Tesis

Analisis Luaran Fungsional Tiga Tipe Bearing Surface Pada Total Hip Replacement Di RSUPN DR CIPTO MANGUNKUSUMO 2011 -2016 = Functional Outcome Comparison Analysis Of Three Bearing Surfaces In Total Hip Replacement In DR CIPTO MANGUNKUSUMO NATIONAL HOSTPITAL 2011-2016.

Pendahuluan: Total Hip Replacement (THR)disebut sebagai operasi abad ini karena menunjukan hasil yang memuaskan walaupun memiliki harga yang relatif mahal. THR telah dilakukan lebih dari 1 juta kali/tahun secara global dan diperkirakan akan meningkat dua kali pada dekade depan. Pada institusi kami, permintaan THR meningkat 313% dari tahun 2011 -2016. Kini telah banyak hadir berbagai jenis desain implant terutama tipe bearing surface dengan kelebihan dan kekurangan masing-masing. Namun pemilihannya masih menjadi kontroversial. Metode: Kami melaporkan penelitian potong lintang terhadap tiga tipe bearing surface yang sering digunakan di institusi kami; ceramic on polyethylene (CoP), metal on polyethylene (MoP)dan ceramic on ceramic (CoC). Enam puluh tiga pasien berhasil dilakukan review dengan usia rata-rata 45 tahun dan follow up rata-rata ±2,5 tahun. Kami menilai luaran fungsional dengan Harris Hip Score (HHS)dan radiologis. Hasil dan Pembahasan: Pada follow up terakhir, rata-rata HHS pascaoperasi yaitu 87,1 ± 10,2 (p=0,79) yang menunjukan tidak ada perbedaan antar kelompok. Rata-rata perbedaan HHS pascaoperasi – praoperasi yaitu 46,48 ± 14,1 (p=0,005)yang menunjukan adanya perbedaan signifikan di dalam kelompok oleh analisis one-way ANOVA. Analisa post hoc menunjukan rata-rata perbedaan HHS pascaoperasi – praoperasi secara statistik lebih tinggi pada kelompok CoC (56,82 ± 12,7) dibandingkan dengan CoP (44,29 ± 14,1, p = 0,007) dan MoP (42,05 ± 11,9, p = 0,015). Tidak ada perbedaan antara kelompok MoP dan CoP (p = 1,000). Tidak ditemukan perbedaan luaran radiologis pada ketiga kelompok. dimungkinkan karena follow up yang relatif pendek sehingga dibutuhkan studi dengan follow up yang lebih lama.
Kata kunci: Total Hip Replacement, Bearing Surface, Ceramic on Polyethylene, Ceramic on Ceramic, Metal on Polyethylene, luaran fungsional


Introduction : Total Hip Replacement (THR) is considered to be the operation of the century with a high level of satisfactory result even though it has relatively high cost. It has been performed more than 1 million times/year worldwide and its demand is estimated to double within decade. In our institution, its demand already increased by 313% from 2011-2016. Nowadays, we are faced with various implant design especially bearing surface with its benefits and weaknesses. But the ideal preference of bearing surface in THR remains a controversy. Methods: We report a cross sectional study of three type of THR bearing surface which are ceramic on polyethylene (CoP), metal on polyethylene (MoP) and ceramic on ceramic (CoC), that was frequently used in our institution. Total patient of 63 were available for review with mean age of 45 years old and mean follow up of ±2,5 years. We assessed their functional outcome with Harris Hip Score (HHS) and radiological outcome. Results and Discussion: At the final follow up, mean post-operative HHS was 87,1 ± 10,2 (p=0,79) that showed there were no difference between groups. Mean post-operative – pre-operative HHS differences was 46,48 ± 14,1 (p=0,005) that showed there were statically significant difference between groups as determined by one-way ANOVA. A post hoc analysis revealed that postoperative – preoperative HHS differences were statistically significantly higher in CoC group (56,82 ± 12,7) compared to CoP group (44,29 ± 14,1, p = 0,007) and MoP group (42,05 ± 11,9, p = 0,015). There was no statistically significant difference between the CoP and MoP (p = 1,000). Radiological outcomes reveal no loosening in all groups. This is predicted due to relatively short follow up time, thus longer follow up is needed.
Keywords: Total Hip Replacement, Bearing Surface, Ceramic on Polyethylene, Ceramic on Ceramic, Metal on Polyethylene, functional outcome.