Abstract
Background and purpose Total hip replacement (THR) with a reverse hybrid (RH), a combination of a cemented polyethylene cup and a cementless femoral stem, has been increasingly used in Scandinavia. In a randomized trial, we compared an RH THR with a proximal hydroxyapatite- (HA-) coated stem to a conventional cemented THR. Both groups received the same polyethylene cup.Patients and methods 51 patients (52 hips) were included. Radiostereometry (RSA) and dual-energy X-ray absorptiometry (DEXA) were performed postoperatively and after 6, 12, and 24 months. 42 patients (43 hips) were followed for 2 years.Results Mean cup rotation around the x-axis was 0.13° for the cemented group and –0.24° for the RH group (p = 0.03). Cup migration in the other axes, and stem migration and wear were similar between the 2 study groups. Bone remodeling around the cup was also similar between the groups. Bone loss in Gruen zone 1 was 18% for the cementless stems, as compared to an increase of 1.4% for the cemented ones (p < 0.001). Bone loss was similar in the other Gruen zones. Harris hip score and Oxford hip score were similar pre- and postoperatively in the 2 groups.Interpretation In the present study, RH THR with a cementless hydroxyapatite-coated stem and conventional cemented THR did not show any major differences regarding stem migration and bone loss after 2 years of follow-up.
Highlights
Background and purposeTotal hip replacement (THR) with a reverse hybrid (RH), a combination of a cemented polyethylene cup and a cementless femoral stem, has been increasingly used in Scandinavia
Bone loss in Gruen zone 1 was 18% for the cementless stems, as compared to an increase of 1.4% for the cemented ones (p < 0.001)
Discussion cup in combination with the Spectron EF stem compared to some other prostheses (Espehaug et al 2009)
Summary
Clinical outcome Mean pre- and postoperative Harris hip and Oxford hip scores were similar in the 2 groups (Table 3). 1 patient with a cementless stem was revised 1 year after the index procedure, due to thigh pain. We had no peroperative femoral fracture in either group. Operating time was 8 min shorter for the RH group (p = 0.05) (Table 3)
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