Short Term analysis (Retrospective and Prospective study) of the functional outcome in Complex Total Primary Hip Replacement

INTRODUCTION: In Human Body, the Hip joints bear the great responsibility of transmitting the ground reaction force against the body weight and simultaneously preserving the mobility. Any disease / trauma involving hips primarily affects locomotion, disables the Individual’s activity of daily living. Patients with painful hips require complete evaluation with standard X-rays, Computed Tomogram (CT) and if necessary Magnetic Resonance Imaging (MRI) to conclude the diagnosis. The treatment protocols for painful hips include Analgesics, Walking stick, Axillary Crutches, Arthrodesis, Osteotomy, Excision Arthroplasty and Total Hip Arthroplasty (THA). Total Hip Arthroplasty is the Most commonly performed Reconstructive procedure that replaces the Femoral Head, Neck and Acetabular Articular Surface. THA is a highly successful procedure that has made numerous patients return to excellent function without pain and provides a stable, pain-free mobile joint. THA demands accurate surgical technique to reproduce a biomechanically sound joint. AIM: The purpose of this study is Short Term analysis (Retrospective and Prospective study) of the functional outcome in 30 patients who underwent complex primary hip arthroplasty in our Institute during the period January 2009 to December 2012. MATERIALS AND METHODS: A retrospective and prospective study was done to evaluate the functional outcome in 30 patients who underwent complex primary Total Hip replacement and to analyze the results. The study group consists of 30 Patients who underwent complex primary Total Hip replacement between Jan 2009 and Dec 2012 at the Institute of Orthopaedics and Traumatology, Madras Medical College and Government General Hospital , Chennai. The study was done with clearance from Hospital ethical committee. Those who fulfilled the inclusion criteria given below, were invited to participate in the study. Informed consent was obtained from all the patients willing to take part in the study. A. Inclusion Criteria: 1. Developmental Dysplasia Hip, 2. Ankylosed Hip, 3. Protrusioacetabuli, 4. Failed Osteosynthesis (previous bony procedures around hip), 5. Skeletal Dysplasia (SED, epiphyseal dysplasia) 6. Neuromuscular disorders (polio, down’s syndrome, cerebralpalsy stroke), 7. Prior hip fractures (acetabular fractures), 8. Severe soft tissue contractures around hip. B. Exclusion Criteria: 1. Primary osteoarthitis hip, 2. Inflammatory arthritis without complications, 3. Secondary arthritis (avascular necrosis, perthes disease). RESULTS: Most of the patient was operated by Hardinge Lateral approach (22 Patients). 8 patients were operated by Posterior Southern-Moore approach. In our study the average surgical time delay was 6 days ranging from 5 to 17 days. The average surgical time was 120 minutes ranging from 60 minutes to 3 hours. Complications encountered in our study were hip dislocation, superficial infection, limb length discrepancy, acetabular bone graft resorption, heterotopic ossification andsubsidience of femoral stem (uncemented). One patient dislocated in the immediate post-operative period; which was reduced instantly under anaesthesia by traction and abduction. In our series of 30 patients operated on complex hips, we bring forward the following results: Excellent – 12, Good – 14, Fair – 2, Poor – 2. CONCLUSION: The Primary Total Hip Arthroplasty has revolutionised the treatment of Hip diseases in the past 3 decades. The indications for the primary THA has been extended to complex hip pathologies which were previously considered ineligiblefor the procedure. Such complex hip cases fall into the categories of Developmental Dysplasia Hip Ankylosed Hip, Protrusioacetabuli, Failed Osteosynthesis (previous bony procedures around hip), Skeletal Dysplasia (SED, epiphyseal dysplasia), Neuromuscular disorders (polio, downs syndrome, cerebral palsy, stroke), Prior hip fractures (acetabular fractures), Severe soft tissue contractures around hip and Post excision arthroplasty hip. The management of these complex hips with altered bony and soft tissue anatomy is challenging with the conventionally available total hip instruments and implants. With the advent of new surgical techniques, implants and instruments, the primary THA in complex hips has given good excellent results which is comparable with the results published worldwide