Prospective Comparative Functional Outcomes of Cemented versus Uncemented Total Hip Replacement in Indian Rural Population

Abstract Background: Total hip replacement is a widely accepted surgical intervention for treating various hip pathologies, such as osteoarthritis, avascular necrosis (AVN), and rheumatoid arthritis. The decision between using cemented or uncemented prostheses remains a key consideration, with differing opinions on their long-term outcomes, especially in terms of implant stability, functionality, and patient satisfaction. Objective: This study aimed to prospectively compare the functional outcomes of cemented versus uncemented total hip arthroplasty (THA) in the rural Indian population, where unique healthcare challenges, such as limited access to advanced facilities and delayed presentation of hip pathologies, exist. Materials and Methods: A total of 62 patients (35 males, 27 females) aged 25–70 years diagnosed with hip pathologies, including AVN and osteoarthritis, who required THA were enrolled in a hospital-based, prospective cohort comparative study. The patients were randomly assigned to either the cemented THA group ( n = 31) or the uncemented THA group ( n = 31). Functional outcomes were assessed using the Harris Hip Score (HHS) at various postoperative intervals, including 6 weeks, 3 months, and 6 months. Results: Preoperative evaluations utilizing the HHS demonstrated no significant disparity between the groups, with mean scores of 41.04 ± 6.88 for the cemented group and 42.72 ± 6.22 for the uncemented group. Postoperatively, notable enhancements were evident in both cohorts, with the cemented cohort demonstrating superior results. At 24 h postsurgery, the cemented cohort exhibited a mean HHS of 87.1 ± 5.11, whereas the uncemented cohort displayed a mean HHS of 83.9 ± 5.16 ( P < 0.01). This trend continued throughout follow-up periods at 6 weeks ( P = 0.009), 3 months ( P = 0.007), and 6 months ( P = 0.008). The average surgical duration was extended in the cemented cohort (115.3 min compared to 101 min, P < 0.05), and intraoperative hemorrhage was also elevated (370.33 ml vs. 340 ml, P < 0.05). Conclusion: The study concludes that cemented THA may offer better early postoperative recovery and functional improvement in the rural Indian population. While both approaches are viable, the choice of prosthesis should be individualized, considering clinical indications, patient needs, and economic factors. Further multicentric, randomized studies with larger sample sizes and longer follow-up periods are recommended to confirm these findings.