The clinical and radiological outcome of uncemented primary total hip arthroplasty in case of AVN of femoral head in middle age group

Authors

  • M. Mamunur Rashid Rangpur Medical College Hospital, Rangpur, Bangladesh
  • M. Hasan Masud National Institute of Traumatology and Orthopaedic Rehabilitation, Dhaka, Bangladesh
  • M. Jahangir Alam National Institute of Traumatology and Orthopaedic Rehabilitation, Dhaka, Bangladesh
  • M. Sieful Islam Department of Orthopaedic, Holy Family Red Crescent Medical College Hospital, Dhaka, Bangladesh
  • M. Zahid Hasan National Institute of Traumatology and Orthopaedic Rehabilitation, Dhaka, Bangladesh
  • M. Zakir Hossain National Institute of Traumatology and Orthopaedic Rehabilitation, Dhaka, Bangladesh
  • Naima Ferdoushi National Institute of Traumatology and Orthopaedic Rehabilitation, Dhaka, Bangladesh
  • Bipul Das National Institute of Traumatology and Orthopaedic Rehabilitation, Dhaka, Bangladesh
  • Raquib Hussain National Institute of Traumatology and Orthopaedic Rehabilitation, Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/2349-2902.isj20223589

Keywords:

Arthroplasty, Femoral, Necrosis, Uncemented

Abstract

Background: The appropriate treatment of avascular necrosis (AVN) of the femoral head has become a serious problem around the world, particularly in adult instances. Objective was to evaluate the clinical and radiological outcome of uncemented primary total hip arthroplasty in case of AVN of femoral head in terms of pain relief, functional capacity, range of motion, absence of deformity, radiological assessment and comparing pre-operative and post-operative functional status.

Methods: This was a prospective observational study of 44 hips of 37 patients at the National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh.

Results: Here, majority (70%) belong to 30-35 years age group, and 75% were male. The affected site of arthroplasty among patients where highest (51.35%) patients had been affected on right side and right side number of hip was (43.18%). Among all, 30 patients underwent unilateral total hip replacement (THR), 7 patients who were affected bilaterally underwent staged bilateral THR at an interval of 6-12 weeks. According to the position of the acetabular component, anteverted in 70% patients, retroverted in 0% patients, neutral in 25% patient, <35º inclined in 0% patients, 35º-50º inclined in 65% patients, and >50º inclined in 20% patients at follow-up cases. Based on modified Harris hip score (HHS), 92% cases rated this treatment as excellent.

Conclusions: Uncemented total hip arthroplasty in individuals, who have arthritis of the hip joint secondary to AVN, provides satisfactory clinical and radiographic outcome. Though the procedure is not free of complications, the overall functional and clinical outcome had shown excellent result.

References

Gold M, Varacallo M. Anatomy, bony pelvis and lower limb, hip joint. StatPearls Publishing, Treasure Island, FL; 2019.

Petek D, Hannouche D, Suva D. Osteonecrosis of the femoral head: pathophysiology and current concepts of treatment. EFORT Open Rev. 2019;4:85-97.

Lai KA, Shen WJ, Yang CY, Shao CJ, Hsu JT, Lin RM. The use of alendronate to prevent early collapse of the femoral head in patients with nontraumatic osteonecrosis. A randomized clinical study. J Bone Joint Surg Am. 2005;87:2155-9.

Pritchett JW. Statin therapy decreases the risk of osteonecrosis in patients receiving steroids. Clin Ortho Relat Res. 2001;386:173-8.

Kakaria HL, Sharma AK, Sebastian B. Total hip replacement in avascular necrosis of femoral head. Med J Armed Forces India. 2005;61:33-5.

Mont MA, Hungerford DS. Non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg Am. 1995;77:459-74.

Salvati EA, Cornell CN. Long-term follow-up of total hip replacement in patients with avascular necrosis. Instr Course Lect. 1988;37:67-73.

Fyda TM, Callaghan JJ, Olejniczak J, Johnston RC. Minimum ten-year follow-up of cemented total hip replacement in patients with osteonecrosis of the femoral head. Iowa Orthop J. 2002;22:8-19.

Kantor SG, Huo MH, Huk OL, Salvati EA. Cemented total hip arthroplasty in patients with osteonecrosis. A 6-year minimum follow-up study of second-generation cement techniques. J Arthroplast. 1996;11:267-71.

Kawamoto K, Hasegawa Y, Iwase T, Iwasada S, Kanamono T, Iwata H. Failed cementless total hip arthroplasty for osteoarthrosis due to hip dysplasia. A minimum five-year follow-up study. Bull Hosp J Dis. 1998;57:130-5.

Yamada H, Yoshihara Y, Henmi O, Morita M, Shiromoto Y, Kawano T, et al. Cementless total hip replacement: past, present, and future. J Orthopaed Sci. 2009;14(2):228-41.

Phillips FM, Pottenger LA, Finn HA, Vandermolen J. Cementless total hip arthroplasty in patients with steroid-induced avascular necrosis of the hip. A 62-month follow-up study. Clin Orthop Relat Res. 1994;303:147-54.

O'Leary RJ, Gaillard MD, Gross TP. Comparison of cemented and bone ingrowth fixation methods in hip resurfacing for osteonecrosis. J Arthroplast. 2017;32:437-46.

Reddy MR, Shivakumar MS, Phad P. Study of clinical and functional outcome of total hip replacement in avascular necrosis of femoral head. Int J Orthop Sci. 2018;4(1), 252-8.

Prakashappa TH, Hanumaih YG, Shamsundar Y, Murugunde AJ. Functional outcome of uncemented total hip arthroplasty in degenerative arthritis of hip. Int J Orthopaed. 2021;7(1):777-82.

Celebi L, Muratli HH, Aksahin E, Yagmurlu FM, Yuksel YH, Bicimoglu A. 2006, Cementless total hip arthroplasty with avascular necrosis of femoral head. Acta Orthopaed Traumatol Turc 2006;40(2):105-10.

Johannson HR, Zywiel MG, Marker DR, Jones LC, McGrath MS, Mont MA. Osteonecrosis is not a predictor of poor outcomes in primary total hip arthroplasty: a systematic literature review. Int Orthopaed. 2011;35(4):465-73.

NIAMS, 2015. Osteonecrosis. Available from: https://www.niams.nih.gov/health-topics/osteonecrosis. Accessed on 2 December 2020.

Choudhary R, Anand R. The radiographic outcome of total hip arthroplasty in patients with displaced femur neck fracture: an observational study, Eur J Mol Clin Med. 2020;7(07).

Lins RE, Barnes BC, Callaghan JJ, Mair SD, McCollum DE. Evaluation of uncemented total hip arthroplasty in patients with avascular necrosis of the femoral head. Clin Orthop Relat Res. 1993;297:168-73.

Bhowmik S, Azmoddin M. Radiological assessment of total hip arthroplasty in displaced neck of femur fracture: an observational study. Int J Orthopaed. 2021;7(1):18-21.

Mclaughlin JR, Lee KR. 2000. Total hip arthroplasty in young patients: 8 to 13 year results using an uncemented stem. Clin Orthopaed Relat Res. 2000;373:153-63.

Kim YH, Oh JH, Oh SH. 1995. Cementless total hip arthroplasty in patients with osteonecrosis of the femoral head. Clin Orthopaed Relat Res. 1995;320;73-84.

Gaikwad S, Agarwal S, Pawar I, Kumar A. (2021). Evaluation of clinical outcome of cementless ceramic on ceramic primary total hip replacement in young patients of avascular necrosis of femoral head. J Arthroscop Joint Surg. 2021;8(4):366-71.

Naveen BS, Hemanth R. Clinical and functional outcome of primary uncemented total hip arthroplasty. Nat J Clin Orthopaed. 2021;5(1):13-5.

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Published

2022-12-30 — Updated on 2023-01-03

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Issue

Vol. 10 No. 1 (2023): January 2023

Section

Original Research Articles