Primary clinical application of stemless hip arthroplasty: the postoperative effects and initial experiences

Abstract

Objective To evaluate the short-term follow-up results of stemless hip arthroplasty and discuss its security, feasibility and validity in clinical application. Methods From February 2002 to March 2007, 51 patients (56 hips) underwent hip arthroplasty using stemless prostheses, including 31 males (34 hips) and 20 females (22 hips) with an average age of 56.2 years (range, 25 to 87 years). The mean preoper-ative Harris hip score was 72.4 ±8.4. There were fresh femoral neck fractures occurring in 6 patients (6 hips), avascular necrosis of femoral head after femoral neck fractures in 4 (4 hips), aseptic necrosis of femoral head (Ficat ID -IV) in 34 (37 hips), ankylosing spondylitis in 2 (3 hips), rheumatoid arthritis in 2 (3 hips) and hip tuberculosis in 3 (3 hips). Total hip arthroplasty were taken in 50 hips and femoral head replacement in 6 hips. The clinical effects were evaluated basing on Harris score and radiographic analysis according to Amstutz's zoning method for the stem and cup implant. Results All the patients were followed up, with a mean period of 4.8 years (range, 2 to 7 years). According to the Harris hip scoring system, the mean score was 92.8±3.2 after operation. There were 44 hips rated as excellent, 7 as good, 4 as fair, and 1 as poor. The excellent-good rate was 91%. Two patients dislocated at 2 and 3 days after operation, respectively, and who both gained manual reduction successfully. One patient got infected at 40 days after operation, and was cured by focal cleaning and continuous lavage of the joint cavity. Hip pain occurred in 1 case after operation and relieved after revision using femoral prosthesis with stem. X-ray showed no prosthesis loosening, disloca-tion or breakage of screws in these cases during follow-up. Conclusion Stemless hip arthroplasty is charac-terized by preservation of femoral neck, less surgical trauma, less blood loss, less complications and fitting f or revision. It is especially suitable for the old and weak cases or the young who need hip replacement. The follow-up results of 2 to 7 years showed its reliable effect, and the long-term outcomes need further e-valuation. Key words: Arthroplasty, replacement, hip; Prosthesis design; Treatment outcome