[A comparative study on short-term effectiveness between cemented and uncemented total hip arthroplasty for osteonecrosis of femoral head after renal transplantation]

Liankui Yu, Chao Qi, Tengbo Yu, Qingyang Meng, Xia Zhao, Kai Liu, Yan Cai
Chinese Journal of Reparative and Reconstructive Surgery 2013, 27 (12): 1409-13

OBJECTIVE: To compare the short-term effectiveness between primary cemented and uncemented total hip arthroplasty (THA) for osteonecrosis of the femoral head (ONFH) after renal transplantation.

METHODS: The clinical data were retrospectively analyzed from 18 patients (21 hips) with ONFH after renal transplantation undergoing cemented THA in 11 cases (13 hips) (cemented group) and uncemented THA in 7 cases (8 hips) (uncemented group) between February 2005 and February 2012. There was no significant difference in gender, age, disease duration, ONFH stage, preoperative Harris score, and bone density between 2 groups (P > 0.05). Postoperative complications were observed in 2 groups; the hip function was assessed based on Harris scores; X-ray film was used to observe the prosthetic situation.

RESULTS: All the wounds healed by first intention. The patients were followed up 6-77 months (mean, 46 months) in the cemented group, and 4-71 months (mean, 42 months) in the uncemented group. Femoral prosthesis infection occurred in 1 case (1 hip) respectively in each group; hip dislocation, femoral prosthesis loosening, and acetabular prosthesis loosening occurred in 1 case (1 hip) of the cemented group, respectively. At last follow-up, the incidences of postoperative complications and revision rate of the cemented group were 30.7% (4/13) and 23.1% (3/13) respectively, which were significantly higher than those of the uncemented group [12.5% (1/8) and 0 (0/8)] (P=0.047, P=0.040). Harris score was significantly increased to 94.1 +/- 3.7 in the uncemented group and 90.0 +/- 4.2 in the cemented group, showing significant differences compared with the preoperative scores in 2 groups (P < 0.05), but there was no significant difference between 2 groups (t = -1.815, P = 0.062). Postoperative X-ray films showed that the initial position of the prosthesis was satisfactory. At last follow-up, the bone fixation, fibrous stability, and loosening of the femoral prosthesis and loosening of acetabular prosthesis occurred in 9 hips, 3 hips, 1 hip, and 1 hip of the cemented group, respectively; bone fixation of the femoral prosthesis and stability of acetabular prosthesis were observed in all hips of the uncemented group. There was no heterotopic ossification in 2 groups.

CONCLUSION: Uncemented THA after renal transplantation can obtain satisfactory shortterm effectiveness, and uncemented THA is better than the cemented THA; however, the middle- and long-term effectivenesses need further observation.

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