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An early experience of the use of dual mobility cup uncemented total hip arhroplasty in young patients with avascular necrosis of the femoral head |
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| Institution: | 1. Hoy Spirit Hospital, Andheri, India;2. Criticare Superspeciality Hospital, Andheri, Mumbai, India;1. Holy Spirit Hospital, Andheri, Mumbai, India;2. Criticare Superspeciality Hospital, Andheri, Mumbai, India;3. Meril Life Sciences, Mumbai, India;4. Upasani Superspeciality Hospital, Mulund, Mumbai, India;5. Holy Spirit Hospital, Andheri, Mumbai, India;6. PD Hinduja Hospital (Khar), Khar West, Mumbai, India;1. Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, 751019, Odisha, India;2. Fellow in Joint Replacement, Department of Orthopaedics, Atlas Hospitals, Tiruchirappalli, 620002, Tamil Nadu, India;3. Department of Orthopaedics, Faculty of Medicine - Sri Lalithambigai Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, 600095, Tamil Nadu, India;4. South Texas Orthopaedic Research Institute (STORI Inc.), Laredo, TX, 78045, USA;1. Allegheny Health Network, Department of Orthopaedic Surgery, Pittsburgh, PA, 15212, USA;2. University of Pittsburgh, Department of Mechanical Engineering and Materials Science, Pittsburgh, PA, 15213, USA;1. Dept of Spine Surgery, Lilavati Hospital & Research Center, Mumbai, India;2. Knee and Orthopaedic Clinic, Mumbai Head of Clinical Research, AIMD Research, India |
| Abstract: | IntroductionTHA (Total hip arthroplasty) in advanced grade (grade 4) avascular necrosis (AVN) is a challenge to the treating surgeon as it affects young patients who have high functional demands and increased dislocation risk. The aim of the study was to evaluate the efficacy, survivorship, and dislocation rate of uncemented dual mobility cups (DMC) in advanced grade IV AVN young patients.MethodsRetrospective cohort study involving 204 DMC THA for advanced grade IV AVN from January 2013 to December 2015. The sample size of the study was estimated to be 188 hips with an α error of 0.05 and β error of 0.2. Inclusion criterion was patients less than 55 years of age with advanced grade IV AVN. Patients >55 years of age, patients diagnosed with primary osteoarthritis of the hip and hip fracture were excluded from the study. 172 patients (32 with bilateral & 140 with unilateral affection) with 204 DMC THA were evaluated clinically by Harris Hip Score (HHS) and radiologically at a follow up of 60 months. P value < 0.05 was considered significant.ResultsMean age of the patients was 42.5 ± 5.3. Preoperative HHS was 50.6 ± 10.5. Postoperative HHS at 5 years follow up was 96.4 ± 2.6. None of the operated patient had any dislocation episode or had undergone hip revision surgery (statistically significant against historical control of 2%, p value = 0.042). The radiological evaluation at 5 years showed no signs of radiolucent lines, periprosthetic osteolysis, polyethylene wear and signs of displacement or migration of the DMC. Cumulative survivorship rate at 5 years follow up was 100% without any revision/dislocation.ConclusionUse of DMC THA in young, advanced grade IV AVN patients was found to be a reliable option showing excellent early functional results with no dislocation. Ongoing follow up of this cohort is required to confirm the maintenance of these excellent functional results at follow up in the long term. |
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