ABSTRACT
Background: Total hip arthroplasty is one of the most successful and cost-effective surgical procedures and remains the treatment of choice for long-term pain relief and restoration of function for patients with diseased or damaged hips. The traditional method of fixation of an implant to bone involved the use of cement. The question regarding the efficacy of cemented as compared with cementless fixation arthroplasty continues. Comparisons of the efficacy of cemented and cementless total hip arthroplasty have been indirect or retrospective in nature without evolution of these issues: is one better than the other. In this study we are comparing functional outcome in cemented versus uncemented primary total hip arthroplasty. Methods: This study was conducted in the department of orthopedic surgery, L.L.R.M. Medical College, Meerut. The study was prospective and retrospective and included the patients operated from February 2011 onwards in S.V.B.P. Hospital. Patient were selected as per Inclusion and Exclusion criteria. All the patients were thoroughly examined including all injuries, abnormalities, pathologies and secondary changes of musculoskeletal system. Based on this, provisional diagnosis was made for every patient. They were divided into 2 groups, one who were operated by cemented THA and the second who were operated by uncemented THA. Patients in whom both cemented and uncemented THA were feasible, final decision to select the treatment was done by alternative case method. Pre and post-operative care were same for both groups. Patients selected for THA were put to pre surgery exercises. Their Harris Hip Score and SF36 score were documented. Patients were operated as given in pro forma. He or she was put to weight bearing / non weight bearing according to per op fixation. Results: The study comprises of a total of 44 patients presenting to S.V.B.P. Hospital, Meerut from August 2011 to October 2013. The mean age of the patients taken up for our study was 45.14 years with the youngest patient being 19 years old and the oldest being 70 years old. There were total 34 male patients (77%) and 10 female patients (23%) in our study. In total 50 operated hips, 26 (52%) were on right side while 24 (48%) were on left side. There were 38 cases, in which unilateral hip (86%) was operated and 6 cases (14%) had both hips operated. 3 cemented cases were bilateral and 3 uncemented cases were bilateral. Of the total (50) hips operated, 23 (46%) were operated by cemented total hip arthroplasty and 27 (54%) were operated by uncemented total hip arthroplasty. Of the total patients (44) operated, 20 (45) patients were operated by cemented total hip arthroplasty and 24 (55%) were operated by uncemented total hip arthroplasty. In all the 23 hips operated by cemented technique 28 mm head was used. In the 27 hips operated by uncemented technique, 28mm head was used in 8 hips (30%) and 36 mm head was used in 19 (70%) hips. The minimum duration of follow up was 2 months and maximum duration of follow up was 2 years. Patients were evaluated in pre op period and at 2 month, 6 month, 1 year and 2 year. Both cemented and uncemented groups were divided accordingly into 5 sub-groups for Harris Hip Score and 5 sub-groups for SF-36 Score. A total of 10 groups were available for Harris Hip Score and 10 groups for SF-36 Score in which comparison was done. Pre op Harris hip scores in both cemented (mean score 28.56) and uncemented (mean score 33.30) groups are poor and difference between them were not significant (P value 0.3536) and Pre op physical component summary score in both cemented (mean score 21.594) and uncemented (mean score 22.052) groups are poor and difference between them were not significant (P value 0.5661). Mean Harris hip scores for pre op, post op 2months, 6 months, 1 year and 2 years were 28.56, 80.56, 85.30, 86.88 and 89.40 respectively. When comparison was done between pre op Harris hip scores and post op scores, difference was extremely significant with a P value of 0.0004 for pre op and post op 4 year pair and P value of 0.0001 for all other pairs. Mean Harris hip scores for pre op, post op 2month, 6 month, 1 year and 2 year were 33.30, 85.70, 91.38, 93.06 and 89.29 respectively. When comparison was done between pre op physical component summary scores of sf-36 and post op scores, difference was extremely significant with a P value of 0.0001 for all the pairs. Mean physical component summary scores of SF-36 for pre op, post op 2month, 6 month, 1 year and 2 year were 21.594, 34.662, 38.190, 40.706 and 41.410 respectively and when comparison was done between pre op physical component summary scores of SF-36 and post op scores, difference was extremely significant with a P value of 0.0001 for all the pairs. Mean physical component summary scores of sf-36 for pre op, post op 2month, 6 month, 1 year and 2 year were 22.052, 38.935, 42.410, 45.206 and 43.557 respectively. Conclusion: Functional outcome evaluation in our study suggested that uncemented total hip arthroplasty is better than cemented total hip arthroplasty when compared using Harris Hip Score and Physical Component Summary Score of SF-36