Results of Cementless Total Hip Arthroplasty in Patients Below 50 Years for Ficat and Arlet Stage Iii and Iv Avascular Necrosis of The Femoral Head

Author(s): Mobinul Hoque, Moshee-ur Rahman SM, Mohammad Lockman, Rabin Chandra Halder, Kazi Mohammad Hannanur Rahman, Afrin Akter

Background: Total hip replacement has proven to be the treatment of choice for patients with intolerable pain and limitation of hip movement due to avascular necrosis of the femoral head suffering for many years. Cementless hip arthroplasty has taken over in recent times and replaced conventional cemented total hip arthroplasty in young adults.

Objective: To evaluate the results of cementless total hip arthroplasty in patients below 50 years for Ficat and Arlet stage III and IV avascular necrosis of the femoral head. Methods: This study was a prospective observational study and was conducted in the Department of Orthopaedics, National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka over a period of one year from May 2022 to April 2023 through non randomized purposive sampling. All patients were admitted with diagnosis of avascular necrosis of the femoral head Ficat and Arlet stage III and IV satisfying the inclusion and exclusion criteria. Functional, postoperative complications and radiological outcome was studied. Functional outcome was evaluated by Modified Harris Hip Score.

Results: The mean age of the patients was 33.20 ± 6.86 years with range 21- 49 years. Majority of patients were male (69.7%). 39.4% were businessman and 9 out of 10 women (27.3% of total) were housewives. Idiopathic AVN was encountered in 57.6% cases and 33.3% was steroid-induced. Majority, 54.5% cases had left hip involvement. The mean per-operative blood loss was 491.2 ± 48.4ml. Only 1 patient (3.03%) had superficial surgical site infection and 3 (9%) had limb shortening. Radiological findings revealed 100% neutral aligments of implants. Evaluation of final outcome by Modified Harris Hip Score showed excellent (69.7%), good (24.2%) and fair (6.1%) result.

Conclusion: The outcome of cementless total hip arthroplasty has shown excellent results in terms of pain relief, relief from limp, improved functional capabilities of the patient, fewer postoperative complications and good radiological outcome.