Abstract
30 patients with diseased hips were treated with uncemented total hip replacement with a 36 mm femur head using a ceramic on ceramic bearing at a tertiary care hospital.
Patients aged 30 years and above were included in the study with the oldest patient being 75 years. The most common indication for surgery was secondary osteoarthritis of the hip joint due to avascular necrosis of the femur head (21 patients). Other causes were primary osteoarthritis of the hip(3 patients),intermediate stage of avascular necrosis of femur head which had not progressed to the stage of osteoarthritis (2 patients), osteoarthritis post old history of trauma(2 patients) , osteoarthritis post healed tuberculosis of the hip(1 patient), and ankylosing spondylitis (1 patient) .
A thorough clinical and radiological examination was performed. All the patients were advised to do isometric quadriceps exercise 8 hours after surgery. Patients were made to sit up on 1st post-operative day and adviced knee bending exercises. Patients were made to stand up and walk on 1stpost-operative day non weight bearing or partial weight bearing as tolerated. Sutures were removed on 12th post operativeday. Average duration of stayin hospital was 5 days. The duration of follow up was till 18 months. Patients were assessed by the modified Harris Hip Score and WOMAC score after 12 and 18 months post op. All the patients were followed up regularly, no patients were lost for follow up.There was no complication during the period of study.
The mean Modified Harris Hip Score increased significantly from 26.6 pre operatively to 89.3 post operatively at 12 months and 90.0 at 18 months.
The mean WOMAC score has decreased significantly from 70.5 pre operatively to 14.8 post operatively at 12 months and 14.2 at 18 months.
This proves that uncemented total hip arthroplasty done with a 36 mm femur head and a ceramic on ceramic bearing gives excellent results.
References
- Finerman GAM, Dorey FJ, Grigoris P, McKellop HA. Commentary. In: Finerman GAM, Dorey FJ, Grigoris P, Mckellop HA, editors. Total Hip Arthroplasty Outcomes. New York: Churchill Livingstone; 1998. p.3-12.
- Ceramic-on-ceramic total hip arthroplasty: incidence of instability and noise. Schroder D, Bornstein L, Bostrom MP, Nestor BJ, Padgett DE, Westrich GH. Clin Orthop Relat Res. 2011 Feb; 469 (2):437-42.
- Fender D, Harper WM, Gregg PJ. Outc-ome of Charnley total hip replacement across a single health region in England: the results at five years from a regional hip J Bone Joint Surg Br. 1999 Jul; 81(4):577-81
- Ng FY, Zhang JT, Chiu KY, Yan CH.A cadaveric study of posterior dislocation after total hip replacement-effects of head diameter and acetabular anteversion Int Orthop.2010 Feb.
- Harkess JW, Crockarell JR Jr. Arthroplasty of the Hip. In: Canale ST and Beaty JH, editors. Campbell’s Operative Orthopaedics, 11th ed. Philadelphia: Mosby; 2008.p.312-482.
- Bellamy N. WOMAC Osteoarthritis Index User Guide. Version V. Brisbane, Australia 2002.
- Beaule PE, Schmalzried TP, Udomkiat P, Amstutz HC. Jumbo femoral head for the treatment of recurrent dislocation following total hip replacement. J Bone Joint Surg Am 2002;84:256-63.
- Cuckler JM, Moore KD, Lombardi AV Jr., McPherson E, Emerson R. Large versus small femoral heads in metal-on-metal total hip arthroplasty. J Arthroplasty 2004;19:414.
- Sugano N, Takao M, Sakai T, Nishii T, Miki H, Ohzono K. Eleven- to 14-year followup results of cementless total hip arthroplasty using a third-generation alumina ceramic-onceramic bearing. J Arthroplasty 2012;27:736-41.
- Willmann G. Ceramics for total hip replacement--what a surgeon should know. Orthopedics 1998;21:173-7.
- Sanjay Agarwala, Ganesh mohrir, Pradeep Moonot. Functional outcome following a large head THR. Indian Journal Of Orthaedics . July 2014;vol.4:410-414 .
- Ahmed Rizle . Early results of ceramic on ceramic THR. The Egyptian Orthopaedic Journal. July 2013;Vol 48:28-36.
- V T Veysi, R W Metcalf, S Balasubramanian, P Gillespie, M E Emerton. Functional outcome of total hip replacement using a large diameter hard on hard bearing . J Bone Joint Surgery 2008. Vol 90- B Supp III 546.
- Somesh P Singh, Haresh P Bholodiya. Head size and dislocation rate in primary THA. Indian Journel of Orthopedics. September 2013. vol.37.Issue 2.p443-448.
- Gagala J, Mazurkiewicz T, Dajewski Z. Large diameter femoral heads in primary alumina/alumina and XSPE/alumina total hip arthroplasty. A followup study of 50 hips after average 40 months and review of Chir Narzadow Ruchu Ortop Pol 2011;76:14-20.
- Porat M, Parvizi J, Sharkey PF, Berend KR, Lombardi AV Jr., Barrack RL. Causes of failure of ceramic-on-ceramic and metal-on-metal hip arthroplasties. Clin Orthop Relat Res2012;470:382-7.
Corresponding Author
Dr Sonu Mehta
7/2 Race Course Road, Silver Stud Building, Indore, M.P. 452003, India
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