mean-square amplitude of centre of pressure and centre of mass displacement in the anterior-posterior and medial-lateral directions were calculated for dual stance task.

Statistical analyses showed greater centre of pressure and centre of mass displacement amplitude in the medial-lateral direction during the dual stance for the total hip arthroplasty compared to the surface replacement and control subjects (P<0.05). All control subjects completed the one leg stance compared to nine in the surface replacement and five in the total hip arthroplasty group. No statistical difference was found between the groups in the hip abductor muscles strength.

The better anatomical preservation, absence of femoral stem and the larger bearing component could account for the return to better postural stability in surface replacement patients in comparison to total hip patients. Further studies are needed to determine the impact of each of these factors on the postural balance.