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Common hip conditions requiring primary total hip arthroplasty and comparison of their post-operative functional
Prasoon Kumar1, Ramesh K Sen2, Sameer Aggarwal1
1Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India.
Insights
Non-traumatic avascular necrosis of the hip is the leading cause for total hip replacement (THR) in our region, affecting males more frequently and at a younger age than in Western countries. Functional outcomes were poorer for inflammatory arthritis cases.
Area of Science:
- Orthopedics
- Arthroplasty
- Hip Surgery
Background:
- Osteoarthritis (OA) is a common cause of total hip replacement (THR) globally.
- Other significant etiologies include avascular necrosis (AVN) of the hip, inflammatory diseases, and trauma sequelae.
- This study retrospectively analyzes the prevalence and outcomes of these conditions at a tertiary healthcare center.
Purpose of the Study:
- To determine the prevalence of different etiologies for primary THR in a specific region.
- To compare patient demographics (age, sex ratio) with Western populations.
- To evaluate and compare surgical outcomes based on the underlying cause of hip pathology.
Main Methods:
- Retrospective analysis of patients who underwent primary THR over a six-year period.
- Exclusion of revision cases; all surgeries performed by a single experienced arthroplasty surgeon.
- Assessment of functional outcomes using Harris Hip Score (HHS) and Short Musculoskeletal Functional Assessment (SMFA) scores.
Main Results:
- 118 hips in 99 patients (M:F ratio 3.2:1, mean age 43.22 years) were analyzed.
- Non-traumatic AVN (42.4%) was the most common indication, followed by traumatic sequelae (30.5%), primary OA (14.4%), and inflammatory arthritis (IA).
- HHS scores were significantly superior for AVN, traumatic sequelae, and OA compared to IA (p<0.05). SMFA scores indicated inferior outcomes for IA.
Conclusions:
- Non-traumatic AVN hip and traumatic sequelae are the most frequent indications for primary hip arthroplasty in this region.
- Hip arthroplasty patients in this population are predominantly male and younger than those reported in Western studies.
- Inflammatory arthritis is associated with inferior functional outcomes, likely due to comorbidities like contractures and spinal issues.
Background:
Primary osteoarthritis of hip has been widely reported to be the leading cause for total hip replacement (THR) in the world. The other common causes are avascular necrosis of hip, inflammatory diseases and trauma sequelae. We report the prevalence of these disease as studied retrospectively at a tertiary healthcare centre and discuss the common age groups and sex ratios of these patients as compared to the West. Additionally, we compare the outcomes of these surgeries based on the aetiologies for which they were done.
Methodology:
Patients who underwent primary THR in our institute within six years were called and retrospectively analysed. Revision cases were excluded. All the surgeries were done by a single experienced arthroplasty surgeon. On follow ups, functional scores were assessed using standard Harris hip score (HHS) and quality of life scores were assessed using the Short musculoskeletal functional assessment (SMFA) score.
Results:
118 hips in 99 patients (M:F- 3.2:1) with a mean age group of 43.22 years, were operated over a period of six years. Non traumatic avascular necrosis (AVN) of hip topped the list in our study with 42.4% of cases, followed by post-traumatic sequelae (30.5%). These were followed subsequently by primary osteoarthritis (OA) (14.4%) and the remaining were inflammatory pathologies (IA). The HHS of patients with non traumatic AVN hip, traumatic sequelae and primary osteoarthritis were significantly superior to inflammatory arthritis with a p value of 0.001, 0.001 and 0.016 respectively. Additionally the short musculoskeletal functional assessment score was also significantly higher in IA than AVN, OA and post trauma groups (p = 0.001, 0.037 and 0.002 respectively); where a higher score denotes inferior outcomes.
Conclusion:
In our part of the world, non traumatic AVN hip is the commonest indication for primary hip arthroplasty, followed by traumatic sequelae. The frequency of males undergoing hip arthroplasty is much more than females and at a younger age as compared to the West. Additionally, the functional outcomes in cases of inflammatory arthritis are inferior as compared to the other indications, probably because of associated contractures, deformity and spinal issues.
