Aims. Uncemented implants are now commonly used at reimplantation of a two-stage revision total hip arthoplasty (THA) following periprosthetic joint infection (PJI). However, there is a paucity of data on the performance of the most commonly used uncemented femoral implants – modular fluted tapered (MFT) femoral components – in this setting. This study evaluated implant survival, radiological results, and clinical outcomes in a large cohort of reimplantation THAs using MFT components. Methods. We identified 236 reimplantation THAs from a single tertiary care academic institution from September 2000 to September 2020. Two designs of MFT femoral components were used as part of an established two-stage exchange protocol for the treatment of PJI. Mean age at reimplantation was 65 years (SD 11), mean BMI was 32 kg/m. 2. (SD 7), and 46% (n = 109) were female. Mean follow-up was seven years (SD 4). A competing risk model accounting for death was used. Results. The 15-year cumulative incidence of any revision was 24%. There were 48 revisions, with the most common reasons being dislocation (n = 25) and infection (n = 16). The 15-year cumulative incidence of any reoperation was 28%. Only 13 revisions involved the fluted tapered component (FTC), for a 15-year cumulative incidence of any FTC revision of 8%. Only two FTCs were revised for aseptic loosening, resulting in a 15-year cumulative incidence of FTC revision for aseptic loosening of 1%. Stem subsidence ≥ 5 mm occurred in 2% of unrevised cases. All stems were radiologically stable at most recent follow-up. Mean Harris Hip Score was 69 (SD 20) at most recent follow-up. Conclusion. This series demonstrated that MFT components were durable and reliable in the setting of two-stage reimplantation THA for infection. While the incidence of aseptic loosening was very low, the incidence of any revision was 24% at 15 years, primarily due to dislocation and recurrent PJI. Cite this article: Bone Joint J 2024;106-B(5 Supple B):125–132

Aims

Joint registries typically use revision of an implant as an endpoint and report survival rates after a defined number of years. However, reporting lifetime risk of revision may be more meaningful, especially in younger patients. We aimed to assess lifetime risk of revision for patients in defined age groups at the time of primary surgery.

The use of total hip arthroplasty in adolescents for end-stage degenerative hip disease is controversial with few reported outcomes in the literature. The purpose of the study was to report the outcomes of total hip arthroplasty in a cohort of adolescents managed by a multidisciplinary team of paediatric and adult orthopaedic surgeons from a single centre. A multidisciplinary clinic consisting of paediatric and adult hip surgeons was established in 2013 to identify, treat and prospectively follow adolescents who would potentially beneift from a total hip arthoplasty. To date 29 consecutive adolescent patients (20 female, 9 male, 32 hips) with end stage degenerative hip disease have undergone cementless primary total hip arthroplasty. Mean age at decision to treat was 15.7 years (age 11.4–18.5). Ten different underlying paediatric specific pathologies were documented including DDH, cerebral palsy, JIA, skeletal dysplasias, SCFE and idiopathic chondrolysis. Three patients had bilateral staged procedures. Clinical baseline and outcomes were measured using Oxford Hip Score (OHS), WOMAC score and ASKp scores. Radiographic follow-up was conducted at 6 weeks, 6 months and yearly thereafter. Post-operative complications were recorded. Twenty-five hips were eligible for minimum 2-year follow-up scoring at a mean 2.7 years (2.0–3.6 years). No intraoperative complications occurred. One case of recalcitrant postoperative psoas tendonitis occured. OHS improved from 25 (7–43) to 41 (23–48). WOMAC improved from 48 (12–8) to 12 (1–44), and ASKp improved from 78% (33–98%) to 93% (73–100%). Radiographic review revealed acceptable alignment of all components with no signs of loosening or wear. No revision of components was required. One patient died at 6 months post op from an unrelated condition. The early term results of total hip arthroplasty in adolescents from our multidisciplinary program are encouraging. Improvements in quality of life to normal values were seen as were hip scores consistent with satisfactory joint function. Depite the range of complex and varied causes of arthritis seen in this population the establishment of combined paediatric and adult orthopaedic surgical teams appears to be a successful model to manage end-stage degenerative hip disease in adolescents

High complication rates and poor outcomes have been widely reported in patients undergoing revision of large head metal-on-metal arthroplasty. A previous study from our centre showed high rates of dislocation, nerve injury, early cup loosening and pseudotumor recurrence. After noting these issues, we implemented the following changes in surgical protocol in all large head MOM revisions: One: Use of highly porous shells in all cases. Two: Use of largest femoral head possible. Three: Low threshold for use of dual mobility and constrained liners when abductors affected or absent posterior capsule. Four: Use of ceramic head with titanium sleeve in all cases. Five: Partial resection of pseudotumor adjacent to sciatic and femoral nerves.

The purpose of the present study is to compare the new surgical protocol above to our previously reported early complications in this group of patients

We specifically looked at (1) complications including reoperations, (2) radiologic outcomes, and (3) functional outcomes. Complication rates after (Group 1), and before (Group 2) modified surgical protocol were compared using Chi-square test, assuming statistical significance p < 0 .05.

Major complications occurred in 4 (8.3%) of 48 patients who had modified surgical technique, compared to 12 (38%) of 32 revisions prior to modification (p < 0 .05). Two hips of 48 (4.17%) endured dislocations in Group 1, compared to 9 of 32 (28%) in Group 2 (p < 0 .05). Four patients of 48 had repeat revision in Group 1: 2 for recurrence of pseudotumor, 1 for dislocation, and 1 for infection, compared to 6 patients who had 7 repeat revisions of 32 patients in Group 2: 3 for acetabular loosening, 3 for dislocation, and 1 for recurrence of pseudotumor (p=0.1). None of 48 revisions in Group 1 had acetabular loosening, compared to 4 of 32 in Group 2 (p=0.02). Two patients had nerve injury in Group 2, compared to none in Group 1 (p=0.16). The mean WOMAC pain score was 87.1 of 100 and the function score was 88.4 of 100 in Group 1, compared to a mean WOMAC pain score of 78 of 100 (p=0.6) and a function score of 83 of 100 in Group 2 (p=0.8).

Modification of the surgical techniques described in the introduction has resulted in a significant decrease in complications in revision of large head MOM total hips. We continue to use this protocol and recommend it for these difficult cases.

Background

High complication rates and poor outcomes have been widely reported in patients undergoing revision of large head metal-on-metal arthroplasty. A previous study from our center showed high rates of dislocation, nerve injury, early cup loosening and pseudotumor recurrence. After noting these issues, we implemented the following changes in surgical protocol in all large head MOM revisions: 1. Use of highly porous shells in all cases 2. Use of largest femoral head possible 3. Low threshold for use of dual mobility and constrained liners when abductors affected or absent posterior capsule 4. Use of ceramic head with titanium sleeve in all cases 5. Partial resection of pseudotumor adjacent to sciatic and femoral nerves.

Aims

The purpose of this study was to evaluate whether an innovative templating technique could predict the need for acetabular augmentation during primary total hip arthroplasty for patients with dysplastic hips.

Introduction

Decreasing tissue damage and recovery time, while improving quality of life have been the focus of many approaches to total hip arthroplasty (THA). In this study, we compared two approaches, a tissue-sparing superior capsulotomy percutaneously assisted approach (SP) and the traditional posterior approach (TR), to address the question of whether the novel technique reduces tissue damage. The secondary aim of this study focused on the measurement technologies utilized to quantify the damage resulting from either SP or TR. Image J, BioQuant, and cellSens were the image analysis programs employed. Statistical validation and comparisons of results between all platforms were performed.

Aims

Our aim was to report survivorship data and lessons learned with the Corail/Pinnacle cementless total hip arthroplasty (THA) system.

Introduction. Highly cross-linked polyethylene has been introduced to decrease osteolysis secondary to polyethylene wear debris generation, but there are few long-term data on revision total hip arthroplasty using highly cross-linked polyethylene liners. The purpose of this study was to report the long-term radiographic and clinical outcomes of a highly cross-linked polyethylene liner in revision total hip arthroplasty. Materials & Methods. We analyzed 63 revision total hip arthoplasties that were performed in 63 patients using a highly cross-linked polyethylene liner between April 2000 and February 2005. Of these, nine died and four were lost to follow-up before the end of the 10-year evaluation. Thus, the final study cohort consisted of 50 patients (50 hips). There were 26 males and 24 females with a mean age at time of revision total hip arthoplasty of 53 years (range, 27–75 years). Mean duration of follow-up was 11 years (range, 10–14 years). Results. Mean Harris hip score improved from 44 points preoperatively to 85 points at final follow-up. No radiographic evidence of osteolysis was found in any hip. One hip required re-revision surgery for acetabular cup loosening at 6.5 years postoperatively. One required re-revision with a constrained liner because of recurrent dislocation. Three sustained deep infections requiring additional surgical procedures. Kaplan-Meier survivorship with an end point of re-revision for any reason was 91.0% and for aseptic cup loosening was 97.9% at 11 years (Figs. 1 and 2). Conclusions. At a minimum of 10 years, the highly cross-linked polyethylene liners showed excellent clinical performance and implant survivorship, and were not associated with osteolysis in our group of patients with revision total hip arthoplasties

Introduction. In most cases of revision acetabular total hip arthoplasty (THA), some degree of bone loss will be accompanied. If the bone loss is massive, the management of bone defect is more challenging problem. We consider that using cementless accetabular cup for revision acetabular reconstruction is good indication when stable interface fit between the acetabular cup and bone is achieved. The purpose of this study is to review the result of revision hip arthroplasty using cementless acetabular cup with and without bone graft. Materials and methods. Between 1998 and 2012, 65 revisions using cementless acetabular cup (Mallory-Head 4 Finned component) were performed in 64 patients, whose mean age was 64.9 years. The cases of revision are aseptic loosening (53 joints), and infection (12 joints). All patients were followed up for a minimum period of 24.0 months (mean, 84 months) and were divided into two groups as follows: in group A, revisions without bone graft (28 joints); in group B, revisions with bone graft (37 joints). We compared clinical and radiographical results of group A with group B. Results. According to Paproski's classification, bone defects in Group A were evaluated as either Type I or Type IIa, and those in Group B were in the range of Type IIb to Type IIIb. Large cementless accetablar compornent with diameters of 58 mm or more were used in 6 joints and 21 cases, respectively. Postoperative radiography showed there were no significant deference of the position of hip center, lateral inclination and anteversion of acetabular cup in each group. The migration of the socket in the superior and medialaxes has not been observed in all cases at the latest follow-up. The mean JOA hip score improved from 63.1 points to 88.3 points and from 53.2 to 86.1, respectively and there were no cases of re-revisions in this series. Conclusions. Depending on the bone defect, large cementless accetablar compornent and bone graft should be considered. We are confident that results of acetabular reconstraction using cementless acetabular cup are satisfactory

Introduction. The development of new bearing surfaces for total joint replacement is constantly evolving. Oxidized zirconium (Oxinium) has been introduced for use in total hip arthroplasty (THA) and total knee arthroplasty (TKA). One of the most common causes of failure of THA is aseptic loosening secondary to polyethylene wear debris. The aetiology of wear is multifactorial and includes adhesive, abrasive, third-body and fatigue wear mechanisms. Oxidized zirconium is a relatively new material that features an oxidized ceramic surface chemically bonded to a hard metallic substrate. This material possesses the reduced polyethylene wear characteristics of a ceramic, without the increased risk of implant fracture While short-term results of oxidized zirconium in THA have been reported, there have been no reports on retrieved highly cross linked PE articulating with Oxinium headsObjectives:. Objectives. The purpose of this study was to compare matched pairs of retrieved highly cross-linked polyethylene (XLPE) acetabular liners with OxZr and CoCr articulation. The liners were examined for evidence of wear damage, including articular surface damage, impingement, screw-hole creep, and rim cracks. Materials and Methods. Four retrieved highly cross-linked polyethylene (XLPE) acetabular liners with 32mm OxZr femoral heads were identified and matched to four retrieved highly cross-linked polyethylene (XLPE) acetabular liners with 32mm CoCr femoral heads by duration of implantation, patient age, and body mass index. Visual damage grading of the articular surface was performed by two independent graders by direct visualization and by light stereomicroscopy. The articular surfaces were subjectively graded for abrasion, burnishing, cracking, delamination, pitting, plastic deformation, third body debris, and scratching using a 0 to 3 scale as described by Hood et al. Liners were divided into quadrants with the elevated rim, when present, to the left and the quadrants labeled in a clockwise fashion beginning in the upper left hand corner. When an elevated rim was not present, liners were divided into quadrants based on the ocation of the etchings. Each quadrant was scored separately. Results. The retrieved components showed predominantly abrasion and burnishing primarily in zones 1 and 2 representing the supero-anterior and supero- posterior regions in the liner. The mean damage score for the Oxinium group was 17.3 vs 23.3 in the CoCr group. The mean time in vivo for the oxinium group was 7.1 yrs vs 4.5 yrs for the CoCr group. Interestingly, the damage scores in zones 3 and 4 were very similar in both groups representing the infero post and anterior portions on the liner. Conclusion. The development of new bearing surfaces for total joint replacement is constantly evolving and will continue to do so as polyethylene wear and osteolysis continue to be a major problem in the long-term survival of total hip arthoplasties. CoCr roughens significantly more in situ compared with OxZr components. Despite the small number of retrieved implants in our study, OxZr demonstrated lower damage on XLPE liners when compared to the CoCr group. Longer-term studies will be necessary to establish the overall clinical fatigue performance of highly crosslinked liners with newer bearing surfaces such as OxZr

The June 2015 Hip & Pelvis Roundup. 360 . looks at: neuraxial anaesthesia and large joint arthroplasty; revision total hip arthoplasty: factors associated with re-revision surgery; acetabular version and clinical outcomes in impingement surgery; hip precautions may be ineffective; implant selection and cost effectiveness; femoroacetabular impingement in the older age group; multiple revision in hip arthroplasty

The aim of this study was to review the role of clinical trial networks in orthopaedic surgery. A total of two electronic databases (MEDLINE and EMBASE) were searched from inception to September 2013 with no language restrictions. Articles related to randomised controlled trials (RCTs), research networks and orthopaedic research, were identified and reviewed. The usefulness of trainee-led research collaborations is reported and our knowledge of current clinical trial infrastructure further supplements the review. Searching yielded 818 titles and abstracts, of which 12 were suitable for this review. Results are summarised and presented narratively under the following headings: 1) identifying clinically relevant research questions; 2) education and training; 3) conduct of multicentre RCTs and 4) dissemination and adoption of trial results. This review confirms growing international awareness of the important role research networks play in supporting trials in orthopaedic surgery. Multidisciplinary collaboration and adequate investment in trial infrastructure are crucial for successful delivery of RCTs.

Cite this article: Bone Joint Res 2014;3:169–74.

Introduction:. The incidence of heterotrophic ossification after primary total hip arthoplasty (THA) has been reported to be between 8 to 90%. The incidence is higher in lateral approach because of extensive muscular trauma associated with it. There exists limited data on the incidence of heterotrophic ossification after direct anterior approach (DAA) THA. The purpose of this study was to assess the incidence of heterotrophic ossification after THA via the direct anterior approach and the influence of surgical technique and chemoprophylaxis. Method:. A consecutive series of four hundred two primary uncemented direct anterior approach total hip arthoplasties in 378 patients were reviewed for incidence of heterotrophic ossification. In the first 200 total hip arthoplasties an anterior capsulectomy (Group 1) was done for exposure while in the subsequent 202 total hip arthoplasties a capsulotomy (Group 2) followed by complete release of supero-lateral flap of from its attachement to the gluteus minimus muscle and trochanter was performed (Figure 1). Group 1 received warfarin for thromboprophylaxis; while aspirin (thromboprophylaxis) and celecoxib (pain) was used in group 2. Heterotrophic ossification was classified according to Brooker's classification on plain radiographs. Results:. Heterotrophic ossification was significantly less in group 2 (4/202, 1.98%) as compared to group 1 (29/200, 14.5%). No severe heterotrophic ossification was found in group 2. Conclusion:. Release of the superior-lateral capsular flap from the gluteus minimus muscle allows the femoral mobilization required during the femoral preparation and exposes the trochanter for easier retractor placement and thereby minimizes the muscular traumatic insult. When combined with aspirin and celecoxib chemoprophylaxis, this technique may diminish heterotrophic ossification