Syed Saad Kadri¹, S Anjaiah^2*

^1,2Consultant, Department of Orthopaedic, Sai Sanjeevni Hospital, Kothapeth Hyderabad, Telangana, INDIA.

Email: dr.syedsaad@gmail.com

RESULTS

In present study, 70 patients underwent THA were studied. Mean age was 52.73 ± 11.82 years, majority were male (72.86 %). Common indication for THA were Avascular necrosis due to Chronic Alcoholism (30 %), Idiopathic Avascular Necrosis (22.86 %), Osteoarthritis (21.43 %), Steroid Induced (8.57 %) and Post Traumatic AVN (7.14 %). anterior thigh pain (10 %), superficial infection (7.14%), stress shielding (7.14 %), nerve injury (4.29 %) and dislocation (1.43 %).

Table 1: General characteristics

Preoperative Modified Harris hip Scores were Poor, Fair and Good in 88.57 %, 8.57 % and 2.86 % patients respectively. While Post -operative (at 1 year follow-up) Modified Harris hip Scores were excellent, Good and fair in 82.86 %, 14.29% and 2.86 % patients respectively.

Table 2: Comparison of the preoperative versus postoperative Harris Hip scores

We compared various parameters of the Modified Harris hip Score System (Pain, gait, activity, Absence of deformity, ROM score and Total Score). Postoperative (at 1 year follow-up) scores were better than Preoperative scores and difference was statistically significant.

Table 3: Preoperative and postoperative scores according to the various parameters of the Modified Harris hip Score System

DISCUSSION

Despite the high frequency of the injury, the way in which displaced femoral neck fractures in elderly patients should be managed surgically remains uncertain.⁴ Studies have identified several potential benefits of total hip arthroplasty over hemiarthroplasty, including superior functional outcome scores, decreased pain, improved ambulation, and lower reoperation rates.⁵ 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. Meta-analyses of studies involving patients with a displaced hip fracture have suggested that total hip arthroplasty results in fewer reoperations and substantially better function than hemiarthroplasty.^6,7 With the advancements in implant designs, materials, fixation techniques, modern operation theatre facilities etc., the outcome of THA have improved significantly. Four types of prosthesis are being used: cemented (cemented cup and stem), cementless (cementless cup and stem), hybrid (cementless cup and cemented stem), and reverse hybrid (cemented cup and cementless stem).⁸ Hossain T et al.,⁹ studied 48 patients, 58.33% (n=28) patients were under the age of 55, 95.9% of cemented implants survived a 10 years in patients aged ≥75 years compared with 93% of uncemented, 93.9% of hybrid and 93.2 % of reverse hybrid. The survival of cemented replacements in patients aged 55 to 64 years was similar. Latiful Bari et al.,¹⁰ conducted study on 500 patients with age ranging from 25 to 65 years, main indication for surgery was AVN in 360 patients (72%). The mean total pre-operative Harris hip score was 49.74. Post operatively the total mean score was 85.12, (range 65- 96). The most common complication was stress shielding (24%). Acetabular component loosening was seen in 2% cases and femoral stem loosening was found in 12% cases. Calcar resorption was present in 8% cases. Total hip Arthroplasty with or without cement gives good clinical and functional outcomes and is decided by multiple factors, like indication for total hip Arthroplasty, placement of prosthesis, and therefore the operative technique. In study by Bansal A et al.,¹¹ 89 were male and 26 were female. The mean age was 38 years. More than 62% patients with less than 40 years. Functional outcome was assessed by Harris Hip score was excellent in 90.5% and good in 9.5%. THA is an excellent procedure to achieve painless, mobile, stable hip in cases with advanced hip problems. Vinjamuri ARS et al.,¹² studied 33 hips of 30 patients of Total Hip Replacement, 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. 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. In study by Ganesan G Ram et al.,¹³ 31 patients who had 38 cemented (or) cementless hip prosthesis for non-traumatic indications were followed for 5-13 yrs. The mean Harris hip score at latest follow up of both cemented and uncemented total hip replacement were 88 and 89 respectively, results were better in patients with avascular necrosis followed by Osteoarthritis and Rheumatoid arthritis. Uncemented group had 95% excellent/good results while in case of cemented group 82% had excellent/good results. Uncemented and cemented total hip replacement give equally good results in non-traumatic indications. P. Thiagarajan¹⁴ studied 140 cases, equally divided into Group 1 (cemented THR) and Group 2 (uncemented THR). In cemented group, majority of the cases were avascular necrosis 24(34%) followed by fracture neck of femur 10 (14%), fracture-dislocation of hip 6 (8%) and in uncemented group, maximum cases were avascular necrosis 36 (51%) followed by fracture neck of femur 21 (30%) and fracture-dislocation of hip 14 (20%). post-operatively Harris hip score among cemented group was 82.41±7.2 at 6 weeks followed by 81.31±7.5 in uncemented group and this difference was found to be statistically significant at p value 0.001. Cemented implants showed better functional outcomes than uncemented in total hip arthroplasty at 6 weeks, 3 months and at 6 months. Incorrect positioning of the implant and improper alignment of the limb following total knee arthroplasty (TKA) can lead to rapid implant wear, loosening, and suboptimal function. Studies suggest that alignment errors of > 3° are associated with rapid failure and less satisfactory function.¹⁵ In response to the problem of loosening of the stem and cup based on the alleged failure of cement, press‑fit, porous‑coated, and hydroxyapatite‑coated stems and cups have been investigated as ways to eliminate the use of cement and to use bone ingrowth or on growth as a means of achieving durable skeletal fixation. Many different techniques have evolved to improve cemented femoral fixation, including injection of low‑viscosity cement, occlusion of the medullary canal, reduction of porosity, pressurization of the cement, and centralization of the stem.¹⁶ The CT scan is a more accurate measurement of the acetabular cup version and shows a good outcome of our unassisted manual cup positioning. Mervinrosario PM et al.,¹⁷ noted that 90% of the acetabular implants were in the acceptable range of version. Among the rest, one episode of dislocation occurred and a few cases had decreased range of motion. 97.8% (45 patients) had an excellent functional outcome.

CONCLUSION

Total hip Arthroplasty gives good functional outcomes at 1 year follow up. Factors such as indication for total hip Arthroplasty, placement of prosthesis, operative technique, post-operative immobilsation play important roles in outcome of surgery.

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