Assessment of clinical and functional outcomes following uncemented total hip arthroplasty in failed primary hemiarthroplasty
Keywords:Radiological assessment, Total hip arthroplasty, Failed primary hemiarthroplasty, Acetabular inclination angle
Background: Modern hip replacement has resulted in huge benefit for patients with arthritic hip disease, providing them with reduction of pain, return of function and consequently an improved quality of life. Evaluation of long term outcomes of an operative procedure is important to determine the durability of the procedures like uncemented total revision hip arthroplasty. In the present study, clinical and functional outcome and complications of uncemented total hip arthroplasty in failed primary hemiarthroplasty was assessed.
Methods: Patients with failed primary hemiarthroplasty with Unipolar or Bipolar prosthesis (cemented and uncemented) due to aseptic loosening, protrusio causing groin pain, dislocation, breakage of implant leading to loss of function, periprosthetic fracture and acetabular osteolysis were included. During each visit, medical history was taken and physical examination was done. Range of movements (ROM) was recorded. The clinical and functional outcomes were evaluated by Harris Hip Score evaluation. Statistical analysis: Student’s paired t-test was used to find out the significance of difference between pre-operative and post-operative Harris Hip scores.
Results: In 7 cases modular series was used for uncemented total hip arthroplasty, of which calcar replacement was done in 4 cases, and in one case constrained liner was placed. The maximum stem size used was 15mm and the minimum stem size 11mm. Stem size 11 was most frequently used. About 30% of the cases presented with pain postoperatively till the last follow-up, of which two cases reported mild pain with no effect on average activities and one case reported with moderate pain with some limitation of ordinary activity or work. The difference between the average pre-operative Harris Hip Score post-operative score was found to be highly significant (p=0.0001).
Conclusions: This study has shown excellent results following the uncemented modular total hip arthroplasty in failed primary hemiarthroplasty in terms of pain relief, increased walking distance, and functional capabilities of the patients.
Bhosale P, Suryawanshi A, Mittal A. Total hip arthroplasty for failed aseptic Austin Moore prosthesis. Indian J Orthop. 2012;46(3):297-303.
Pankaj A1, Malhotra R, Bhan S. Conversion of failed hemiarthroplasty to total hip arthroplasty: A short to mid-term follow-up study. Indian J Orthop. 2008;42(3):294-300.
Hunter GA, Welsh RP, Cameron HU, Bailey WH. The results of revision of total hip arthroplasty. J Bone Joint Surg. 1979;61:4.
Ilinas A, Sarmiento, William J. Total hip replacement after failed hemiarthroplasty or mould arthroplasty, Comparision of results with those of primary replacements. J Bone Joint Surg. 1991;73(6):902-7.
Hooper GJ, Rothwell AG, Stringer M, Frampton C: Revision following cemented and uncemented primary total hip replacement: A seven-year analysis from the New Zealand joint registry. J Bone Joint Surg. 2009;91(4):451-8.
Faroug R, Shah Y, Michael JH. Carthy M, Halawa M. Two stage one component revision in infected total hip replacements- two case reports and literature review. Hip Int. 2009;19(3):292-8.
Rogers M, Blom AW, Barnett A, Karantana A, Bannister GC. Revision for recurrent dislocation of total hip replacement. Hip Int. 2009;19(2):109-13.
Engelbert DJ, Weber FA, Jakim I. Long term results of revision total hip arthroplasty. J Bone Joint Surg. 1990;72:41-5.
Jones JM, Cardiff, Wales. Revisional total hip replacement for failed ring arthroplasty - from department of orthopaedic surgery. J Bone Joint Surg. 1979;61:7-14.
Manley M, Ong K, Lau E, Kurtz SM. Effect of volume on total hip arthroplasty revision rates in the United States Medicare population. J Bone Joint Surg. 2008;90:11-8.
Peters CL, Rivero DP, Kull LR, Rosenberg AG. Revision total hip arthroplasty without cement: Subsidence of proximally porous-coated femoral components. J Bone Joint Surg. 1995;77:8-14.
Ash SA, Callaghan JJ, Johnston RC, Moines D. Revision total hip arthroplasty with cement after cup arthroplasty, long term follow-up. J Bone Joint Surg. 1996;78:1-8.
Chen WM, McAuley JP, Engh A, Hopper RH, Engh CA. Extended slide trochanteric osteotomy for revision total hip arthroplasty. J Bone Joint Surg. 2000;82:9-16.