Comparison of the early effects of bone cement versus cementless prostheses in very elderly patients undergoing total hip arthroplasty / 中华老年医学杂志

ABSTRACT

Objective To evaluate the early effects of bone cement prostheses versus cementless prostheses in very elderly patients undergoing total hip arthroplasty.Methods A total of 110 patients aged 70 years and over who had undergone hip replacement because of hip disease from March 2011 to March 2013 were selected.104 cases were followed up for 3 years,with 46 cases treated with the bone cement prostheses(Group A) and 58 cases with cementless prostheses(Group B).The conditions before and after surgery were recorded.Postoperative Harris scores were collected to evaluate the function of the hip joint,and the loosening of hip prostheses was detected by x-ray.Results Intraoperative blood loss and postoperative drainage volume were lower in Group A than in Group B [(236.0±26.3) ml vs.(296.0±34.5) m1,(123.0±20.3) ml vs.(156.0±26.4) ml,both P ＜0.05].Harris scores before,6 months,1,2 and 3 years after surgery were(40.2±7.2),(80.3±5.2),(90.2±4.5),(90.6±4.2),and(90.8±3.5) in Group A,and(39.8±6.3),(76.5±8.7),(86.5±5.1),(89.3± 4.8),and(91.0± 4.1) in Group B,respectively.Harris scores 6 months and 1 year after surgery were higher in Group A than in Group B,and there was no significant difference in Harris scores between the two groups 2 and 3 years after surgery(P＞0.05).Pain scores before,6 months,1,2 and 3 years after surgery were(13.5± 5.3),(37.5± 6.2),(38.4±5.3),(39.1 ±2.5) and(39.0±2.1) in Group A and(12.9±6.2),(30.2±8.7),(35.9±6.5),(38.6±4.8) and(39.2±2.6) in Group B,respectively.Pain scores 1 year after surgery was better in Group A than in Group B,and there was no significant difference in pain scores between the two groups 2 and 3 years after surgery(P＞0.05).Bone cement implantation syndrome occurred in 6 cases in Group A,of which 1 case had respiratory and cardiac arrest and was successfully rescued after cardiopulmonary resuscitation.In addition,in Group A,1 case had osteolytic disease 2 years after surgery,and,in Group B,4 cases had proximal femoral fractures and 1 case had osteolytic disease 3 years after surgery.Conclusions For very elderly patients undergoing total hip replacement,satisfactory early therapeutic effects can be achieved by using bone cement or cementless prostheses.Intraoperative blood loss,postoperative drainage volume and Harris scores 1 year after surgery are better with bone cement prostheses than with cementless prostheses.Close attention should be paid to possible development of bone cement implantation syndrome during operation.