Abstract
Introduction: Acetabular loosening can limit long-term success of total hip replacement. There are at least 62 different prosthesis designs available in the UK, many of which have no long term results. Revision surgery is expensive, challenging and potentially dangerous. There is still currently debate about the best method of acetabular fixation, in particular, regarding the use of press fit devices in elderly osteoporotic bone. Our study aims to test the null hypothesis that there is no significant difference in outcome between cemented and non-cemented acetabular fixation in this group of patients.
Methods: Patients over 72 years of age were prospectively randomised to receive either a cemented Exeter cup or a HA coated press fit cementless cup. Both groups received a cemented Exeter stem. The patients were assessed pre-operatively and reviewed at 6 weeks, 6 months and yearly in a research clinic, by an independent observer. Outcome measures were the Merle D’Aubignon Postel, Oxford Hip and Visual analogue pain scores. The implants were also assessed radiographically and all complications were recorded.
Results: To date 151 patients have been recruited into the trial. 2 year data is available for 69 patients. There were no differences in satisfaction, pain or hip scores between the groups.
There have been no major surgical complications. In particular, there have been no failures of acetabular fixation, dislocations or deep infections.
Discussion: There have been no failures in either group. Although there is insufficient data at this stage to reject our null hypothesis, there is no early evidence for concern in using cementless cups in elderly patients.
Correspondence should be addressed to The Secretary, BHS, c/o BOA, The Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
