A Randomized Study Comparing Uncemented and Hybrid Hip Replacements in Young Patients with Osteonecrosis Femoral Head

Objectives There is a scarcity of data comparing cemented and hybrid implants for total hip arthroplasty in relatively younger patients. The aim was to evaluate the clinical outcomes of uncemented and hybrid implants in patients who undergo total hip arthroplasty for avascular necrosis (AVN) of the hip. Material and Methods A prospective, interventional, randomized study included patients aged 30-55 with grade 3 or 4 AVN as per the modified Ficat and Arlet classification. Results The mean age of patients for hybrid total hip arthroplasty (THA) (Group 1) was 43.1±6.2 years, and for uncemented total hip arthroplasty (Group 2) was 42.4±4.3 years. The age difference between the groups was not statistically significant (Independent t-test, P=0.744). Both treatment groups demonstrated a significant improvement (P<0.05) in Harris hip score (HHS) at 1, 3, and 6 months after THA. Patients in Group 1 had significantly higher (P<0.05) HHSs than those in Group 2. The length of hospital stay for patients with hybrid implants (11.5±1.6 days) was significantly longer than for those with uncemented implants (10.8±0.9 days, independent t-test, P=0.040). The quantity of blood transfusion units administered was comparable between the two groups (P=0.123). There was no statistically significant difference observed in the incidence of deep infections, prosthetic fractures, or implant dislocations between the two groups (P>0.05). Group 2 exhibited a higher rate of superficial infections, whereas intraoperative complications were more common in Group 1. Conclusion For young patients with osteonecrosis, both uncemented and hybrid hip replacements represent viable surgical options. Recent advancements in implant design and bearing surfaces have contributed to the growing preference for uncemented prostheses. Nevertheless, our study demonstrated that the HHS at 6 months postoperatively was higher in the hybrid implant group, indicating superior functional outcomes. It is noteworthy, however, that patients receiving THA had a longer mean hospital stay (11.5 ± 1.6 vs. 10.8 ± 0.9 days, P=0.040) compared to those with uncemented arthroplasty. Additionally, the uncemented group exhibited a higher incidence of superficial infections, while the rates of other complications were comparable between the two cohorts.