Problems Encountered in Uncemented THR in AVN of Hip Patients

  • Singh V Study performed at Department of Orthopaedics, R. D. Gardi Medical College & C. R. G. Hospital & Associated Charitable Hospital, Ujjain (M.P.)
  • Jain S Study performed at Department of Orthopaedics, R. D. Gardi Medical College & C. R. G. Hospital & Associated Charitable Hospital, Ujjain (M.P.)
  • Gupta N Study performed at Department of Orthopaedics, R. D. Gardi Medical College & C. R. G. Hospital & Associated Charitable Hospital, Ujjain (M.P.)
  • Patidar A Study performed at Department of Orthopaedics, R. D. Gardi Medical College & C. R. G. Hospital & Associated Charitable Hospital, Ujjain (M.P.)
  • Rathore S S Study performed at Department of Orthopaedics, R. D. Gardi Medical College & C. R. G. Hospital & Associated Charitable Hospital, Ujjain (M.P.)
  • Jain A Study performed at Department of Orthopaedics, R. D. Gardi Medical College & C. R. G. Hospital & Associated Charitable Hospital, Ujjain (M.P.)
  • Bhinde S Study performed at Department of Orthopaedics, R. D. Gardi Medical College & C. R. G. Hospital & Associated Charitable Hospital, Ujjain (M.P.)
  • Agrawal A Study performed at Department of Orthopaedics, R. D. Gardi Medical College & C. R. G. Hospital & Associated Charitable Hospital, Ujjain (M.P.)
  • Jain P Study performed at Department of Orthopaedics, R. D. Gardi Medical College & C. R. G. Hospital & Associated Charitable Hospital, Ujjain (M.P.)
Keywords: Uncemented THR, AVN of hip, Problems

Abstract

Background: Avascular necrosis of femoral head is a common problem. It mostly affects the femoral head (hip joint). Its management can be conservative or invasive. Total hip arthroplasty is the treatment of choice for third and fourth stage avascular necrosis. Problems and complications are associated with every surgery. Here, we will see the common problems and complications encountered in uncemented total hip replacement in avascular necrosis of hip patients.

Material and Method: Fifty patients of Avascular necrosis of femoral head of stage III and IV are operated in last three years by uncemented total hip arthroplasty and their results were assessed by Harris hip score. There are some problems which we encountered in preoperative, intraoperative and post operative period. Their assessment and solution are done in this study.

Results: The mean Harris hip score during preoperative stage was 52 and during postoperative stage was 94. Excellent results are seen in 43 patients, good results are seen in 6 patients and poor results are seen in one patient. Preoperative problems like protrusio acetabuli was seen in 5 hips and fixed flexion deformity is seen two patients. Intraoperative problem like periprosthetic fracture was seen in one patient. Postoperative complication like limb length discrepancy was seen in 6 patients, foot drop in one patient, posterior dislocation of hip in one patient, superficial infection in 3 patients, deep infection in one patient and periprosthetic fracture in one patient.

Conclusion: Problems and complications are the part and parcel of any surgery. we should not get panic and try to treat the problems and complications encountered in uncemented THR. If, properly treated any problem of the uncemented THR can be managed. Long learning curve and lot of patience is required to produce long term good results in uncemented THR in AVN of hip patients.

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References

1. Avascular necrosis of the femoral head. In: Recent advances in Orthopaedics. Babhulkar S, Kulkarni SS, editorial 1985;359-81
2. Mankin HJ. Nontraumatic necrosis of bone (osteonecrosis) N Engl J Med. 1992;326:1473–1479.
3. Hungerford DS. Bone marrow pressure, venography and core decompression in ischemic necrosis of the femoral head. In: Riley LH, editor. The Hip: Proceedings of the Seventh Open Scientific Meeting of The Hip Society. St Louis, MO: CV Mosby; 1979. pp. 218–237.
4. Jones JP. Fat embolism and osteonecrosis. Orthop Clin North Am. 1985;16:595–633. [PubMed] [Google Scholar]
5. Zalavras CG, Lieberman JR. Osteonecrosis of the femoral head: evaluation and treatment. J Am Acad Orthop Surg. 2014;22:455–464. [PubMed] [Google Scholar]
6. Harkess JW: Arthroplasty of hip., Campbells Operative Orthpeadics, Edited by AH Crenshaw, 8th edition, Vol. 1: CV Mosby Company, St. Louis, Washington DC, Torto, 1982.
7. Eftekhar NS., Total hip replacement using principles of low-friction arthroplasty: The Hip. Surgery of the musculoskeletal system, Edited by CM Evarts, Vol.3: Churchill Livingston, 1983.
8. Charnley J; Low friction arthroplasty of the hip: Theory and practice, Springer- Verlag, Berlin, Heidelberg, New York, 1979.
9. Eftekhar NS. Total hip replacement using principles of lowfriction arthroplasty: The hip surgery of the musculoskeletal system, Edited by CM Evarts, Vol.3: Churchill Livingston, 1983.
10. Steinberg, Marvin E. Osteonecrosis:Merck Manual of Diagnosis and Therapy. Archived from the original on 12 May 2009.
11. Tofferi JK,Gilliland W,Avascular necrosis,available at http:// emedicine.medscape.com/article/333364, updated: Jan 19, 2012. Accessed March 20, 2012.
12. Jacobs B. Epidemiology of traumatic and nontraumatic osteonecrosis. Clin Orthop. 1998;130:51- 67.
13. A Case of Bilateral Aseptic Necrosis of the Femoral Head October 2014 DOI:10.12865/CHSJ.40.04.12
14. Study of clinical and functional outcome of total hip replacement in avascular necrosis of femoral head Dr. M Rama Subba Reddy, Dr. Shivakumar MS and Dr. Pandurang Phad DOI: https://doi.org/10. 22271/ortho.2018.v4.i1d.38
15. Kakaria HL, Sharma AK, Sebastian B. Total Hip Replacement in avascular Necrosis of Femoral Head. Med J Armed Forces India. 2005; 61(1):33-35.
16. Koo KH, Kim R, Kim YS et al. Risk period for developing osteonecrosis of the femoral head in patients on steroid treatment. ClinRheumatol. 2002;21(4):299-303.
17. Callaghan JJ, Dysart SH, Savory CG. The uncemented porous coated anatomic total hip prosthesis. Two-year results of a prospective consecutive series. J Bone and Joint Surg. 1988; 70-A:337-346.
18. Katz JN, Phillips CB, Baron JA, Fossel AH, Mahomed NN, Barrett J et al. Association of hospital and surgeon volume of total hip replacement with functional status and satisfaction three years following surgery. Arthritis Rheum 2003;48:560– 568.
19. Bourne, R. B.; Rorabeck, C. H.; Ghazal, M. E.; and Lee, M. H.: Pain in the thigh following total hip replacement with a porous-coated anatomic prosthesis for osteoarthrosis. A five-year follow- up study. J. Bone and Joint Surg., 76-A: 1464- 1470, Oct. 1994.
20. Heekin, R. D.; Callaghan, J. J.; Hopkinson, W. J.; Savory, C. G.; and Xenos, J. S.: The porous-coated anatomic total hip prosthesis, inserted without cement. Results after five to seven years in a prospective study. J. Bone and Joint Surg., 75-A: 77- 91, Jan. 1993.
21. Katz, R. L.; Bourne, R. B.; Rorabeck, C. H.; and McGee, H.: Total hip arthroplasty in patients with avascular necrosis of the hip. Follow-up observations on cementless and cemented operations. Clin. Orthop., 281: 145-151, 1992.
22. Barrack, R. L., and Lebar, R. D.: Clinical and radiographic analysis of the uncemented LSF total hip arthroplasty. J. Arthroplasty, 7 (Supplement): 353-363, 1992.
23. Meek RM, Garbuz DS, Masri BA, Greidanus NV, Duncan CP. Intraoperative fracture of the femur in revision total hip arthroplasty with a diaphyseal fitting stem. J Bone Joint Surg Am. 2004;86:480- 5.
24. https://aoj.amegroups.com/article/view/3848/4495 Cemented or cementless fixation for primary hip arthroplasty—evidence from The International Joint Replacement Registries Chaofan Zhang1,2, Chun Hoi Yan2,3, Wenming Zhang.1
25. Salvati EA, Cornell CN. Long-term follow-up of total hip replacement in patients with avascular necrosis. Instr Course Lect 1988; 37:67–73.
26. Kim YH, Kim JS, Cho SH. Primary total hip arthroplasty with a cementless porous-coated anatomic total hip prosthesis: 10- to 12-year results of prospective and consecutive series. J Arthroplasty 1999; 14:538–548.
27. Piston RW, Engh CA, De Carvalho PI, Suthers K. Osteonecrosis of the femoral head treated with total hip arthroplasty without cement. J Bone Joint Surg Am 1994; 76:202–214.
28. 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; 297:168–173.
29. Mullaji ab, shetty gm. Acetabular protrusio: surgical technique of dealing with a problem in depth. The bone & joint journal. 2013 NOV;95(11_SUPPLE_A):37-40.
30. Mohanty A, Parida S, Biswas R, Mohanty A. Evaluation of Uncemented Total Hip Arthroplasty in Acetabular Protrusio. ICJMR, Volume 7, Issue 5, May 2020, 5-10
31. Pencho kosev et al, soft tissue balancing in total hip arthroplasty, Journal of IMAB, 2015, volume 21, issue 1
32. Learmonth ID. The management of periprosthetic fractures around the femoral stem. J Bone Joint Surg Br. 2004;86:13-9.
33. Jesse W P Kuiper, corresponding author 1 Stan J (CJ) Vos, 1 Rachid Saouti, 2 Diederik A Vergroesen, 3 Harm C A Graat, 2 Yvette J Debets-Ossenkopp, 4 Edgar J G Peters, 5 and Peter A Nolte 3, Prosthetic joint-associated infections treated with DAIR (debridement, antibiotics, irrigation, and retention), Acta Orthop. 2013 Aug; 84(4): 380–386.
Published
2024-06-30
How to Cite
1.
V S, Jain S, N G, A P, Rathore SS, A J, S B, A A, P J. Problems Encountered in Uncemented THR in AVN of Hip Patients. ojmpc [Internet]. 2024Jun.30 [cited 2024Dec.30];30(1):4-11. Available from: https://ojmpc.com/index.php/ojmpc/article/view/182
Issue
Vol 30 No 1 (2024): Jan-Jun
Section
Original Article
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