03 Years Outcome Analysis of Non-cemented Total Hip Arthroplasty in Complicated Hip Pathologies in Young Adults of Poor Socioeconomic Background
Place of Study: Department of Orthopedic Surgery and Traumatology Unit I, K.EM.U, MHL, LHR.
Period: September 2008 to September 2011.
Design: Analytical.Hip joint is very commonly involved by traumatic and non-traumatic conditions in younger age group especially of poor socioeconomic and industrial wor-kers (who are commonly encountering such problems) and frequently requires surgical intervention and Non-cemented Total Hip Arthroplasty in young Patients is considered a better option.1-3 We evaluated the out-come of this procedure in such cases and operated 53 cases of complex Hip problems with NC THA, which were Hydroxyapatite coated. Majority of the cases were Idiopathic AVN (15), Post Infectious Hip Arthri- tis (07), Skeletal Dysplasia (01), Post Traumatic Collapse (11), 01 case of B/L hip neglected dislocation in an epileptic patient, Ankylosing spondylitis (08) and Old Perthe's disease (03), Rheumatoid Arthritis (03), Old Fracture Acetabulum with Posterior Dislocation with AVN of femoral Head (01). There were more males (25) as compared to 05 females with M:F ratio 5:1. Mean age was 32 years (range from 18 years to 48 years). There were 03 cases of bilateral involvement so total No of THRs were 53. All the patients were asses-sed pre-operatively by Harris Hip score, which was 49 with Pain interfering with daily activities, was the main complaint. Average shortening was 02 cm except in three Hips (02 of Girdle Stone Procedure and 01 Old Fx neck of femur). These 03 hips were having 5 - 7 cm shortening with GT abutting against the Ileum. Skeletal traction was applied pre-operatively for 03, and GT were brought down and THR was done after 06 - 08 Wks of removal of fixator. Mean shortening was 03cm. Harding's anterolateral approach was used in all cases. Hydroxyappatite coated Modular type Non-cemented THA was used. Wt. bearing started at 12 - 14 weeks. Mean Harris Hip Score Improved from 49 to 88 at 03 years after surgery. We had only one case of superficial Infection, which settled with anti-biotics. Only one case developed recurrent (05 episo-des in 03 years) dislocation on left side in epileptic patient, which occurred each time after fits & could be reduced under GA. The right hip remained stable. There was no DVT, implant subsidence, Myositis ossi-ficans or NV damage no residual shortening. There was a learning curve with positioning of acetabulum, which was vertical in the beginning but improved sub-sequently. Although the follow up is very short but so far now, Non-cemented THA is a good option in youn-ger pts even with complex Hip problems that signifi-cantly improves the functional abilities of the patient as well as eliminates pain. Moreover, even if it requi-res revision later on it can be done with cemented imp-lants.
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