Comparison Of Different Factors Influencing On Therapeutic Effect Of THR

Background and Purposes: Total Hip Replacement (THR) is presently one of the most effective surgeries to reconstruct the stability and mobility of hip joint, relieve pain and rectify malformation. Many joint surgeons emphasize that THR should be limited to the relatively older people who has insufferable pain or severe hip joint malfunction which could not be relieved or reconstructed by other surgeries. Although THR is a mature technology, the therapeutic effect of THR is influenced by various factors. As marching into the old age society along with the aging of populations, it has the extraordinary significance to enhance the curative effect of THR and raise the survival rate of prosthesis. The purpose of the study is to analyze the follow-up results of primary THR and to provide the reference of the extension service life of prosthesis for our clinical work.Material and Methods: 127 THR patients (144 hips) who had received THR in our department during 1997-2005 were followed-up with an interval of 12 months. In term of Harris Hip Score and Classified Harris Hip Score, the therapeutic effect of THR was evaluated. A standardization database was established and SPSS11.5 software was employed to carry on the analysis. First, each target of the database was carried on a descriptive analysis. Then, the factors which could be obtained were selected according to the potential influence to therapeutic effect of THR, they included group of age, gender, years after operation, unilateral or bilateral THR(s), disease types, co-morbidities, anaesthesia ways, chief surgeons, operative approaches, methods of fixation of socket and stem, preoperative HHS, surgical time-expenditure and blood loss during operation and so on 13 items. Finally, the factors were carried on statistical analysises. A preliminary appraisal of the influence levels of different factors on therapeutic effect of THR was executed.Results: The average age of 127 THR patients (144 hips) at time of operation was 58.9 years old (22-85 years). Only 52 THR patients (60 hips, 41.67%) provided intact follow-up information, 2 died (1.4%) and 73 THR patients (82 hips, 56.93%) were lost. The mean Harris hip score had increased from 30.67±11.418 points at the preoperative time to 80.18+13.388 points at the time of final follow-up. ANOVA of Classified Harris Hip Score showed the significant differences (p < 0.05) which included years after operation, group of age, co-morbidities and chief surgeons and so on 4 items, and excluded methods of fixation of socket and stem, disease types 2 items. The t-tests of Harris Hip Score showed the significant differences (p<0.05) which included unilateral or bilateral THR(s), anaesthesia ways and post-op HHS vs preoperative HHS 3 items, and which excluded gender and operative approaches 2 items. Correlation analysis showed that there is no correlation between the post-op HHS and age of patients, blood loss during operation and surgical time-expenditure respectively.Conclusions: 1. The post-op HHS is significantly higher than preoperative HHS in this group of cases, it shows that the therapeutic effect of THR is affirmed. 2. The therapeutic effect of the cases of THR of 2004 year and 2005 year is better than the cases of THR of the 1997-2002 year group, it indicates that the progress is obtained in the aspects of prosthesis design, produce technology and operation technology. Along with the increase of tenure of use, therapeutic effect of THR has probably the tendency that drops. 3. In this group of cases, the therapeutic effect of THR of the cases of group of 60-69 years-old and of 49 years-old below are better than the cases of group of 50-59 years-old respectively. The actual age of patients is not related with post-op therapeutic effect of THR. 4. It is the most notable that the co-morbidities of the neurological disease, such as CVA or Parkinson's disease, affect the therapeutic effect of THR apparently, especially their postoperative Harris Function Score is lower generally than other cases. This condition should be explained emphaticly to the patients and to their family members at preoperative time of THR. 5. The therapeutic effect of bilateral THRs is better than the unilateral THR. So, it is suggested that a bilateral total hip arthroplasties should be performed for the case of double side hip disease within indicatio. 6. Comparison of cemented , uncemented fixation and hybrid fixation of THR, the therapeutic effect of these three group cases of follow-up is no significant difference detected. The doctor can choose different methods of fixation of socket and stem according to the specific condition of the case of difference. 7. Comparison of male THR and female THR, the therapeutic effect of these two group cases of follow-up is not significant difference. 8. The postoperative total results of THR are no significant difference between the greater trochanter anterolateral invasive approach and the greater trochanter posterior invasive approach. Both the anterolateral and the posterior incision approaches are reasonable alternatives, and surgeons should choose the approach that they feel most comfortable with. 9. There is a direct relation between the maturation of operation technology and therapeutic effect of THR. So, it is an important diplomacy and step to achieve good outcomes of THR to set up the special training system and the admittance system for articular surgeons.