Uncemented total hip arthroplasty (THA) implants have become the standard for younger patients on account of increased implant survivorship and multiple other advantages. Nevertheless, uncemented THA remains controversial in elderly patients. The evidence base for this is limited, as previous studies have compared octogenarians to a younger control group. The aim of this prospective cohort study is to evaluate the outcome of octogenarian patients undergoing uncemented THA with a control group of similarly aged patients undergoing hybrid THA with a minimum 5 years follow up. Clinical outcomes including intra and postoperative complications, blood transfusion, revision rate and mortality were recorded. Radiological analysis of pre and postoperative radiograph assessed bone quality, implant fixation and any subsequent loosening. 143 patients, (mean age 86.2 yrs.) were enrolled in the study. 76 patients underwent uncemented THA and 67 underwent hybrid THA. The uncemented cohort had fewer intraoperative and postoperative complications. The uncemented cohort also had a lower transfusion rate (p=0.002). Mean hospital stay (p=0.27) was comparable between the 2 groups. Two patients underwent revision surgery in either cohort. Our study demonstrates uncemented THA is safe for the octogenarian patient and we recommend that age should be not be a barrier of choice of implant. However intraoperative assessment of bone quality should guide surgeon to the optimum decision regarding uncemented and hybrid implant.

Background

The R3 cementless acetabular system (Smith & Nephew, Memphis, Tennessee, United States) is a modular titanium shell with an asymmetric porous titanium powder coating. It supports cross-linked polyethylene, metal and ceramic liners with several options for the femoral head component. The R3 cup was first marketed in Australia and Europe in 2007. Two recent papers have shown high failure rates of the MoM R3 system with up to 24% (Dramis et al 2014, Hothi et al 2015). There are currently no medium term clinical papers on the R3 acetabular cup.

Late infection is the most frequent complications after hemiarthroplasty. Urinary tract infections are the only distant septic focus considered to be a risk factor in the literature. We retrospectively reviewed 460 patients with hip fracture treated by hemiarthroplasy over a period of one year. Preoperative positive urine dipsticks and urine analysis have been looked at as causes for delay of surgery in absence of clinical manifestations of urinary tract infection. 367 patients were operated within 24 hours. 78 patients were delayed more than 78 hours. Urinary tract infection had the least contribution as a cause of delay. 99 patients had preoperative urinary tract infection and 57 patients had postoperative wound infection. Of these with postoperative surgical site infection, 31 patients did not show any evidence of preoperative urinary tract infection, 23 patients had preoperative urinary tract infection, two had leg ulcer and one had chest infection. 13 patients had chronic urinary tract infection and five patients had the same causative organism in urine & wound. The most common organisms of urinary infection are E. Coli, mixed growth, Enteroccocus Faecalis, Pseudomonas and others. The most causative organism of the postoperative surgical site infection are Staph aureus including MRSA, mixed growth including Staph. Epidermidis, Enteroccocus Faecalis and others There is no direct significant correlation between preoperative urinary tract infection and surgical site infection. We recommend that preoperative urinary tract infection should be treated as a matter of urgency but it should not delay hip fracture surgery unless it is causing symptoms.