Immediate weight bearing after uncemented total hip arthroplasty with an anteverted stem: A prospective randomized comparison using radiostereometry

Background In uncemented total hip arthroplasty with hydroxyapatite coating, early weight bearing is frequently practiced but there is still not much evidence to support this recommendation.

Method In a prospective randomized study we evaluated the effect of partial and full weight bearing after cementless total hip arthroplasty (ABG; Stryker-Howmedica) using radiostereometric analysis (RSA). Between February 1996 and February 2000, 43 consecutive patients (mean age 53 (41–63) years, 23 women) with hip osteoarthrosis received an uncemented and hydroxyapatite-coated prosthesis with an anteverted stem. All patients were operated in a standardized way by three experienced surgeons and they were randomized to partial (P) or full (F) weight bearing during the first 6 weeks after surgery. The patients in the partial weight bearing group were equipped with a pressuresensitive insole signaling when their load exceeded the prescribed weight limit.

Results At 3-month follow-up, the mean proximal (+)/ distal (-) migration of the stem was -0.14 mm (-1.93– 0.11) in group P and -0.31 mm (-4.30–0.16) in group F (p = 0.6). At 1-year follow-up, the mean migration was –0.17 mm (-2.18–0.21) and -0.28 mm (-4.31–0.11), respectively (p = 0.9). There was no significant difference in stem rotations either (p < 0.2). The cup translations, rotations, and femoral head penetration were similar in the two groups (p < 0.1). There were no re-operations during the first year.

Interpretation We did not find any adverse effect of full weight bearing immediately after operation, which justifies use of this regimen after uncemented total hip arthroplasty of the ABG type.