Traumatic hip dislocation is a rare injury in orthopaedic practice and typically occures in high energy trauma. The goal of this study was to analyze hip morphology in patients with low energy traumatic hip dislocations and to compare it with a control group. We performed a retrospective comparative study. The study group included 45 patients with 45 traumatic posterior hip dislocation. Inclusion criteria were traumatic hip dislocation with simple acetabular rim or Pipkin I or II fracture. Traumatic dislocations combined with other acetabular or femoral fractures were excluded. The control group consisted of 90 patients (180 hips) that underwent radiographic examination for urogenital indication and had no history of hip pain. Hip morphology was assessed on antero-posterior and axial views. The study group showed significantly increased incidence (p<0.001) of positive cross-over sign (82% vs. 27%) with a increased retroversion index (26 ± 17 [0–56] vs. 6 ± 12 [0–53]), positive ischial spine sign (70% vs. 34%), and positive posterior wall sign (79% vs. 21). Hips that underwent an low energy posterior traumatic hip dislocation show significanly more radiographic signs for acetabular retroversion compared to a control group. Therefore, acetabular retroversion seems to be a contributing factor for posterior traumatic hip dislocation

Background. Habitual hip subluxation and dislocation is a potentially disabling feature of Trisomy 21. We describe long-term outcomes following precise use of the femoral varus derotation osteotomy to achieve and maintain hip stability and community ambulation. Methods. All individuals with Trisomy 21, who had hip surgery at Toronto's Hospital for Sick Children between 1998 and 2008, were searched using the hospital databases. 16 hips in 9 children aged less than 10 years, were identified. All had a femoral varus derotation osteotomy (VDRO) with a target femoral neck shaft angle (NSA) of 105° and less than 20° external rotation. All were performed by the senior author JHW. The clinical notes and radiographs were reviewed from presentation to final follow up. Continuous variables were assessed for normality with the d'Agostino Pearson test. Normally distributed variables are presented as means with 95% confidence intervals. Pre and postoperative means were compared using the student's t-test for paired samples. Results. Mean age at first known hip dislocation was 4.56 years (3.98, 5.15), mean age at surgery 6.07 years (5.15, 7.0) and mean follow-up 5.4 years (3.75, 7.06). Mean femoral neck shaft angle (NSA) fell from 166.7° (162.2°, 171.1°) to 106.0° (103.1°, 110.2°). In 2 hips, significant intraoperative instability persisted and periacetabular osteotomies with capsulorraphies were required. All patients developed an asymptomatic waddling gait postoperatively. 14 hips developed peritrochanteric varus deformities, mean 20.7° (15.96°, 25.4°)2 (12.5%) sustained periprosthetic fractures 4 and 8 years postoperatively. 1 hip (6.2%) developed painful arthritis. None re-dislocated at latest follow up. Conclusion. Prevention of long term disabling pain from habitually dislocating or recurrently subluxed hips, in patients with Trisomy 21, requires surgical intervention to increase hip containment. We believe surgical management of habitually subluxed or dislocated Trisomy 21 hips allows for a predictable result. We recommend a varus producing proximal femoral osteotomy to correct the NSA to 105° with less than 20° of external rotation. This technique was successful at restoring and maintaining hip stability in 16 hips with a mean follow-up of 5.4 years, whilst maintaining the patient's ability to remain community ambulators. It should be performed before aged 8 or signs of a widened or V-shape teardrop develops. In our experience this has been effective in maintaining hip stability. However, little is known about the natural history of habitual hip dislocation in these children. Patients with Trisomy 21 are living longer with hips that are at continuous risk. Thought should be given to the potential benefits of periodic screening of this treatable hip condition

This study reports on the natural history of acetabular fracture dislocations. We retrospectively reviewed patients who sustained an acetabular fracture associated with a posterior hip dislocation from a prospective database. Patient characteristics, complications and the requirement for further surgery were recorded. Patient outcomes were measured using the Oxford Hip score and Short Form SF-12 health survey. A total of 99 patients were treated over a 24 year period. The mean age was 41 years. Open reduction and internal fixation was performed in the majority (n=87), 10 were managed conservatively following closed reduction and two underwent primary total hip replacement (THR). At a median follow up of 12.4 years (range 4–24 years) patient outcomes were available for 53 patients. 12 patients had died. 19 patients went onto have a THR as a secondary procedure, of which 11 had confirmed avascular necrosis. Median time to THR was 2 years (range 1–17 years). The mean Oxford hip score was 35 (range 2–48), SF-12 physical component score (PCS) was 40 and a third of the patients used a walking aid. In THR group the mean Oxford score was 32 (range 3–46), SF-12 PCS was 39 and almost all required a walking aid. This is the first study to present the long term outcomes following an acetabular fracture dislocation. Our study suggests there is considerable disability in this group of patients and the requirement for subsequent THR has inferior patient reported outcomes

NICE Guidelines suggest patients should be offered a Total Hip Replacement (THR) rather than Hemiarthroplasty for a displaced intracapsular hip fracture. We investigated outcomes of patients aged 40–65 who received a THR or Hemiarthroplasty following a traumatic intracapsular hip fracture and had either high-risk (Group 1) or low-risk (Group 2) alcohol consumption (>14 or <14 units/week respectively). This was a retrospective study (April 2008 – December 2018) evaluating patients who underwent THR or Hemiarthroplasty in Greater Glasgow and Clyde. Atraumatic injuries, acetabular fractures, patients with previous procedures on the affected side and those lost to follow up were excluded. Analysis of length of admission, dislocation risk, periprosthetic fractures, infection risk, and mortality was conducted between both cohorts. Survival time post-operatively of Group 1 patients with a THR (61.9 months) and Hemiarthroplasty (42.3 months) were comparable to Group 2 patients with a THR (59 months) and Hemiarthroplasty(42.4 months). Group 1 patients with THR had increased risk of dislocation (12.9%; p=0.04) compared to those that received Hemiarthroplasty (2.5%). Group 1 Hemiarthroplasty patients had increased wound infection risk (11.6%) compared to Group 2 (3.7%). In conclusion, we found that amongst our population the life expectancy of a post-operative patient was short irrespective of whether they had high or low-risk alcohol consumption. A hip fracture may represent increased frailty in our study population. The Group 1 THR cohort presented a higher risk of hip dislocation and periprosthetic fracture. With this in mind, Hemiarthroplasty is a more cost-effective and shorter operation which produces similar results

Femoroacetabular impingement (FAI) is a pathologic condition of the hip that leads to osteoarthrosis. The goal of the surgical hip dislocation is to correct the bony malformations to prevent the progression of osteoarthrosis. We investigated the topographical cartilage thickness variation in patients with FAI and early stage osteoarthrosis using an ultrasonic probe during surgical hip dislocation. We performed a prospective case-series of 38 patients (41 hips) that underwent surgical hip dislocation. The mean age at operation was 30.6 (range, 18–48) years. Indication for surgery was symptomatic FAI with 4 hips (10%) with pincer-type, 7 hips (17%) with cam-type, and 20 hips (73%) with mixed-type of FAI. Cartilage thickness was measured intraoperatively using an A-mode 22 MHz ultrasonic probe at 8 locations on the acetabular cartilage. The thickest acetabular cartilage was found in the weight bearing zone (range 2.8–3.5mm), whereas the thinnest cartilage was in the posterior acetabular horn (1.0–2.2 mm). In all hips, cartilage was thicker in the periphery area compared to the central area. In the anterior and posterior acetabular horn, the anterior area, and the superior area (central parts) a significantly decreased cartilage thickness in pincer-type compared to cam-type of FAI was found (p<0.05). Cartilage thickness shows topographical differences in all types of FAI with pincer-type of FAI having generally thinner cartilage than cam-type FAI. This is the first study measuring in vivo cartilage thickness in the human hip

Introduction. Femoroacetabular impingement (FAI) is a relatively recent recognised condition and a potential cause of anterior hip pain in the young military adult population. Both Cam and Pincer type FAI may lead to inflammation, labral tears, and or damage to the smooth articular cartilage of the acetabulum leading potentially to early osteoarthritis of the hip. Open Surgical hip dislocation using the Ganz Trochanteric Flip approach is an accepted technique allowing osteoplasty of the femoral neck and acetabular rim combined with labral repair if required. We present our results of this technique used in military personnel. Methods. All Military personnel who underwent FAI surgery in our unit since August 2006 were included in the study. Functional outcome was measured using the Oxford hip and McCarthy non-arthritic hip scores pre and post-operatively. Results: 13 hips in 11 patients with an average age of 36 years (21–45) underwent surgical hip dislocation for treatment of FAI. Average time of downgrading prior to surgery was 9.3(3-18) months. 6 out of the 11 patients have been upgraded to P2. Average time to upgrading was 6.8(3-17) months. There were no infections, dislocations, or neurovascular complications. Mean Oxford Hip Score improved from 22.8(range 8–38) to 39.5(11–48) and mean McCarthy hip score from 49.6(33.75–80) to 79.2(36.25–100) with an average follow up of 19.4 months (range 4– 42 months). Discussion. The early results of surgical hip dislocation in military personnel are encouraging. Long-term follow-up is required to see if this technique prevents the natural progression to osteoarthritis

Background:. Leg length discrepancy related to absence of the femoral head with proximal migration of the femur presents a treatment dilemma. Late sequelae of neonatal hip sepsis and chronic hip dislocation due to developmental dysplasia are the most common causes. Traditional teaching dictates that the hip is stabilised prior to limb lengthening. Reconstructive options alter the shape of the proximal femur which complicates future surgery. Methods:. We retrospectively reviewed 3 cases of femoral lengthening with an ‘unstable’ hip without prior stabilization. The aetiology was neonatal hip sepsis in 2 cases and chronic hip dislocation due to developmental dysplasia in 1 case. Lengthening was performed with the use of a retrograde Precice lengthening nail. Results and Discussion:. The desired length (range 5.5 to 6cm) was achieved in all patients without migration of the proximal femur. In all cases patient satisfaction was high with the lengthening and the ability to abort shoe raises. There was an improvement in gait pattern in all patients. Conclusion:. Femoral lengthening is possible without prior stabilisation of the hip in so called ‘unstable’ hip situations. The proximal femoral anatomy is not further altered and future salvage procedures such as a total hip replacement are not compromised

Aims

To assess the feasibility of a randomized controlled trial (RCT) that compares three treatments for acetabular fractures in older patients: surgical fixation, surgical fixation and hip arthroplasty (fix-and-replace), and non-surgical treatment.

INTRODUCTION. Management of neglected residually displaced acetabular fractures is a big challenge. ORIF is often doomed to failure so a primary total hip replacement is usually kept in mind as a method of choice. However THR is a technically difficult and results are quiet unpredictable. OBJECTIVE. To present our experience with THR in maltreated grossly displaced acetabular fractures and to discuss operative technique and prognostic factors in that complicated surgery. MATERIAL. THR was applied in 14 patients (11 males and 3 females, mean age 51 years) with at least three-months old and significantly displaced acetabular fractures. In 12 cases preceding treatment was conservative, and in 2 it was operative. Fracture nonunion was recognized in 5 cases, old hip dislocation in 4 and protusion in 3. Large interfragmentary gaps and local bone defect were detected in almost all cases. METHOD. THR was performed 3–31 months after injury. Extensile iliofemoral or Y-shaped approach with trochanteric osteothomy was used in most cases. Depending of particular situation a variety of techniques were applied to provide adequate bone stock for the cup, such as an approximate ORIF, periacetabular osteotomy, structural or morcelised bone grafting. Reinforcement ring was used in 6 cases. The cup fixation was cemented in 12 procedures and uncemented in 2. Cemented stem was introduced in 10 cases and uncemented in 4. Preoperative selective embolisation of superior gluteal artery was carried out in 1 patient. RESULTS. The operative duration was 3–7 hours and blood loss was 850–2200 ml. The only intraoperative accidentwas jatrogenic lesion of superior gluteal artery required embolisation. The follow up was a 16–94 months. Average postoperative Harris Hip Score was 78, compared with 54 before surgery (P<0.01). There was 2 aceptic and 1 septic loosenings with subsequent revisions (21.4%). In 2 cases sight asymptomatic migration of the cap was noted. DISCUSSION. The most difficult but most important stage of operation is a creating of sufficiently stable bone stock for the acetabular cap, impeded by by fragment displacement, nonunion or prolonged hip dislocation. If nonuion the achievement of bone healing is essential. Any instability should be overcomed by stable osteosynthesis. The gaps should be filled by ORIF or bone grafting. We consider cemented fixation possibly with reinforcement ring as a most secure way to provide strong cup anchorage. Uncemented pess-fit cup may be used in cases with lesser initial displacement. In spite of all late results are considerable worse than in conventional hip replacement. CONCLUSION. THR after neglected acetabular fractures is a challenging and demanding procedure. Successful outcome may be only expected if a solid bone stock is made using various surgical techniques

Aims

It is imperative to understand the risks of operating on urgent cases during the COVID-19 (SARS-Cov-2 virus) pandemic for clinical decision-making and medical resource planning. The primary aim was to determine the mortality risk and associated variables when operating on urgent cases during the COVID-19 pandemic. The secondary objective was to assess differences in the outcome of patients treated between sites treating COVID-19 and a separate surgical site.

Background. Femoroacetabular impingement due to a reduced femoral head-neck-offset or excessive acetabular coverage will lead to early cartilage lesions of the hip joint. The purpose of the present study was to analyze the relationship between the extent of bony deformity and the presence and extent of cartilage lesions in femoroacetabular impingement. Methods. On the radiographs of 92 hip joints in 86 patients with a mean age of 36.5 ± 9.2 years who were operated on for with femoroacetabular impingement by surgical hip dislocation, the acetabular index of the weight-bearing zone, the center-edge-angle, the inclination of the acetabulum, the lateral-head-extrusion-index, retroversion signs of the acetabulum, the neck-shaft-angle, asphericity, superior and anterior alpha angles, and superior and anterior offset and offset ratios were assessed and correlated to the presence and extent of chondromalazia. Results. Acetabular chondromalazia was found in 60 hip joints. Full-thickness delamination of the acetabular cartilage was present in 42 of these hips with an average size of 1.1 ± 0.5 cm2. Femoral-sided chondromalazia was found in 9 hip joints. Hip joints with chondromalazia had a lower center-edge-angle (p = 0.014) and anterior offset ratio (p = 0.028) and a higher lateral-head-extrusion-index (p = 0.029). Hip joints with acetabular cartilage delamination had a significantly lower center-edge-angle (p = 0.012) and anterior offset (p = 0.03) and a significantly higher lateral-head-extrusion-index (p = 0.001) and superior (p = 0.006) and anterior alpha angles (p = 0.003). Conclusions. Marked cam-type femoral deformity and lesser coverage of the femoral head are associated with the acetabular cartilage lesions, arousing suspicion to the assumption that a large lateral aperture of the acetabulum abets proximal femora with cam-type deformity to inflict cartilage damage in femoroacetabular impingement

Aim of the study. Aim of this study was to find out which factors influence the outcome after both column fractures of the acetabulum. Methods. We performed a retrospective analyse of 115 patients with both column acetabular fractures. The period between the injury and follow-up ranges between 2 and 19 years, 5,7 years on average. The initial displacement, the presence of a dislocation of the hip and fractures of the femoral head were analyzed on the initial radiographs. Postoperative displacement was classified according the classification of Matta. The common classifications of Helfet (posttraumatic arthrosis), Ficat/Arlet (femur head necrosis) and Brooker (periarticular calcification) were used to radiologically classify the long term results. Statistics were performed by the Chi-square-test. Results. We could find a clear tendency between the result of replacement and the radiological long-term result. 10 % of the patients with a postoperative displacement 1 mm had a joint failure compared to 28 % of the patients with 2–3 mm and 31,6 % with >3 mm displacement. In cases with good radiological results the average of initial displacement was 11,4mm but it was 17,8 mm for patients with a bad result. This difference is high significant (p=0,008). If the primary displacement was < 10 mm the rate of joint failure was 10,85%, whereas the rate increased up to 27,5% in patients with primary displacement > 10mm. Patients with hip dislocations had no significant higher risk for a joint failure (21,5% without vs. 25,9% with dislocation). Also patients with injuries of the femoral head had no significant (p>0,05) worse outcome. 19,8% of the patients without femoral head injury suffers on joint failure in comparison to 15,4% (2) of the patients with impression or contusion of the femoral head. The presence of intraarticular fragments is accompanied by a worse result (p=0,041). In 50% of the cases with intraarticular fragments a joint failure appeared whereas only 18% of the patients without fragments developed joint failure. Discussion. Matta could show in 1996 that anatomic replacement is a very important factor for a good outcome after acetabular fractures. These findings were supported by other publications. Our data show that there is a significant worse outcome after nonanatomical replacement. Several authors could show the presence of additional factors which predict the outcome independently of the replacement. In our data the primary displacement and the presence of intraarticular fragments showed a high influence. Dislocation of the hip, injuries of the femoral head and the presence of acetabular comminution had no significant influence but their number was maybe too small to detect it. Conclusion. Anatomical replacement is the major goal to avoid joint failure in the treatment of both-column acetabular fractures. Additional factors including the primary displacement and intraarticular fragments have a worse influence independent of the replacement

Total hip arthroplasty (THA) has been efficacious for treating hip fractures. However, in these patients with fractures a widely variable prevalence of dislocation has been reported, partly because of varying durations of follow-up for this specific end-point. The purpose of the present study was to determine the risk of dislocation as a function of time after total hip arthroplasty in these patients with fractures and to investigate if constrained liners influence the cumulative risk of dislocation. Between 2000 and 2005, 425 patients with neck fracture underwent primary THA using a constrained acetabular liner (Cemented retentive cup, Groupe lépine, Genay, France). The results of these 425 constrained acetabular liners were compared with 380 THA without constrained liners performed for neck fractures between 1994 and 1999 in the same hospital. All patients were followed for a minimum of 5 years for radiographic evidence of implant failure. The patients were followed at routine intervals and were specifically queried about dislocation. The cumulative risk of dislocation was calculated with use of the Kaplan-Meier method. Results. For patients without constrained liners, the cumulative risk of a first-time dislocation was 5% at one month and 12% at one year and then rose at a constant rate of approximately 2% every five years to 17% at five years, 19% at ten years, 21% at 15 years for patients who were alive and had not had a revision by that time. For patients with constrained liners, the cumulative risk of a first-time dislocation was 1% at one month, 2% at one year and then did not changed at 5 years and at 10 years for patients who were alive and had not had a revision by that time. Multivariate analysis revealed that the relative risk of dislocation for female patients (as compared with male patients) was 2.1 and that the relative risk for patients who were 80 years old or more (as compared with those who were less than 80 years old) was 1.5. Two underlying diagnoses - cognitively impaired patients or neurologic desease—were also associated with a significantly greater risk of dislocation. At minimum 7 year follow up (range 5 10 yrs), there were 8 radiographic failures (dislocations) of the 425 constrained liners (2%), and no loosenings were noted. Conclusions. The cumulative long-term risk of dislocation for patients with hip fractures is considerably greater than has been reported in short-term studies. The incidence of dislocation is highest in the first year after arthroplasty and then continues at a relatively constant rate for the life of the arthroplasty. Patients at highest risk are old female patients and those with a diagnosis of neurologic desease. Constrained liners in these patients is an efffective technique to prevent post operative hip dislocation

Aims

Echocardiography is commonly used in hip fracture patients to evaluate perioperative cardiac risk. However, echocardiography that delays surgical repair may be harmful. The objective of this study was to compare surgical wait times, mortality, length of stay (LOS), and healthcare costs for similar hip fracture patients evaluated with and without preoperative echocardiograms.

Background. An increasing number of hip prostheses are inserted without bone cement. Experimental research has shown that hydroxyapatite (HA) coated implants are strongly fixated in the bone, which is believed to reduce the likelihood of prosthetic loosening. However, in recent years, there has been much debate about the role of HA particles in third-body polyethylene (PE) wear and formerly we have shown the revision rate to be high among older-design HA coated cups. Purpose. We hypothesized increased PE wear-rate using HA coated acetabular components in comparison with non-HA coated components (control group). Materials and Methods. We performed a retrospective comparative clinical study based on two patient populations identified in the Danish Hip Arthroplasty Registry (October 2006). All patients had primary total hip arthroplasty (THA) between 1997 and 2001 with cementless Mallory-Head acetabular components. One group received HA coated acetabular components (75 patients, 77 hips). The other group received identical components without HA (70 patients, 73 hips). In all cases the liner was similar and 28 mm metal femoral heads were used. All patients were invited for a radiographic follow-up in 2007. The AP radiographs were analysed for two-dimensional (2D) polyethylene wear using the semi-automated PolyWare software. All cases of non-responders, stem revisions, hip dislocations and patients with less than 5 years of follow-up were excluded from the analysis. Findings/Results. The 2D linear PE wear-rate of 0.18 mm/year (SD 0.09) was higher (P<0.001) in the group with HA coated cups (n = 54) compared with 0.12 mm/year (SD 0.07) in the group of non-HA coated cups (n = 35). The Effect size of the difference in linear PE wear-rate, established as Cohen's d, was large (0.9). The time of follow-up was similar (p = 0.11) in the HA group (7.2 years) versus the non-HA group (7.6 years). There was no case-mix concerning distribution of gender and operated side in the groups; however, the mean age was lower (P = 0.001) in the HA group (57 years) compared with the non-HA group (63 years). Conclusions. We found a significantly increased PE wear rate in HA coated acetabular components at midterm follow-up. The patients with HA coated cups were younger on average, and this might partly explain the findings because the activity level expectedly is higher in younger patients. Still an effect size of 0.9 is large and should raise concern and supplement considerations in future clinical decisions on component selection. A randomized (RSA) study on newer type crosslinked polyethylene liners is recommended to bring about more information on the clinical performance and longevity of HA coated acetabular components

The prevalent cause of implant failure after total joint replacement is aseptic loosening caused by wear debris. Improvement of the wear behaviour of the articulating bearing between the cup and femoral head is essential for increased survival rate of artificial hip joints. Cross-linking of the polyethylene (PE) material is one attempt to reduce wear particle release at the articulating surface. Various cross-linked polyethylenes (X-PE) are used in orthopaedics since several years. In total hip arthroplasty (THA) the use of larger femoral head sizes has specific reasons. Larger heads lead to a decreased risk of total hip dislocation and impingement as well as an improved range of motion in comparison to smaller head sizes like 28mm or less. However, the increasing diameter of femoral head can be associated with lower thickness of the PE liner and increased wear rate. Cross-linking of PE can improve the wear rate of the liner and hence supports the use of larger femoral heads. The aim of this experimental study was to evaluate the wear of standard vs. sequential X-PE (X3-PE) liner in combination with different ceramic femoral head sizes. Wear testing was performed for 5 million load cycles using standard UHMW-PE liners (N2Vac) and X3-PE liners (each Stryker GmbH & Co. KG, Duisburg, Germany) combined with 28mm ceramic ball heads and the Trident PSL acetabular cup (Stryker). Furthermore, X3-PE liners with an internal diameter of 36mm and 44mm and decreased wall thickness (5.9mm and 3.8mm) were combined with corresponding ceramic heads. An eight station hip wear simulator according to ISO 14242 (EndoLab GmbH, Rosenheim, Germany) was used to carry out the standard wear tests. The tests were realised in temperature-controlled chambers at 37°C containing calf serum (protein content 20g/l). The average gravimetrical wear rates of the standard UHMW-PE (N2Vac) liners combined with 28mm ceramic heads amounted to 12.6 ± 0.8mg/million cycles. Wear of X3-PE liners in combination with 28 mm ceramic heads was not detectable. The average gravimetrical wear rates of the X3-PE liners in combination with 36mm and 44mm ceramic heads amounted to 2.0 ± 0.5mg and 3.1 ± 0.3mg/million cycles, respectively. The purpose of this study was to evaluate the effect of femoral head size at THA on standard and sequential X-PE liner. The wear simulator tests showed that the wear rate of PE liners with small heads (28mm) decreased by cross-linking of the PE significantly. The amount of wear at X-PE increased slightly with larger head size (36mm and 44mm). However, by sequential cross-linking, the wear rate using thinner liners and larger femoral heads is reduced to a fractional amount of wear at conventional UHMW-PE. Hence, the above-mentioned advantages of larger femoral head diameters can be realised by improved wear behaviour of sequential X-PE

Goal. The goal of this prospective, non-randomized study is to compare functional and life-quality changes in primary total hip replacement (THR) with minimally invasive anterior (MIA) and direct lateral (DL) approach in six months follow-up. Materials and Methods. Sixty (30 MIA and 30 DL) consecutive patients underwent primary THR were operated by the same senior surgeon. Patients completed functional and life-quality scores (Oxford Hip Score, Harris Hip Score, EQ-5D) before operation and four times (2 and 6 weeks, 3 and 6 months) after THR. Physical examination was taken all times. 15–15 patients underwent MRI examination to adjudge status of abductor muscles. The average patient age was approximately equal in both group. Results. The average OHS values were 13,4; 27,5; 40,9; 45,3; 47,5 in MIA and 15,3; 25,3; 39,7; 43,8; 45 in DL, the average HHS values 43,1; 68,7; 85,3; 91,9; 96,7 in MIA and 43; 58,2; 81,5; 90,2; 93,9 in DL, the average EQ-VAS 41,1; 72,5; 85,9; 87,8; 92,4 in MIA and 55,6; 67,8; 80,6; 84; 91,3 in DL consecutively. In MIA group both functional and life-quality scores showed better results, but for the 3rd postoperative month increases were approximately equal. Abductor muscle strength was significantly greater in MIA group in this period. In the 6th postoperative week Trendelenburg-sign was detected in 24 cases (80%) in DL and in 2 cases (6,7%) in MIA group, but in MIA patients were greater trochanter fractures, which had gone healing and limping was not detected 3 months after surgery. 3 months after surgery Trendelenburg-sign was detected in 2 cases in DL group. In follow-up period residual trochanteric pain was detected in 3 cases in DL but none in MIA group. Two weeks after THR climbing a flight of stairs was normal and public transport could be used by 80% of patients in MIA group. Distance walk was unlimited, support had not needed, daily activities were easy. There were 7 operative complications in MIA group, including 2 greater trochanter fracture, 1 haematoma and 4 transient lateral femoral cutaneous nerve palsy, which showed change for the better after 6 months. Postoperative hip dislocation was not detected. In DL group MRI represented fatty infiltration and atrophy of abductor muscles in most cases. Conclusions. Besides the fact that our learning curve may influence the results. It seems that earlier mobilisation and faster postoperative recovery can be achieved by MIA approach, which have many financial and social benefits. It preserves muscles and tendons, which probably can influence the long-term results. By preventing abductor muscles can assure better gait pattern. Of course additional long-term studies are needed

Aims

Displaced, comminuted acetabular fractures in the elderly are increasingly common, but there is no consensus on whether they should be treated non-surgically, surgically with open reduction and internal fixation (ORIF), or with acute total hip arthroplasty (THA). A combination of ORIF and acute THA, an approach called ’combined hip procedure’ (CHP), has been advocated and our aim was to compare the outcome after CHP or ORIF alone.

Aims

The aims of this study were to determine the cumulative ten-year survivorship of hips treated for acetabular fractures using surgical hip dislocation and to identify factors predictive of an unfavourable outcome.

In the time since Letournel popularised the surgical treatment of acetabular fractures, more than 25 years ago, there have been many changes within the field, related to patients, surgical technique, implants and post-operative care. However, the long-term outcomes appear largely unchanged. Does this represent stasis or have the advances been mitigated by other negative factors? In this article we have attempted to document the recent changes within the surgery of patients with a fracture involving the acetabulum, outline contemporary management, and identify the major problem areas where further research is most needed.

Cite this article: Bone Joint J 2017;99-B:1125–31