Osteoarthritis of the Hip Joint; To Compare the Outcomes of Total Hip Arthroplasty With Hip Resurfacing Procedures in Patients, at a Tertiary Care Hospital in Karachi, Pakistan

Abstract

The aim of our study is to determine the surgical outcome and rates of complication in patients undergoing surgical treatment for osteoarthritis of the hip joint with total hip arthroplasty and compare it with hip resurfacing procedures. Study Design: A prospective cohort study. Period: Five years duration from January 2011 to December 2016. Setting: Tertiary Care Centre in Karachi, Pakistan. Materials and methods: The study population consisted of n= 170 patients (n= 110 patients undergoing cementless THA and n=60 patients undergoing hip resurfacing procedures). The inclusion criteria was all the patients who came to our outpatient clinic, with unilateral or bilateral osteoarthritis (grade 3,4) of the hip joint requiring surgical treatment, were fit for surgery and gave informed consent to participate in the study. All the procedures were done by the same team of surgeons at the same institute in series under general anesthesia. Data was collected in a pre-designed proforma. Postoperatively the patients were restricted to a reduction of weight bearing by half for the first six weeks, and were involved in physiotherapy till discharge from the hospital. The patients from both groups received the same thromboembolic and infection prophylaxis. Data was analyzed using IBM SPSS version 22. Results: In our study we found that the rates of reoperation had statistically significant differences, being n= 5 in THA group and n=9 in resurfacing group having a p value of 0.019. In the resurfacing group n= 4 patients had fractures of the femoral neck. All the revision surgeries were undertaken utilizing the posterolateral approach, n= 2 patients were revised utilizing cementless femoral stems while n=2 were revised utilizing cemented femoral stem, n= 5 patients were revised to total hip arthroplasty procedure on account of aseptic loosening. No dislocations were observed after the revision surgical procedures. There was no statistically significant difference in the total rates of complications among the two groups, having a p value of 0.44. The pre-operative Harris hip scores were similar in the two groups having a p value of 0.2. Conclusion: According to the results of our study the outcome in the both the cementless total hip arthroplasty and hip resurfacing procedure are similar in terms of implant survival and clinical results however rate of complication is higher in the patients undergoing hip resurfacing technique and needed revision surgeries. The patients undergoing hip resurfacing had better mobility post operatively, and hence this consideration is to be made during patient selection, as hip resurfacing is preferred by younger patients due to its higher functional outcomes.