Total Hip Joint Replacement in Osteoarthrosis and Polyarthritis A Statistical Study of the Results

This is a report of 360 total hip joint replacements in 297 patients using the McKee-Farrar and Howse prostheses, carried out by one surgeon at the Victoria Infirmary, Glasgow, from 1967 to June, 1972. The operation was done for both osteoarthrosis and polyarthritis, most of the latter cases being transferred from the Center for Rheumatic Diseases after a full rheumatological survey. All operations were carried out in a standard orthopedic theater without any particular air conditioning or laminar flow technic. All patients were admitted prior to operation for a general assessment which included full blood count, erythrocyte sedimentation rate, chest X-ray and electrocardiogram. Only those cases where there was some infective lesion present or where there was extreme cardiac ischemia were discarded from the possibility of total joint replacement. Initially the McKee-Farrar was used4, 7 but the occurrence of occasional early dislocation and the trend to favor stainless steel on RCH 1,000 prostheses prompted a change to the Howse prosthesis. A standard 5 day course of chemotherapy was used as an umbrella. Colomycin was administered because of the fear of Pseudomonas infection, this being the main hospital organism, and Cloxacillin to prevent the ever-present risk of staphylococcal infection. Adequate steroid cover was planned where necessary to combat the abnormal plasma cortisol stress response in those patients previously on prolonged courses of corticosteroids. Severe pain, gross deformity or inability to walk were the main indications for operation but bony ankylosis of both hips in ankylosing spondylitis was considered to be a sufficiently severe disability to warrant total hip joint replacement on one or both sides. High liters of rheumatoid factor or high sedimentation rate were not considered contraindications to surgery but it was necessary on occasions to correct the feet into a plantigrade position and to obtain sufficient strength in both upper limbs to manage a walking aid or crutches before the major hip replacement was carried out.