Uncemented Total Hip Replacement Research Articles

Magnum metal-on-metal uncemented total hip replacement: 8- to 18-year outcomes of 211 cases.

Reports of adverse reactions to metal debris contributed in part to a decline in use of large-bearing metal-on-metal total hip devices. We hypothesize an optimal trunnion design may reduce risk of this failure mode in large-bearing total hip arthroplasty systems. The purpose of this study is to report mid- to long-term outcomes for a single-surgeon series of 211 total hip arthroplasties using the large-bearing Biomet Magnum metal-on-metal system. Between December 2004 and January 2016, the primary surgeon performed 211 uncemented Magnum total hip arthroplasties in 181 patients. The average length of follow-up was 10.1 ± 3.5years (range 8-18years). Using failure of any component as the endpoint, the overall survivorship rate was 98.1% at 10years and 97.4% at 18years. These eight failures (3.8% of cohort) included one case of adverse wear-related failure (0.5%), two cases of acetabular ingrowth failure (0.9%), three cases of trunnion corrosion (1.4%), one failure of late infection (0.5%), and one inappropriate revision of components for trochanteric nonunion without instability (0.5%). Excluding failed cases, all components were radiographically stable with no radiolucencies. Except for the one wear failure, ion testing revealed that 97.2% of cases were within optimal whole blood metal ion levels with the remaining ion test results within acceptable levels. With the uncemented Magnum metal-on-metal total hip, we achieved 97.4% 18-year implant survivorship, exceeding the NICE criteria and registry benchmarks for implant survivorship. We observed a trunnion corrosion rate of 1.4% and no cases of instability. The single case of adverse wear-related failure was caused by acetabular component malposition.

FUNCTIONAL OUTCOME OF UNCEMENTED TOTAL HIP ARTHROPLASTY IN POST-TRAUMATIC AVASCULAR NECROSIS OF FEMORAL HEAD IN YOUNG PATIENTS

Objective: To determine the frequency of different outcomes of uncemented total hip replacement in young patients with avascular necrosis due to traumatic cause Materials and Methods: This study was done in Khyber Teaching Hospital Peshawar, Pakistan from March 2022 to January 2024. 96 patients of the younger age group (20-45 years) consisting of both genders with uncemented total hip arthroplasty for AVN femoral head due to traumatic cause, were studied. Age, gender, side of hip affected by AVN, and pre-operative Harris Hip Score were noted. Functional outcomes of uncemented THA were determined in terms of improvement in postoperative Harris hip score was documented at 3 months postoperatively. Results: A total of 96 patients, 80 (83.33%) men and 16 (16.67%) women underwent uncemented total hip arthroplasty. The age ranged from 20 to 45 years, with a mean of 40±7.02 years. Reasons for osteonecrosis included femoral neck fracture (50%), hip dislocation (36.46%), and acetabular fracture (13.54%). After 3 months of surgery, the Harris hip score improved and was excellent in 86.46% of patients, good in 8.33% of patients, fair in 5.2% of patients and none of the patients had poor scores. Conclusion: The cementless hip prosthesis for the treatment of post-traumatic avascular necrosis of the femoral head in active and young individuals is a very good option. The results of cementless hip arthroplasties are good and encouraging in terms of functional outcome postoperatively. Keyword: Harris Hip Score; Uncemented Total Hip Arthroplasty; Avascular Necrosis Hip

Failed nonunion subtrochanteric femur fracture managed with uncemented total hip replacement

Abstract Subtrochanteric fracture is a fracture between the lesser trochanter and 5 cm distal to the lesser trochanter. It accounts approximately for 10%–30% of all hip fractures and affects persons more than 60 years of age. Bimodal distribution has greater incidences in 20–40 years of age and persons more than 60 years of age. Deforming forces on the proximal fragment are abduction by the gluteus medius and minimus, flexion by iliopsoas, and external rotation by short external rotators; whereas, deforming forces on the distal fragment are adduction and varus by adductors. Failure of subtrochanteric fracture treatment is frequently associated with unstable fracture patterns, poor bone quality, or suboptimal position of fixation devices. Such complications following treatment failure may result in nonunion, leading to pain or malunion, severe bone defects, infection, articular cartilage damage, and even post-traumatic arthritis hip, which poses a significant challenge in subsequent surgeries. Therefore, in this particular case, we were left with only two options, such as (1) re-osteosynthesis using limb reconstruction surgeries (LRS) and (2) and prosthetic replacement. We opted for uncemented long stem total hip replacement to get diaphyseal hold as it has many advantages over LRS like a high success rate, a better quality of life, improved early mobility, and life-long lasting results. LRS was not opted as a choice of surgery as it has some disadvantages like pin-tract infection, more maintenance and compliance needed, the frame being bulky and cumbersome, and the risk of fracture at the pinhole site. Moreover, in this particular case, bone grafts from all accessible sites were used from previous surgeries. Uncemented long-stem total hip replacement can serve as an efficient salvage procedure in such cases. Post-operatively on follow-up at 2 months, the patient was able to fully bear weight without support. The range of motion at the right hip joint where the patient was able to do flexion 100ʹ, abduction 50ʹ, and adduction 30ʹ. We were able to correct limb length discrepancy by 5 cm (pre-operative discrepancy was 7 cm). Our achievement shows that uncemented long stem total hip replacement is a beneficial and effective procedure for salvaging the failed treatment of subtrochanteric fractures. Such procedures have shown satisfactory functional outcomes, stable fixation, and survival rates for these complex situations.

A Radiographic Evaluation of Uncemented Total Hip Replacements and the Role of Uncemented Implants in the Management of Hip Osteoarthritis in the Elderly Population.

Introduction The idea of an uncemented, fully coated hydroxyapatite (HA) stem was introduced almost 40 years ago, aiming to achieve a solid biological fixation by preserving natural bone activity. While many studies underline the longevity of uncemented total hip replacement (THR), NHS England's Best Practice Tariff (BPT) recommends using cemented implants in patients over the age of 69, with financial penalties when this policy is not met. At the same time, the 'paradox' of increased use of uncemented implants worldwide has been well described, with many surgeons using them regardless of the age group of the patient. Materials and methods This study focuses on the radiographic evaluation of the uncemented Pinnacle/Corail total hip replacement construct in 123 patients of all age groups who underwent an elective procedure, with a minimum radiographic follow-up of two years. Implant information (collared or non-collared stem), femur type (Dorr classification), age, gender, and revision rate were collected and radiographic analysis of the femoral stem and acetabular component was performed for the immediate post-operative, six-month, one- to two-year follow-up radiograph of all patients. We conducted a statistical analysis, dividing the patients into two groups based on age: those above or below 69 years old. Results There was no statistically significant difference in rates of radiographic lucency after two years with regard to the femoral component. Both collared and non-collared stems seem to perform equally well, with no significant difference detected. However, a statistically significant difference in rates of radiographic lucency of the acetabular cup was noted between the two age groups (p=0.018), with higher rates detected in the under-69-year-old age group. Conclusion This study demonstrates that, radiographically, the uncemented Pinnacle/Corail construct performs equally well in all age groups. In our cohort of patients, the age of the patient did not predict the osseointegration of the implant in the short-term follow-up.

Functional Outcome of Uncemented Total Hip Replacement in Low Socioeconomic Group Using Modified Harris Hip Score: A Prospective Midterm Follow-Up Study.

Background Total hip replacement is a safe and effective surgery with excellent outcomes in most patients with hip arthritis. The aim of this study was to evaluate functional outcomes and complications of total hip replacement among patients with low socioeconomic status in India. Methods We assessed 50 patients whose incomes fell below the poverty line and who underwent uncemented total hip replacement. We used a modified Harris Hip Score, replacing two items (one measuring range of motion and one measuring deformity) with two new ones (one related to return to professional activity and another regarding sexual activity). Results At the final follow-up, patients' modified Harris Hip Score improved from a preoperative meanvalueof 13.28 (0-46) to a postoperative meanvalueof 88.52 (64-100), suggesting marked improvement in functional outcome (p<0.001). In total, 32 (64%) patients returned to their original profession, and 12 (24%) switched to alternate work with mild pain. All patients reported satisfaction with their sexual activity at the final follow-up. Conclusions Many patients in India whose income is below the poverty line work in manual labor professions (e.g., farmers, masons, and cobblers) that increase their risk of hip damage. Total hip replacement is beneficial for these patients, offering good personal and professional quality of life after the surgery.

Outcomes of direct anterior approach for uncemented total hip replacement in medial femoral neck fractures: a retrospective comparative study on the first 100 consecutive patients

BackgroundWith the aging of the population, the incidence of medial femoral neck fractures is likely to increase, and along them the need for total hip replacement. The present study aimed to analyze whether the use of the direct anterior hip approach, compared with posterolateral approach in medial proximal femur fracture patients, results in any advantage in terms of complications rate and functional recovery.MethodsA total of 162 patients were included in the study, and divided by approach: 100 performed with direct anterior approach (group A) and 62 with posterolateral approach (group B). The two populations were overlapping in age (75 vs 74 years; p = 0.13), sex (58F 42M vs 46F 16M; p = 0.12) and BMI (24 vs 24; p = 0.77).ResultsGroup A showed a higher ASA score compared to group B (3 vs 2; p = 0.04). Similar hospital stays (7 vs 7 days; p = 0.55) and complication rates (6% vs 8%; p = 0.61) were observed among groups, the most frequent being periprosthetic fractures, and need for allogeneic blood transfusion (20% vs 13%; p = 0.25). Patients in group A (96 vs 85 min; p = 0.10) showed a slightly, longer surgical time and a faster postoperative functional recovery witnessed by the ability to climb stairs at hospital discharge (37% vs 21%; p = 0.041).ConclusionThe use of the direct anterior hip approach was effective in the management of frail patients with medial femoral neck fractures managed by total hip arthroplasty, allowing faster functional recovery in the elderly population.

Comparing Intraoperative Blood Loss in Cemented, Uncemented, and Hybrid Total Hip Replacement for Neck of Femur Fractures.

Background As the aging population increases, osteoporotic neck of femur fracture cases will continue to rise. Although hemiarthroplasty or half hip replacement is the treatment of choice in a majority of patients, a small but definite cohort of patients would need a total hip replacement. In these elderly patients who often have comorbidities, the use of cement to fix the prosthesis is often quoted as beneficial in view of perceived lower blood loss compared to uncemented fixation of the prosthesis. However, the cementation of the implant in itself has inherent problems. This study examined three modalities of fixation of a prosthesis for total hip replacement in the neck of femur fractures, namely, cemented, hybrid, and uncemented, and compared their relative intraoperative blood loss. Methodology This is a retrospective study with a follow-up of two years. Patients who presented to a level 1 trauma center in an inner city metropolitan with neck of femur fractures and were treated by total hip replacement were included in the study. Intraoperative blood loss was calculated using Nadler's formula. Results There was no statistical difference in intraoperative blood loss in either of the three groups of patients, namely, cemented, hybrid, or uncemented total hip replacement for neck of femur fractures. Conclusions Intraoperative blood loss should not influence the modality of prosthesis fixation for total hip replacement in neck of femur fractures.

Effect of the surface geometry of uncemented acetabular cups on primary stability in a model of uncemented total hip replacement in dogs.

To compare the in vitro stability of acetabular cups with peripherally reinforced fixation in a model of uncemented total hip replacement in dogs. 63 polyurethane foam blocks and 3 acetabular implant designs: hemiellipsoidal (Model A) and 2 models with equatorial peripheral fins (Model B with 1 level and Model C with 2 levels of fins). 2 loading patterns-edge loading and push-out tests-were performed until failure and peak forces were recorded. Implantation behavior was visually assessed and the required seating force was assessed using a force-displacement curve. Model B showed significantly lower peak force than Model A in edge loading tests with standardized impaction. In the push-out test, Model A had a greater maximal force than Models B and C, with mean maximal forces of 213.7 N, 139.4 N, and 138.9 N, respectively. In the seating force test, Models B and C required a higher force for 2-mm deep implantation (362.0 N and 361.6 N, respectively) than Model A (194.4 N), and were associated with dorsal tilting of the components. Our results suggest that cups with a peripheral design (B, C) have less primary stability than hemiellipsoidal cups (A). Furthermore, models with peripheral fins (B, C) appeared to have incomplete seating if a higher force was not used during implantation and, therefore, the risk of malpositioning was increased. These data indicate that hemiellipsoidal cups provide the same or better initial stability and require a lower impaction force.

PIGMENTED VILLONODULAR SYNOVITIS OF HIP: A RARE CASE

Pigmented villonodular synovitis (PVNS) is a rare disease that can affect any joint, bursa or tendon sheath. The hip is less frequently affected than the knee.1 We report a case of a 46 years old male presented with history of pain and limp over right hip since 6months associated with difculty in sitting cross legged and squatting to performing day today activity. There was no history of fever, weight loss, and long term drug intake. Radiological assessment showed secondary arthritis of right hip with features of avascular necrosis (AVN). The provisional diagnosis was Arthritis of right hip secondary to AVN/ Inammatory arthritis and the patient underwent uncemented right total hip replacement(THA), Intra operatively the articular erosion was noted with reddish gray abnormal synovial growth. Histological assessment showed diffuse expansive sheets of histiocytes admixed with hemosiderin laden macrophages and alveolar spaces lined by synovial cells and collagenized stroma. A short term follow up of 18months did not show any clinical recurrence. We conclude that, from our observation, complete excision of lesion combined with THA is an effective treatment for PVNS of Hip.

Uncemented total hip replacement with impaction bone grafting in protrusio acetabuli

Protrusio acetabuli is a central acetabular defect resulting from migration of femoral head medial to Kohler’s line. Idiopathic central displacement of femoral head within the acetabulum is quite rare. However, it may be seen in arthritic hips secondary to rheumatoid arthritis, ankylosing spondylitis, previous trauma, osteomalacia, etc. Primary Total Hip Replacement (THR) in such cases is difficult because of the deficient medial bone, decreased peripheral bony support to the acetabular component and proximal and medial migration of the joint centre. Several techniques described previously in the surgical management of protrusio acetabuli include cemented acetabular components with cement alone or in association with morselized bone graft to reconstruct the acetabulum. However, cement has high rates of migration and loosening of cemented acetabular components in young patients leads to more revision surgeries within the first decade of implantation. The purpose of the study is to describe the technique and results of using impacted morselized bone graft with a porous coated cementless acetabular component in patients with protrusio acetabuli.A total of 20 primary THR’s (10 unilateral and 5 bilateral) in 15 patients (8 females and 7 males) with protrusio acetabuli were performed between 2018 and 2021, out of which 4 had mild,7 had moderate and 9 had a severe grade of protrusion. A total of 10 hips were affected by rheumatoid arthritis,3 by ankylosing spondylitis and 7 had unknown etiology. After the surgery, all bone grafts had united by the sixth month with no perceptible change in acetabular component position in any case. The mean preoperative Harris Hip Score was 48 which improved to 82 at the latest follow-up. 45% had excellent,33% had good, and 22% had fair results. There was no dislocation. The use of impacted morselized autograft with a cementless porous acetabular component is a good technique of restoration of hip biomechanics and sound fixation in cases of protrusio acetabuli.

Analysis of Achievement of Radiological Parameters in Uncemented Total Hip Replacement: A Retrospective Cohort Study

Introduction: The Total Hip Replacement (THR) procedure is indicated to the treatment of choice in chronic refractory joint pain and some types of proximal femoral fractures. Component malalignment is a major cause of THR failure, making it crucial to position the components anatomically for long-term joint survival. Aim: To assess the radiological parameters of uncemented THR surgery. Materials and Methods: This retrospective cohort study was conducted in the Department of Orthopaedic Surgery, King’s George Medical University (KGMU), Lucknow, Uttar Pradesh, India, from June 2017 to May 2021. It included 72 patients who underwent unilateral uncemented THR for isolated hip diseases. Data was collected over the first two years and analysed. Demographic information and radiographic characteristics such as acetabular cup inclination and anteversion, femoral stem placement, vertical and horizontal centers of rotation, and limb length discrepancy were determined. Data was entered into Microsoft Excel 2018-19, and Statistical Package for the Social Sciences (SPSS) software version 28.0 was used for statistical analysis. Results: The average age of the patients was 50.75±9.1 years. Comparison of acetabular cup inclination (preoperative 41.4±3.9° and postoperative 42.2±5.1°) and anteversion (preoperative 13.1±2.96° and postoperative 14.5±3.75°) showed non significant differences following treatment with a normal hip. However, there was a significant difference in the horizontal and vertical Centers Of Rotation (COR) following treatment with a normal hip. Conclusion: Preoperative radiological characteristics of the damaged hip were significantly restored to normal anatomy and alignment following surgery

Management of Pipkin Type 3 Fracture-Dislocation in Young Adults: A Dilemma

Pipkin type 3 fracture-dislocation constitutes a rare subgroup of fractures involving the femoral neck and head fracture. The management is difficult and controversial, including osteosynthesis using Herbert or cancellous screws and hip replacement surgery. In this case report, a 26-year-old male suffered a road traffic accident leading to a hip fracture. Radiographs and computed tomography scan of the hip depicted three large fragments of the femur head, dislocated posteriorly along with the neck of femur fracture. Considering the needs of the patient, fracture morphology, and unpredictable results of the osteosynthesis, the patient was treated primarily with uncemented total hip replacement. The complexity of the fracture leads to more chances of malreduction and avascular necrosis of the femur head. The patient had an uneventful intra and postoperative period. At the 3-year follow-up, the patient was walking unaided, pain-free, and performing all the activities of daily living satisfactorily.

Mortality associated with cemented and uncemented fixation of hemiarthroplasty and total hip replacement in the surgical management of intracapsular hip fractures: A systematic review and meta-analysis

BackgroundThe use of bone cement for implant fixation in the surgical management of intracapsular hip fractures (IHFs) remains controversial. Although UK national guidance supports cementation, many surgeons remain cautious of its use. In this systematic review and meta-analysis, we aimed to evaluate evidence surrounding post-operative mortality associated with cemented and uncemented total hip replacement and hemiarthroplasty implants. MethodsWe conducted a search of MEDLINE and Embase databases for randomised controlled trials (RCTs) from commencement until 17 June 2020. Articles reporting mortality or patient survival as an outcome following total hip replacement (THR) or hemiarthroplasty (HA) to manage IHFs were included. Articles not comparing cemented and uncemented fixation were excluded. A meta-analysis on mortality stratified by post-operative follow-up period was conducted using a fixed-effects model. The Revised Cochrane risk-of-bias tool for randomized trials was used to assess risk of bias. ResultsOur initial search found 77 references, 13 of which were eligible for full-text review. Mortality data from 12 studies were pooled and included in the meta-analysis. 1 599 operations were reported: 882 involved cemented fixation; 717, uncemented. Mortality outcome reporting ranged from less than 7 days to 5 years post-operation. No significant difference was observed between the two groups in mortality at any follow-up period. Study quality assessment revealed low certainty in mortality estimates. ConclusionExisting evidence indicates that cementation has no effect on mortality at any reported follow-up time period. Even with the use of evidence synthesis, the sample size remains relatively low for mortality outcomes and insufficiently powered to reliably determine differences between groups.

Comparison of functional outcomes and complications of cemented vs uncemented total hip arthroplasty in the elderly neck of femur fracture patients: A systematic review and meta-analysis

PurposeThe neck of femur fractures in the elderly is a global concern. These fractures impair the quality of living and add to morbidity and mortality. A Multitude of treatment options for the same. This systematic review focuses on evaluating outcomes between cemented and uncemented total hip replacement in the elderly population with neck of femur fractures. Material and methodsThe search was conducted in databases PubMed, Embase, Scopus, open grey, and Cochrane following PRISMA guidelines. The studies fulfilling the inclusion criteria were included, scrutinized for data analysis, and also quality appraisal of all the included studies was conducted to be included in this article. ResultsA total of 7 studies were included (2 RCT, 5 retrospective studies) comprising 1171 THRs. Data analysis showed a higher HHS in cemented compared to uncemented(p < 0.001). The uncemented group had a significantly higher rate of revision, dislocation, and periprosthetic fracture compared to cemented group(p < 0.001). However, VAS score, loosening rates, and heterotopic ossification were similar in both statistically insignificant groups. ConclusionChoosing between cemented and uncemented techniques had been a controversy with lesser data due to higher morbidity and mortality. This systematic review provides information regarding functional outcomes and complications in both groups. The cemented group had better outcomes and lesser complications which should be preferred in elderly patients as the conclusion of this study. However, a larger RCT with better follow-up is still required. Level of evidenceLevel I, systematic review and meta-analysis.

A STUDY OF OUTCOME OF MINIMUM 1 YEAR FOLLOW UP OF JOINT REPLACEMENT IN VARIOUS GOVERNMENT SCHEME (A STUDY OF 35 CASES)

The hip joint is the most important joint of the body as it enables a person to assume various postures. Diseases of this joint are always alarming because if untreated, produces serious disability, for this reason various methods of management of hip diseases have been devised, but failure of conventional management in advanced stages of hip diseases like AVN, osteoarthritis, rheumatoid arthritis, congenital subluxation or dislocation, bone tumor etc. have brought a new surgical era of Total Hip Replacement (THR). The knee joint is the largest articulation in the body. Also this is a main weight bearing joint of the body. The usual degenerative changes due to advancing age most commonly affect this joint. Diseases of this joint are alarming because if untreated it produces more and more pain and disability, for this reason various methods of management of knee joint ailments have been devised, but failure of conventional management in the advanced stage of knee arthritis have brought a new surgical era of total knee replacement. Arthroplasty is an operation to restore pain free motion to a joint and function to the muscles, ligaments and other soft tissue structures that control the joint. There has been an explosion in this eld of knowledge in recent years. Objectives: The aim of this work is to study outcomes of 1 year follow-up of joint replacement (THR+TKR) under government scheme and to study in terms of Pain relief,Range of motion, Functional improvements- To measure the functional outcomes, Complications - To evaluate short term as well as long term complication rate. Materials and Methods: This is the retrospective study operated with total hip arthroplasty and total knee arthroplasty with atleast 1 year follow up of cases belonging to various age groups and having various pathologies of hip joint and knee joint and treated with uncemented THR and cemented TKR were assessed in respect to midterm follow up. Cases were assessed in respect to postoperative results of short and long term follow up with proforma and post operative radiographs at department of Orthopaedics, Guru Gobind Singh Govt. Hospital, Jamnagar Results: TKR- Average functional score is 91.15 with 12 patients having score &gt;90. Maximum score is 100 and minimum score is 5. Average knee score is 93.5 with maximum score 99 and minimum score 88. THR- Almost all patients were walking with normal gait. Almost All (100%) patients were pursing their daily activities either normally or with minor modication in life style.82% had excellent Harris hip score.

Uncemented Total Hip Arthroplasty For Osteonecrosis of The Femoral Head in Late Diagnosed Developmental Dysplasia of The Hip: A Case Report

Background: Osteonecrosis of the femoral head (ONFH) is a disease in which local death of osteocytes and the component of the bone marrow occurs owing to venous stasis or arterial blood supply damage or interruption in the femoral head. Developmental dysplasia of the hip (DDH) is characterized by an abnormal anatomical relationship between the femoral head and acetabulum, and includes acetabular dysplasia, subluxation and in the most severe cases, development dislocation of the hip joint. Total Hip Arthroplasty (THA) is among the most successful orthopedic procedures worldwide. For acute and chronic hip diseases, THA can relieve joint pain, correct deformities, and restore and improve hip function. This study aims to understand the efficacy of Uncemented Total Hip Arthroplasty as the treatment of choice for osteonecrosis of the femoral head and late diagnosed developmental dysplasia of the hip in young adult patient. Case Report: We present a case of osteonecrosis of the femoral head and late diagnosed developmental dysplasia of the hip in a 32 years old active male. He had a history of falling trauma from a height of about 1.5 meters at the age of 12 years (20 years ago), and at that period the patient was diagnosed with right femoral head fracture and had a special condition, namely developmental dysplasia of the hip, since that incident the patient had not been looking for any treatment and was unable to walk normally and always had a limping gait. Uncemented Total Hip Replacement procedure is chosen and performed successfully with good outcomes within 16 weeks after the procedure. Discussion: Uncemented and cemented replacement had satisfactory long-term survival but they differed in their modes of failure. Patients who undergo total hip arthroplasty for osteonecrosis of the femoral head are younger and more active compared to those with osteoarthritis, showing a high likelihood of future revision procedures. Therefore, cementless applications is more appropriate alternative in young adult patient with osteonecrosis of femoral head. Conclusion: Uncemented Total Hip Arthroplasty in young adult male patients with osteonecrosis of the femoral head and late diagnosis of DDH is a suitable option and has a high level of the functional effectiveness and good material durability.

Total Hip Arthroplasty in Ochronotic Arthropathy

Ochronotic arthropathy is a rare amino acid metabolic disorder that causes arthritis knee and hip in the 4th and 5th decades of life. There are only a few documented cases in the literature. We report one such case of a 46-year-old washer man, its clinical presentation, imaging findings, intraoperative findings, and treatment by uncemented total hip replacement.

Does Cementing Influence CRP and ESR Levels after Total Hip Replacement in Early Postoperative Period? A Prospective Interventional Study

Introduction: The role of CRP and ESR in diagnosing delayed (&gt;6 weeks) periprosthetic joint infection prior to performing a revision joint arthroplasty is well established. Aim: To evaluate the effect of bone cement on C-Reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR) in the first 3 weeks after Total Hip Replacement (THR). Materials and Methods: This prospective interventional study conducted in Departemnt of Orthopaedics at Government Medical College ,Chandigarh, India, between June 2014 and December 2017. Sixteen patients who underwent an uncemented THR and 15 patients who underwent a hybrid THR were included in the study. Serum CRP and ESR were measured on the day before surgery and postoperatively on days 1, 2, 3, 7, 12, and at 3 weeks. Comparison of ESR and CRP values between the groups were performed using a Student’s t-test. Results: There was no significant difference between the two groups with respect to age, gender, indication of surgery, comorbidities, operative time and blood loss. CRP showed a peak at day two with a mean value of 203.74±46.15 mg/L in the uncemented group and a mean of 206.10±46.78 mg/L in the hybrid group, with normalisation by 3 weeks. ESR values showed a peak on day three with a mean of 94.28±5.97 mm/ hour in the uncemented group and 92.15±6.86 mm/hour in the hybrid group and remained elevated even at 3 weeks. Statistically, no significant difference was observed in CRP and ESR values after the usage of cement in total hip arthroplasty (p-value &gt;0.05 in all cases). Conclusion: Bone cement does not affect CRP or ESR values significantly in the early phase after uncomplicated total hip arthroplasty

Functional outcome in the total hip arthroplasty

Total hip arthroplasty is a surgical treatment that has been thoroughly documented. The capacity of Total Hip Replacement arthroplasty to treat pain associated with hip joint pathology while retaining mobility and stability of the hip joint is the key to its effectiveness.The goal of this study was to use the Modified Harris hip score and radiological examination to assess the clinical and functional outcomes of total hip arthroplasty.The study was carried out on 33 hips of 30 patients of Total Hip Replacement operated in the Department of Orthopedics, Vinayaka missions medical College and Hospital and Vinayaka missions Hitec Hospital, Salem, from August 2012 to September 2014. This was a retrospective as well as prospective study. Patient follow up was for a minimum of 6 weeks to a maximum of 12 months (1yr).9 patients underwent uncemented total hip replacement in which for 5 patients the acetabular cup was fixed with 2 acetabular screws each. During the procedure 1 patient had Type A2 Vancouver fracture of the proximal femur which was fixed with SS wire cerclage which united as documented by the follow up X-rays. Postoperatively, for two patients we came across dislocation due to adductor contracture, was reduced following adductor tenotomy. Patients were found to be doing normal daily activities by the follow-up. The mean overall pre-operative score was 33.3, which improved to a mean score of 94.2 after surgery.Dislocation was seen in 2 individual patients.After THR, which was conducted on a population of active individuals, 96.9% of patients experienced excellent or good pain reduction and function. When pain sufferers were included, the overall average score was 90 points, but after a minimum of five years of follow-up of 91 hips treated with the PCA prosthesis, the average score was 93 points.

Future of total hip arthroplasty with the Metha short stem in modern surgeries

The aim of the study was to analyse the results of uncemented total hip replacement, using the Metha (metaphyseal) stem. A total of 158 patients (70 females and 88 males) were qualified to the study and submitted to total hip arthroplasty (183 procedures altogether), using the Metha stem. The mean age of the patients on the day of surgery was 51.7 years (the range from 17 to 69 years). The mean follow up period was 9.2 years (the range from 5 to 13.5 years). Preoperative assessments gave poor scores, according to the Merle d’Aubigne and Postel classification, modified by Charnley. The average improvement after surgery, according to the used scale, was 6.9 points. A very good outcome was recorded in 154 cases (84.2%), a good outcome was achieved in 20 cases (10.9%) and a poor outcome was confirmed in 9 cases, while no satisfactory case was observed. Poor outcomes were associated with implant loosening. Extraskeletal ossification was noted in 10 cases (5.5%). According to the Kaplan–Meier estimator, the 10-year survival was 93.2% and 97.3% for the whole implant and the stem alone, respectively. 1. Our follow-up period of more than 9 years on the average, indicates that Metha stems produce excellent clinical and functional results in operated young patients with advanced degenerative changes of the hip joint. 2. Assuming a proper qualification for the procedure, the absence of complications and a correct surgical technique, which is slightly more difficult, when compared to standard stem implantation, the risk of aseptic loosening is fairly negligible.