Uncemented Total Hip Replacement Research Articles

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.

Surgical management of avascular necrosis of femoral head in young adults treated with uncemented total hip replacement

<p class="abstract"><strong>Background: </strong>Normal hip joint is subjected to many stresses during daily activities performed by an individual. Since it is one of the major weight bearing joints of the body, its normal function is necessary for daily activities. Avascular necrosis (AVN) of the femoral head is one of the common causes of painful hip in a young adult. Core decompression, fibular sturt graft can be considered in early stages, total hip arthroplasty in later stages of AVN of femoral head.</p><p class="abstract"><strong>Methods:</strong> This is a retrospective study of 30 patients following uncemented total hip replacement, who were operated between August 2017 and March 2020 at MNR medical college and hospital, Sangareddy. They were followed up for a minimum period of 1 year and evaluated using Harris hip scoring system. Harris hip score is designed specifically for measuring functional outcomes in hip arthroplasty.</p><p class="abstract"><strong>Results: </strong>There was a significant improvement in function as measured with the Harris hip score. The overall preoperative Harris hip score was 43, which remarkably improved to 89 postoperatively. The results observed, showed that all patients had good to excellent results, (Harris hip score ≥0) thus showing a good degree of pain relief, improvement in function and range of motion.</p><p class="abstract"><strong>Conclusions: </strong>Although the use of total hip arthroplasty in young patients will more likely necessitate future revision surgery, the consistent relief of pain and good functional results have made this procedure an attractive treatment choice for the debilitating arthritis resulting from osteonecrosis of the femoral head. </p>

Uncemented versus cemented arthroplasty after metal-on-metal total hip replacement in patients with femoral neck fractures: a retrospective study.

ObjectiveTo compare the clinical outcomes of primary metal-on-metal total hip replacement (MoM-TR) converted to uncemented total hip replacement (UTR) or cemented total hip replacement (CTR) in patients with femoral neck fractures (AO/OTA: 31B/C).MethodsPatient data of 234 UTR or CTR revisions after primary MoM-TR failure from March 2007 to January 2018 were retrospectively identified. Clinical outcomes, including the Harris hip score (HHS) and key orthopaedic complications, were collected at 3, 6, and 12 months following conversion and every 12 months thereafter.ResultsThe mean follow-up was 84.12 (67–100) months for UTR and 84.23 (66–101) months for CTR. At the last follow-up, the HHS was better in the CTR- than UTR-treated patients. Noteworthy dissimilarities were correspondingly detected in the key orthopaedic complication rates (16.1% for CTR vs. 47.4% for UTR). Statistically significant differences in specific orthopaedic complications were also detected in the re-revision rate (10.3% for UTR vs. 2.5% for CTR), prosthesis loosening rate (16.3% for UTR vs. 5.9% for CTR), and periprosthetic fracture rate (12.0% for UTR vs. 4.2% for CTR).ConclusionIn the setting of revision of failed primary MoM-TR, CTR may demonstrate advantages over UTR in improving functional outcomes and reducing key orthopaedic complications.

Total Hip Replacement in Sickle Cell Disease Patients with Avascular Necrosis of Head of Femur: A Retrospective Observational Study

BackgroundFemoral head avascular necrosis leads to osteoarthritis of the hip joint and affects its functional capacity in sickle cell disease patients. The functional outcomes of total hip replacement (THR) on patients with congruous joints who underwent hip replacement after having a failed joint preservation surgery are unknown. This study aimed to compare the functional outcomes of THR in patients with sickle cell disease having avascular necrosis with and without loss of hip joint congruency.MethodsThis retrospective study included 35 patients (age, 20–52 years; 18 males and 17 females) who underwent uncemented THR. Patients were divided into Group-A (n = 18, good hip joint congruency) and Group-B (n = 17, obliterated hip joint congruency). The Harris Hip Score (HHS) was used to assess functional outcomes. All patients were followed up at 6-weekly intervals then 6-monthly intervals.ResultsThe mean follow-up period was 8.26 ± 3.01 years. The mean preoperative HHSs of Group-A and Group-B were 45.22 ± 3.021 and 25.94 ± 4.437, respectively. Postoperatively, a subsequent increase in HHS was found in both groups, and a significant difference between the groups was observed at 6 weeks (p < 0.0001*) and 1 year (p < 0.0006*). Interestingly, HHS was not significantly different (p = 0.0688) at 5-year follow-up between the groups. The differences in HHS within the group at each subsequent follow-up were also statistically significant (ANOVA, p < 0.0001*).ConclusionA significant improvement was observed with THR in both groups. Nevertheless, the flattened hip joint congruency group showed significantly better HHS improvements than the normal congruency groups. These findings may aid in the decision-making capabilities of the surgeons.

Functional outcome of total hip replacement in degenerative arthritis, a prospective study

A prospective study conducted on 39 hips of 30 degenerative arthritis patients with mean age of 39years (range 20-70yrs) who underwent uncemented total hip replacement performed in the Department of Orthopaedics, Sanjay Gandhi Institute of Trauma and Orthopaedics, Bangalore during 18months period from November 2014 to April 2016.In our study, 70% were males & 30% females. 85% patients had secondary osteoarthritis and 15% had primary osteoarthritis of hip. Mean follow up was 10.13months (3-16 months). Functional evaluation using modified harris hip score showed excellent results in 97% hips and good results in 3% hips. 10% of patients had complications. In Conclusion, the current generation of uncemented Prosthesis used in the total hip replacement for degenerative arthritis of hip, provides satisfactory clinical and radiographical outcomes after a short duration of follow up. Even though the study was not free of complications, the overall functional and radiological outcome showed excellent results.

The Proximal Femoral Bone Geometry in Plain Radiographs.

Osteoporosis represents the most common bone disease and has to be respected in planning total hip replacement, especially against the background of increasing uncemented total hip replacement. In this context, the radiographic geometry of the proximal femur got into focus and is controversially discussed.The aim of the presented study was to find any difference regarding known indices for proximal femur bone geometry between patients with high-grade osteoarthritis and patients suffering from a femoral neck fracture caused by low impact trauma. Retrospective matched-paired analysis of 100 plane pelvic radiographs from 50 patients who suffered from high-grade hip osteoarthritis and 50 patients who suffered from femoral neck fracture was performed. Measurement of Canal-Bone Ratio (CBR), Canal-Calcar Ratio (CCR), Mineral Cortical Index (MCI) and Canal Flare Index (CFI) were performed. CBR was significantly higher in the fracture-group (0.45 +/- 0.06 vs. 0.41 +/- 0.08) (P-value= 0.008). Moreover, the femoral thickness 10 cm below the trochanter minor [F] was significantly higher in the osteoarthritis-group (34.68 +/- 4.14 vs 32.11 +/- 3.43) (P-value 0.001). In conclusion, patients with a femoral neck fracture demonstrated a higher CBR, which indicates a poorer bone quality. In case of planning a THA, the CBR is an index which can easily be measured and can be seen as one decision criterion in THA regarding fixation technique.

Cemented versus uncemented total hip replacement for femoral neck fractures in elderly patients: a retrospective, multicentre study with a mean 5-year follow-up

BackgroundCemented or uncemented total hip replacement (CTR or UTR) for femoral neck fractures (AO/OTA type 31B/C) is a relatively common procedure in elderly individuals. The recent literature is limited regarding long-term outcomes following CTR versus UTR in the Asian population.MethodsUsing our institutional database, we performed long-term outcome analysis on 268 patients with femoral neck fractures (AO/OTA type 31B/C) who had undergone a primary UTR or CTR (CTR: n = 132, mean age, 67.43 ± 6.51 years; UTR: n = 136, mean age, 67.65 ± 6.13 years) during 2007–2014, and these patients were followed until 2019. Follow-up occurred 1, 3, 6, and 12 months postoperatively and yearly thereafter. The primary endpoint was the Harris hip score (HHS); the secondary endpoint was the incidence of orthopaedic complications.ResultsThe mean follow-up time was 62.5 months (range, 50.1–76.1 months). At the final follow-up, the HHS was 79.39 ± 16.92 vs 74.18 ± 17.55 (CTR vs UTR, respectively, p = 0.011). Between-group significant differences were observed regarding the incidence of prosthesis revision, prosthesis loosening, and periprosthetic fracture (7.6% [95% CI, 6.4–8.2] for CTR vs 16.9% [95% CI, 14.7–17.3] for UTR, p = 0.020; 9.8% [95% CI, 8.3–10.7] for CTR vs 19.9% [95% CI, 18.2–20.9] for UTR, p = 0.022; 5.3% [95% CI, 4.4–6.7] for CTR vs 13.2% [95% CI, 12.1–13.8] for UTR, p = 0.026, respectively).ConclusionCTR showed superiority to UTR by improving the HHS and decreasing the incidence of orthopaedic complications. Our findings need to be confirmed in a prospective, randomized controlled study to verify whether they can be applicable to a broader population.

A prospective study on cancer risk after total hip replacements for 41,402 patients linked to the Cancer registry of Norway

BackgroundConcerns have been raised that implants used in total hip replacements (THR) could lead to increased cancer risk. Several different materials, metals and fixation techniques are used in joint prostheses and different types of articulation can cause an increased invasion of particles or ions into the human body.MethodsPatients with THR registered in the Norwegian Arthroplasty Register during 1987–2009 were linked to the Cancer registry of Norway. Patients with THR due to osteoarthritis, under the age of 75 at time of surgery, were included. Standardized incidence ratios (SIR) were applied to compare cancer risk for THR patients to the general population. Types of THR were divided into cemented (both components), uncemented (both components), and hybrid (cemented femoral and uncemented acetabular components). To account for selection mechanisms, time dependent covariates were applied in Cox-regression, adjusting for cancer risk the first 10 years after surgery. The analyses were adjusted for age, gender and if the patient had additional THR-surgery in the same or the opposite hip. The study follows the STROBE guidelines.ResultsComparing patients with THR to the general population in Norway we found no differences in cancer risk. The overall SIR for the THR-patients after 10 years follow-up was 1.02 (95% CI: 0.97–1.07). For cemented THR, the SIR after 10 years follow-up was 0.99 (95% CI: 0.94–1.05), for uncemented, 1.16 (95% CI: 1.02–1.30), and for hybrid 1.12 (95% CI: 0.91–1.33). Adjusted Cox analyses showed that patients with uncemented THRs had an elevated risk for cancer (hazard ratio: HR = 1.24, 95% CI: 1.05–1.46, p = 0.009) when compared to patients with cemented THRs after 10 years follow-up. Stratified by gender the increased risk was only present for men. The risk for patients with hybrid THRs was not significantly increased (HR = 1.07, 95% CI: 0.85–1.35, p = 0.55) compared to patients with cemented THRs.ConclusionsTHR patients had no increased risk for cancer compared to the general population. We found, however, that receiving an uncemented THR was associated with a small increased risk for cancer compared to cemented THR in males, but that this may be prone to unmeasured confounding.

Defining the Most Effective Patient Blood Management Combined with Tranexamic Acid Regime in Primary Uncemented Total Hip Replacement Surgery.

The application of patient blood management (PBM) combined with tranexamic acid administration (TXA) results in decreased total blood loss volume (TVB) and transfusions in total hip replacements (THRs). Dosages, timing, and routes of administration of TXA are still under debate as all these aspects, as well as interpatient variations, may affect the efficacy of the protocol. This study aims to examine the effectiveness of timing and route of administration of TXA in combination with PBM by reducing the TBV following THR surgery. Consecutive primary uncemented THRs operated by a single surgical and anaesthetic team had the data prospectively collected and then retrospectively studied. Five treatment groups were formed, reflecting the progressive evolution of our protocol. Group 1 included patients managed with PBM alone (preoperative erythrocyte mass optimisation to at least 14 g/dL haemoglobin (Hb), hypotensive spinal anaesthesia and restrictive red blood cell transfusion criteria). Group 2 included patients with PBM and topical 3 g TXA diluted in normal saline to a total volume of 50 mL. Group 3 were patients with PBM and an IV dose of 20 mg/kg TXA at induction, followed by 20 mg/kg TXA as a continuous infusion for the duration of the operation. Group 4 consisted of patients managed as per Group 3 plus another 20 mg/kg TXA at three-hour post-procedure. Group 5 (combined): PBM and IV TXA as per Group 4 and topical TXA as per Group 2. A generalised linear model with the treatment group as an independent variable was modelled, using TBV as the dependent variable. The transfusion rate for all groups was 0%. TBV at 24 h, oscillated from 613.5 ± 337.63 mL in Group 1 to 376.29 ± 135.0 mL in Group 5. TBV at 48 h oscillated from 738.3 ± 367.3 mL (PBM group) to 434 ± 155.2 mL (PBM + combined group). The multivariate regression model confirmed a significant decrease of TBV in all groups with TXA compared with the PBM-only group. Overweight and preoperative Hb were confirmed to significantly influence TBV. The optimal regime to achieve the least TBV and a transfusion rate of 0% requires PBM and one loading 20 mg/kg dose of TXA, followed by continuous infusion of 20 mg/kg for the duration of the operation in uncemented THRs. Additional doses of TXA did not add a clear benefit.

Dynamic trial fitting by an expanding trial cup does not jeopardize primary acetabular component stability

BackgroundTrial fitting of the acetabular component in uncemented total hip replacement is traditionally done by trial cups. Since trial cups do not resemble the real press-fit obtained by the definitive cup, a dynamic trial inserter, called the X-pander ®, was developed to mimic the real amount of press-fit. However, the concern is raised of losing the initial press-fit by using the X-pander® due to pre-expansion of the acetabulum. The purpose of this study was to assess if there is a difference in primary stability between both methods. MethodsA biomechanical randomized study was performed with bovine calf acetabula, with randomization between either using the X-pander® or the traditional trial cups to assess primary stability. The primary outcome was the force needed to achieve lever out of the implanted cup (Anexys, Mathys or Trident, Stryker), measured in Newton meter (Nm) with a biomechanical testing set up. FindingsIn total, 54 cups (19 Anexys, 35 Trident) were inserted and tested after randomized trial fitting. Overall mean lever out was 45.1 Nm (SD 14.6) for the X-pander® group and 45.0 Nm (SD 14.5) for the trial cups group. After adjustment for potential confounders (cup size and type) mixed model analysis did not reveal a significant difference in lever out force between both testing devices (mean 1.0 Nm, 95%CI (−5.9; 8.0), p = .77). InterprationInitial press-fit of the implanted cup is not lost by pre-expansion as done with dynamic trial fitting with the X-pander®.

Cortical Strut Graft for Enigmatic Thigh Pain in Uncemented Total Hip Replacement.

AimsEnigmatic thigh pain in uncemented femoral components of a total hip replacement can be severe and disabling. Treatment can be conservative or surgical with cortical strut graft or revision of the femoral stem. Cortical strut grafting may offer good results with reduced morbidity. The aim of this study was to report the functional and radiographic outcomes of four patients with enigmatic thigh pain treated with cortical strut allograft.Materials and MethodsBetween 2016 and 2018, four women underwent cortical strut allografting at two centres. All patients had an uncemented, proximally porous S-ROM femoral implant (DePuy, Warsaw, In, USA). All other causes of anterolateral thigh pain were excluded. The mean age was 36.7 years (range: 29-51 years). Patients were followed up for a minimum of 14 months (range: 14-38 months). The University of California, Los Angles (UCLA) activity score, pain scores, complications, and radiographs at six weeks, three months, six months, nine months and one year were recorded.ResultsMean UCLA activity scores increased from 3.2 (range: 2-4) to 6.2 (range: 6-7) post-operatively. Radiologically, all four patients had complete osseointegration of their strut grafts. Pain scores decreased at six weeks and at six months. One deep venous thrombosis occurred. One patient experienced recurrence of anterolateral thigh pain 26 months post-strut graft, which resolved with protected weight-bearing and analgesia for three months.ConclusionsIn uncemented femoral prostheses, cortical strut grafting to treat enigmatic thigh pain can reduce symptoms and increase activity without the need to revise a well-fixed femoral stem. We add to the growing body of evidence that this can be a successful surgical technique.

Assessment of Functional Outcome between Cemented and Uncemented Total Hip Replacement: A Comparative Study

Assessment of Functional Outcome between Cemented and Uncemented Total Hip Replacement: A Comparative Study

Functional outcome of uncemented total hip replacement in AVN femoral head- A prospective study

Functional outcome of uncemented total hip replacement in AVN femoral head- A prospective study

How deep acetabular cup can be positioned from transverse acetabular ligament to have an ideal inclination?

Introduction: Acetabular component positing is the major deterministic step that defines the outcome following total hip replacement. Although various methods exist to measure and maintain cup inclination, intraoperative landmarks always guide to get the individual native inclination. This study aims to estimate the safe cup depth from the transverse acetabular ligament to get an ideal cup inclination.Methodology: This is a prospective study conducted between 2017-2019. Patients who underwent uncemented total hip replacement for reasons other than hip dysplasia were included in the study. Modified Hardinge approach was used in all the cases. Archbold grading of TAL was done intra-operatively. The distance of the inferior rim of the cup to the TAL is measured and cup inclination is measured in post-operative radiograph with reference to the inter-teardrop line in anteroposterior radiograph of the hip. Correlation between cup depth and inclination is calculated by Spearman’s correlation and regression curve analysis was used to analyze the results. Results: We included 35 patients in our study and TAL was identified in all the cases and the mean radiological inclination achieved was 41.4o (SD=7.15) and the mean distance from TAL noted was 4.2 mm (SD=2.73). 85.7% of the cups were within the safe zone target of 300 to 500. There was a significant positive correlation between the cup depth and inclination angle (r=0.93, p

A study to assess functional outcome of cemented and uncemented total hip replacement in a tertiary care center

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Total hip replacement (THR) is the most successful and cost effective treatment with aim of pain relief and functional rehabilitation for hip disorders. As the implant designs of THR have evolved over time, the functional outcome and survivorship has improved. Even after so many advancements, it remains unclear that which implants are better, uncemented or cemented. Hence, we took up this study to analyze which of the uncemented or cemented THR have better functional outcome.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was a longitudinal study conducted during 2014 to 2018. Hundred cases were randomized into groups of 50 each. All patients with age between 55-80 years in whom THR was indicated were included in the study. Uncemented THR was done in Group A and cemented THR was done in Group B. Patients were followed up at 12 weeks, 6 months, 12 months, and 3 years. At follow-up, functional examination in terms of visual analogue scale (VAS) score and Harris hip score (HHS) was done.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The mean age of patients in Group A (uncemented) and Group B (cemented) was 62.5 years and 60 years respectively. We found that the difference of VAS score and HHS between Group A and B was statistically significant at 12 weeks and 6 months. The difference of VAS and HHS scores between Group A and B at 12 months and 3 years was not significant.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; We conclude that cemented THR has better functional outcome at short term. They are cost effective option at age ≥55-60 years.&lt;/p&gt;

Risk factors for early revision after total hip and knee arthroplasty: National observational study from a surgeon and population perspective.

AimsTo identify predictors of early revision (within 3 years of the index operation) for hip and knee replacement (HR, KR) from both surgeon and population perspectives.Patients and methodsHierarchical logistic regression on national administrative data for England for index procedures between April 2009 and March 2014.ResultsThere were 315,273 index HR procedures and 374,530 index KR procedures for analysis. Three-year revision rates were 2.1% for HR and 2.2% for KR. The highest odds ratios for HR were for 3+ previous emergency admissions, drug abuse, Parkinson’s disease, resurfacing and ages under 60; for KR these were patellofemoral or partial joint replacement, 3+ previous emergency admissions, paralysis and ages under 60. Smaller effects were found for other comorbidities such as obesity (HR) and diabetes (KR). From a population perspective, the only population attributable fractions over 5% were for male gender, uncemented total hip replacements and partial knee or patellofemoral replacements.ConclusionsMeeting the rising demand for revision surgery is a challenge for healthcare leaders and policymakers. Our findings suggest optimising patients pre-operatively and improving patient selection for primary arthroplasty may reduce the burden of early revision of arthroplasty. Our study gives useful information on the additional risks of various comorbidities and procedures, which enables a more informed consent process.Clinical relevanceSurgeons should make patients with certain risk factors such as age and procedure type aware of their higher revision risk as part of shared decision-making.

Secondary osteoarthritis hip in young individuals managed with primary uncemented total hip replacement using ha-coated conventional stem and acetabular component

Background: The management of young individuals seeking medical attention due to progressive hip pain as a result of secondary osteoarthritis and who want active and pain-free hip was challenging in past. The actual incidenece of secondary osteoarthritis is difficult to ascertain. Young individuals with secondary osteoarthritis hip due to developmental dysplasia of hip, coxa plana (Legg-Calvé-Perthes disease), post-traumatic, slipped capital femoral epiphysis, Paget disease, Haemophilia, Avascular necrosis of femoral head, and so on can be effectively managed with primary uncemented total hip replacement (THR) with good functional outcome in short-term follow-up. This will increase the revision THR rate later. Long-term follow-up is required to watch for prosthesis-related complications Materials and Methods: Material includes 64 patients who attended our OPD from Oct 2013 to Dec2017 and all of them were diagnosed to have secondary osteoarthritis hip with poor hip function as assessed by Harris hip score. All of them underwent uncemented total hip replacement (THR) through posterior/anterolateral approach to hip. Conventional HA-coated stem and acetabular components were used. They were post-operatively assessed at regular intervals with Harris hip score and were found to have excellent functional outcome with high level of patient satisfaction. Result: All patients have excellent Harris hip scorepost-operatively. Patients became independent and were able to carry out day-to-day activities with ease. No complications were noticed. The dramatic change in their hip function was appreciable even on the day of surgery itself. Conclusion: We conclude that uncemented THR using conventional HA-coated components is an excellent surgical modality for the management of secondary osteoarthritis in young individuals with poor hip function. The functional outcome is promising and makes patient independent and pain free. The said procedure is cost-effective and reliable based on excellent hip function achieved in immediate post-operation. Long-term follow-up is recommended.

A prospective study to evaluate the clinical and functional outcome of uncemented total hip replacement in avascular necrosis of femoral head in adults

Background: Osteonecrosis, also referred to as avascular necrosis (AVN), aseptic necrosis, and ischemic necrosis, is not a specific disease but rather a condition in which a circumscribed area of bone becomes necrotic as a result of a loss of its blood supply. The femoral head is the site most often affected. A number of procedures have been described to accomplish this. Total hip replacement is a reconstructive surgical procedure that provides stability, better quality of life and mobility in patients suffering from hip disorders thus eliminates pain and restore functions of hip. In hip arthroplasty, the acetabulum, femoral head and proximal neck is replaced with metal shell, plastic liner and metal ball.Purpose: To evaluate the clinical, functional, radiological outcome and the complications of uncemented total hip replacement in avascular necrosis of femoral head in adults.Materials and Methods: This prospective study done in the Department of Orthopaedics, Post Graduate Institute of Swasthiyog Prathistan, Miraj, from February 2013 to February 2014. We included the patients of avascular necrosis of femoral head, in the age group of 30 to 60 years.Results: 36 hips of 30 patients with avascular necrosis of femur head who underwent uncemented Total Hip Replacement admitted during above period after evaluating clinically and radiologicallyHarris Hip Score was used to measure the functional outcome. 36.11 % of the patients were found to be in the 50 and above age group, with age ranging from 30 to 60 years and a mean age of 43.8 years. Majority, 27 (75%) were males and 9 (25%) were females. Excellent or good pain relived and function were obtained in 86.01%. The mean total preoperative score was 34.61, which improved postoperatively to a mean score of 90.83. In the scoring system ie, pain, gait, functional activity and ROM, there was a statistically significant improvement (‘p’ value of

Randomised clinical trial assessing migration of uncemented primary total hip replacement stems, with and without autologous impaction bone grafting.

Uncemented stems in primary total hip replacement (THR) are concerning in the elderly due to ectatic femoral canals and cortical thinning resulting in higher incidence of fracture and subsidence in this population. To obviate this concern, the authors developed a technique using autologous impaction bone grafting to achieve a better fitting femoral stem. The aim of this randomised clinical trial was to assess the efficacy of the technique. From 2013 to 2015, a total of 98 consecutive participants (100 primary THR procedures) were inducted into a single-institution, single-blinded, randomised clinical trial assessing, with radiostereometric analysis (RSA), the efficacy of autologous impaction bone grafting in uncemented primary THR compared with traditional uncemented primary THR technique. The primary outcome measure was femoral component migration using RSA. Secondary outcomes were post-operative proximal femoral bone density (using DEXA), hip function and quality of life using Oxford Hip Score (OHS) and Short Form-12 Health Survey (SF-12), hip pain and patient satisfaction. There was no difference in femoral component stability (p > 0.5) or calcar resorption between the Graft and No Graft Groups at two years. There was also no difference in OHS, SF-12, pain or satisfaction between the Graft and No Graft Groups at two years (p > 0.39). Autologous impaction bone grafting in uncemented primary THR has shown its short-term post-operative outcomes to be equivalent to standard uncemented technique, whilst offering a better fit in patients who are between femoral stem sizes. ACTRN12618000652279.