Harrogate district hospital, UK
Title: Uncemented Hips -- current status
Dr Juned S Ansari graduated from MAMC, New Delhi and completed FRCS (Ortho & Trauma), London in 2014 while working in Singapore. He did his Fellowship in Hip & Knee Arthroplasty from Chapel Allerton Hospital, Leeds, UK. He did a literature search on Uncemented hips under Prof Hemant Pandit and managed to publish the paper on Uncemented hips – current status in Feb 2018.
Background and purpose: Total hip replacement (THR) has been an established procedure for symptomatic end stage arthritis of hip to improve function and alleviate pain thereby improving the quality of life of millions of patients. Of the range of possible joint replacements, it is suggested that THR is a landmark surgery. Its success in the short-term as well as in the long-term has led to THR being performed in younger and more active patients. Survival of THR in the young and active patients was suboptimal for many years and management of this group continues to be a challenge.
Methods: This paper provides an up to date review of relevant history of Uncemented hips, key design features, mechanisms of fixation, current status, guidance to use and long-term results of Uncemented hips.
Results: THRs have long-term survival rates of more than 90% for uncemented as well as cemented stems. Despite encouraging long-term fixation of the metallic shell, long-term survival of uncemented cups is frequently compromised by excessive liner wear and peri-acetabular osteolysis particularly in the young and active patients. Kearns et al looked at the survival of femoral and acetabular components and noted that femoral stem survival was 99.3% (range, 98.4–100%), 98.9% (range, 97.7–100%), and 96.8% (92.5–100%) at 5, 10, and 15 years, respectively. Including all component designs acetabular survival was 98.7% (range, 97.4–100%), 84.6% (78.8–90.4%), and 52.5% (40.7–64.3%) at 5, 10, and 15 years, respectively. Overall survival was 46.8% (33.5–58.1%) at 15 years.
Conclusion: Uncemented THR is increasing globally as a good option for young and active patients needing hip replacement. It provides long lasting good to excellent results provided the indications are met.