No adverse effects of early weight bearing after uncemented total hip arthroplastyA randomized study of 20 patients

Abstract

Background Few guidelines are available whether early weight-bearing after an uncemented total hip arthroplasty (THA) can be recommended or not. Stability and ingrowth may be jeopardized by immediate loading of the implant while functional recovery may be promoted and periprosthetic demineralization reduced.Patients and methods We did a prospective study of 20 patients who were operated on with a hydroxyapatite-coated (HA), uncemented total hip arthroplasty with a tapered stem because of unilateral arthrosis, and randomized the patients to the immediate (I) or late (L) weight-bearing (after 3 months) group. The shoe on the operated side was equipped with an auditory device signaling when the patient placed a load on the extremity. The clinical assessment was done with the Harris hip score at the time of the operation and after 12 and 24 months. Radiographs and dual-energy x-ray absorptiometry (DEXA) were evaluated for migration, femoral remodeling and bone mineral density (BMD) after 3, 6, 12 and 24 months. Tc-scintigraphy was done after 6, 12 and 24 months.Results Postoperatively, the Harris hip score showed no group difference. After 3 months, we noted a large reduction in BMD around the stem prosthesis. This was most marked in the proximal regions and the bone loss was significantly larger in zone 1, 4 and 5 in the L group. Distally, the BMD normalized with time, but the loss of bone persisted in the proximal zones after 24 months. An initial increase in the scintigraphic uptake ratio in all zones in both groups declined with time, but it was still increased on the operated side after 24 months. Several radiographic signs of bone remodeling were seen, but the patterns were similar in both groups.

Immediate weight bearing after uncemented total hip arthroplasty with an anteverted stem: A prospective randomized comparison using radiostereometry

“…However, if rigid initial stability is acquired at surgery, ingrowth of bone onto uncemented implants will occur (Jasty et al 1997, Pilliar et al 1986). Recently, satisfactory clinical results have been obtained using weight bearing immediately after uncemented total hip arthroplasty (Chan et al 2003, Boden et al 2004. Few studies have used a randomized design, however, and we have not been able to find any study in which early weight bearing has been studied with high-precision radiostereometry.…”

“…Boden et al (2004) used the same device as we did, in a prospective study of 20 patients who were operated with a hydroxyapatite-coated total hip arthroplasty.…”

Total hip arthroplasty in an outpatient setting in 27 selected patients

“…However, no adverse effects of early full weight bearing of uncemented THAs have been described (Bodén and Adolphson 2004, Thien et al 2007, Wolf et al 2012). Moreover, early loading of the THA is not unique to outpatient THA.…”

The effects of different weight-bearing regimes on press-fit cup stability: a randomised study with five years of follow-up using radiostereometry

“…Immediate weight bearing may in theory be beneficial regarding rehabilitation time and minimising bone mineral loss due to disuse but may jeopardise initial stability and prevent safe bone ingrowth. Previous controlled studies show no adverse effects of immediate weight bearing as assessed with radiographs [1], radiographs and scintigraphy [2] or radiostereometric analysis (RSA) [3]. Few studies, however, have used a randomised protocol to examine the effect of rehabilitation [3,4] and, to our knowledge, only Thien et al [3] have investigated acetabular cup stability in relation to the postoperative weight-bearing regime.…”

“…The difficulty in complying to prescribed weight bearing is well documented [13,14]. Some studies have used auditory devices placed in insoles for at-home feedback [2,3]. Keeping this in mind, we also set up an intensive rehabilitation programme supervised by our PT for the I group to secure differences in hip loading.…”