The main objective of THR is to relieve pain and improve hip function. A lot of research has been done in recent decades to achieve this objective. In the 1990s LDH MoM articulation was an answer to implant loosening related to MoP wear debris and to dislocation related to smaller head size THAs. However, in recent years problems related to MoM articulation have been noted and complications and revision rates have significantly increased with longer follow-up.
In the future care must be taken in selection of implant type. The selection is determined by multiple factors which are surgeon preference, patient factors such as age and bone shape and bone quality, availability of implant combinations and the available evidence in the literature.
The latest studies have showed that certain features of THR appear to confer some benefit over traditional MoP THR. These features are large femoral head size with MoP or cerami-on-ceramic or cerami-on-ceramic-on-polyethylene articulations, cemented femoral component, trabecular metal acetabular component and cross-linked polyethylene cup liner. The conclusion of this study is that the orthopaedic surgeon must be aware of the possible complications related to hip arthroplasty and also know how to avoid them. Most of the complications, especially intraoperative ones, are not patient-based but surgeon-based.
7 Conclusion
The main conclusions of this research are as follows:
1. THAs experience more intraoperative complications and have a marginally lower cumulative survival rate than HRAs; however, time to revision was longer. HRA and female gender were associated to a higher revision risk and reason for this might be smaller head size which may predispose females to early HRA implant loosening. Higher intraoperative complication rate of THAs is mainly caused by more heterogeneous primary operative diagnoses (e.g. hip fractures and acetabulum dysplasias) compared to HRAs.
2. Patients with osteoporosis, hip dysplasia, and/or a history of previous hip surgery, fracture or small proximal femurs and wide proximal femur canals with thin cortices were at a higher risk of intraoperative calcar fracture. Generally, female gender and elderly age increased the risk of calcar fracture; thus, cementless stems are not the best choice for elderly female patients. The Hardinge approach was associated with a significantly higher risk of calcar fracture compared to the posterior approach. Our results demonstrate the necessity of considering the various shapes of the proximal femur when selecting femoral stems.
3. A cementless hemispherical acetabular component stabilises during the early postoperative months. However, adequate component stabilisation is not achieved in 1% of patients and osseointegration fails. Based on the results of the current study, acetabular morphology and cup positioning seem to have a significant impact on the risk of early loosening of cementless monoblock acetabular components. Age, gender, operative diagnosis, diseases affecting bone quality, the presence of hip dysplasia or acetabular component type did not predict early loosening. The risk for early failure could be lowered by optimal cup positioning during primary implantation; if there is uncertainty about the initial press-fit of the monoblock component, modular acetabular components with screws or cemented acetabular components should be used.
4. Dislocation of LDH THA is a rare complication. Hip dysplasia was associated with dislocation, even with larger head sizes. Placing the acetabulum component in the correct inclination and anteversion angles and restoring the hip anatomical rotation centre reduces the risk of dislocation. In our study, most of the dislocations occurred in THAs with head sizes of
≤38mm and in THAs where the acetabulum component anteversion angles were smaller.
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