Aims. The aim of this study was to explore the relationship between reason for revision total hip arthroplasty (rTHA) and outcomes in terms of patient-reported outcome measures (PROMs). Methods. We reviewed a prospective cohort of 647 patients undergoing full or partial rTHA at a single high-volume centre with a minimum of two years’ follow-up. The reasons for revision were classified as: infection; aseptic loosening; dislocation; structural failure; and painful THA for other reasons. PROMs (modified Oxford Hip Score (mOHS), EuroQol five-dimension three-level health questionnaire (EQ-5D-3L) score, and visual analogue scales for pain during rest and activity), complication rates, and failure rates were compared among the groups. Results. The indication for revision influenced PROMs improvement over time. This finding mainly reflected preoperative differences between the groups, but diminished between the first and second postoperative years. Preoperatively, patients revised due to infection and aseptic loosening had a lower mOHS than patients with other indications for revision. Pain scores at baseline were highest in patients being revised for dislocation. Infection and aseptic loosening groups showed marked changes over time in both mOHS and EQ-5D-3L. Overall complications and re-revision rates were 35.4% and 9.7% respectively, with no differences between the groups (p = 0.351 and p = 0.470, respectively). Conclusion. Good outcomes were generally obtained regardless of the reason for revision, with patients having the poorest preoperative scores exhibiting the greatest improvement in PROMs. Furthermore, overall complication and reoperation rates were in line with previous reports and did not differ between different indications for rTHA. Cite this article: Bone Joint J 2022;104-B(7):859–866

Aims. Modular dual mobility (MDM) acetabular components are often used with the aim of reducing the risk of dislocation in revision total hip arthroplasty (THA). There is, however, little information in the literature about its use in this context. The aim of this study, therefore, was to evaluate the outcomes in a cohort of patients in whom MDM components were used at revision THA, with a mean follow-up of more than five years. Methods. Using the database of a single academic centre, 126 revision THAs in 117 patients using a single design of an MDM acetabular component were retrospectively reviewed. A total of 94 revision THAs in 88 patients with a mean follow-up of 5.5 years were included in the study. Survivorship was analyzed with the endpoints of dislocation, reoperation for dislocation, acetabular revision for aseptic loosening, and acetabular revision for any reason. The secondary endpoints were surgical complications and the radiological outcome. Results. The overall rate of dislocation was 11%, with a six-year survival of 91%. Reoperation for dislocation was performed in seven patients (7%), with a six-year survival of 94%. The dislocations were early (at a mean of 33 days) in six patients, and late (at a mean of 4.3 years) in four patients. There were three intraprosthetic dissociations. An outer head diameter of ≥ 48 mm was associated with a lower risk of dislocation (p = 0.013). Lumbrosacral fusion was associated with increased dislocation (p = 0.004). Four revision THAs (4%) were further revised for aseptic acetabular loosening, and severe bone loss (Paprosky III) at the time of the initial revision was significantly associated with further revision for aseptic acetabular loosening (p = 0.008). Fourteen acetabular components (15%) were re-revised for infection, and a pre-revision diagnosis of reimplantation after periprosthetic joint infection (PJI) was associated with subsequent PJI (p < 0.001). Two THAs had visible metallic changes on the backside of the cobalt chromium liner. Conclusion. When using this MDM component in revision THA, at a mean follow-up of 5.5 years, there was a higher rate of dislocation (11%) than previously reported. The size of the outer bearing was related to the risk of dislocation. There was a low rate of aseptic acetabular loosening. Longer follow-up of this MDM component and evaluation of other designs are warranted. Cite this article: Bone Joint J 2021;103-B(7 Supple B):66–72

Aims. Studying the indications for revision total hip arthroplasty (THA) may enable surgeons to change their practice during the initial procedure, thereby reducing the need for revision surgery. The aim of this study was to identify and describe the potentially avoidable indications for revision THA within five years of the initial procedure. Patients and Methods. A retrospective review of 117 patients (73 women, 44 men; mean age 61.5 years (27 to 88)) who met the inclusion criteria was conducted. Three adult reconstruction surgeons independently reviewed the radiographs and medical records, and they classified the revision THAs into two categories: potentially avoidable and unavoidable. Baseline demographics, perioperative details, and quality outcomes up to the last follow-up were recorded. Results. A total of 60 revision THAs (51.3%) were deemed potentially avoidable and 57 (48.7%) were deemed unavoidable. The following were identified as avoidable factors: suboptimal positioning of the acetabular component (29; 48%), intraoperative fracture or a fracture missed on an intraoperative radiograph (20; 33%), early (less than two weeks) aseptic loosening (seven; 11.7%), and symptomatic leg length discrepancy of > 1 cm (four; 6.7%). Conclusion. A surprisingly large proportion of acute revision THAs are potentially avoidable. Surgeons must carefully evaluate the indications for revision THAs in their practice and identify new methods to address these issues. Cite this article: Bone Joint J 2019;101-B(6 Supple B):97–103

Aims

This study compares the re-revision rate and mortality following septic and aseptic revision hip arthroplasty (rTHA) in registry data, and compares the outcomes to previously reported data.

Aims. Revision total hip arthroplasty in patients with Vancouver type B3 fractures with Paprosky type IIIA, IIIB, and IV femoral defects are difficult to treat. One option for Paprovsky type IIIB and IV defects involves modular cementless, tapered, revision femoral components in conjunction with distal interlocking screws. The aim of this study was to analyze the rate of reoperations and complications and union of the fracture, subsidence of the stem, mortality, and the clinical outcomes in these patients. Methods. A total of 46 femoral components in patients with Vancouver B3 fractures (23 with Paprosky type IIIA, 19 with type IIIB, and four with type IV defects) in 46 patients were revised with a transfemoral approach using a modular, tapered, cementless revision Revitan curved femoral component with distal cone-in-cone fixation and prospectively followed for a mean of 48.8 months (SD 23.9; 24 to 112). The mean age of the patients was 80.4 years (66 to 100). Additional distal interlocking was also used in 23 fractures in which distal cone-in-cone fixation in the isthmus was < 3 cm. Results. One patient (2.2%) died during the first postoperative year. After six months, 43 patients (93.5%) had osseous, and three had fibrous consolidation of the fracture and the bony flap, 42 (91.3%) had bony ingrowth and four had stable fibrous fixation of the stem. No patient had radiolucency around the interlocking screws and no screw broke. One patient had non-progressive subsidence and two had a dislocation. The mean Harris Hip Score increased from of 57.8 points (SD 7.9) three months postoperatively to 76.1 points (SD 10.7) 24 months postoperatively. Conclusion. The 2° tapered, fluted revision femoral component with distal cone-in-cone-fixation, combined with additional distal interlocking in patients with bony deficiency at the isthmus, led to reproducibly good results in patients with a Vancouver B3 fracture and Paprosky type IIIA, IIIB, and IV defects with regard to union of the fracture, subsidence or loosening of the stem, and clinical outcomes. Cite this article: Bone Joint J 2024;106-B(4):344–351

Aims. The use of trabecular metal (TM) shells supported by augments has provided good mid-term results after revision total hip arthroplasty (THA) in patients with a bony defect of the acetabulum. The aim of this study was to assess the long-term implant survivorship and radiological and clinical outcomes after acetabular revision using this technique. Patients and Methods. Between 2006 and 2010, 60 patients (62 hips) underwent acetabular revision using a combination of a TM shell and augment. A total of 51 patients (53 hips) had complete follow-up at a minimum of seven years and were included in the study. Of these patients, 15 were men (29.4%) and 36 were women (70.6%). Their mean age at the time of revision THA was 64.6 years (28 to 85). Three patients (5.2%) had a Paprosky IIA defect, 13 (24.5%) had a type IIB defect, six (11.3%) had a type IIC defect, 22 (41.5%) had a type IIIA defect, and nine (17%) had a type IIIB defect. Five patients (9.4%) also had pelvic discontinuity. Results. The overall survival of the acetabular component at a mean of ten years postoperatively was 92.5%. Three hips (5.6%) required further revision due to aseptic loosening, and one (1.9%) required revision for infection. Three hips with aseptic loosening failed, due to insufficient screw fixation of the shell in two and pelvic discontinuity in one. The mean Harris Hip Score improved significantly from 55 (35 to 68) preoperatively to 81 points (68 to 99) at the latest follow-up (p < 0.001). Conclusion. The reconstruction of acetabular defects with TM shells and augments showed excellent long-term results. Supplementary screw fixation of the shell should be performed in every patient. Alternative techniques should be considered to address pelvic disconinuity. Cite this article: Bone Joint J 2019;101-B:311–316

Aims

United Classification System (UCS) B2 and B3 periprosthetic fractures in total hip arthroplasties (THAs) have been commonly managed with modular tapered stems. No study has evaluated the use of monoblock fluted tapered titanium stems for this indication. This study aimed to evaluate the effects of a monoblock stems on implant survivorship, postoperative outcomes, radiological outcomes, and osseointegration following treatment of THA UCS B2 and B3 periprosthetic fractures.

Aims. The purpose of this study was to determine the sensitivity, specificity and predictive values of previously reported thresholds of proximal translation and sagittal rotation of cementless acetabular components used for revision total hip arthroplasty (THA) at various times during early follow-up. Patients and Methods. Migration of cementless acetabular components was measured retrospectively in 84 patients (94 components) using Ein-Bild-Rontgen-Analyse (EBRA-Cup) in two groups of patients. In Group A, components were recorded as not being loose intra-operatively at re-revision THA (52 components/48 patients) and Group B components were recorded to be loose at re-revision (42 components/36 patients). Results. The mean proximal translation and sagittal rotation were significantly higher in Group B than in Group A from three months onwards (p < 0.02). Proximal translation > 1.0 mm within 24 months had a positive predictive value (PPV) of 90% and a specificity of 94%, but a sensitivity of 64%. Proximal translation > 1.0 mm within the first 24 months correctly identified 76 of 94 (81%) of components to be either loose or not loose. However, ten components in Group B (24%) did not migrate proximally above 1.0 mm within the first 60 months. Conclusion. The high PPV of EBRA-Cup measurements of proximal translation (90%) shows that this can be used in early follow-up to identify patients at risk of aseptic loosening. The absence of proximal translation within the first 60 months indicates a component is not likely to be loose at re-revision THA although it does not exclude late aseptic loosening as a cause of failure. Cite this article: Bone Joint J 2017;99-B:465–74

Aims. The purpose of this retrospective study was to evaluate the minimum five-year outcome of revision total hip arthroplasty (THA) using the Kerboull acetabular reinforcement device (KARD) in patients with Paprosky type III acetabular defects and destruction of the inferior margin of the acetabulum. Patients and Methods. We identified 36 patients (37 hips) who underwent revision THA under these circumstances using the KARD, fresh frozen allograft femoral heads, and reconstruction of the inferior margin of the acetabulum. The Merle d’Aubigné system was used for clinical assessment. Serial anteroposterior pelvic radiographs were used to assess migration of the acetabular component. Results. At a mean follow-up of 8.2 years (5 to 19.3), the mean Merle d’Aubigné score increased from 12.5 (5 to 18) preoperatively to 16.5 (10 to 18) (p < 0.0001). The survival rate at ten years was 95.3% (. sd. 4.5; 95% confidence interval (CI) 86.4 to 100) and 76.5% (. sd. 9.9, 95% CI 57.0 to 95.9) using aseptic loosening and radiological loosening as the endpoints, respectively. Conclusion. These results show that the use of the KARD with reconstruction of the inferior margin of the acetabulum in revision THA is associated with acceptable clinical results and survival at mid-term follow-up with, however, a high rate of migration of the acetabular component of 21.6%. Cite this article: Bone Joint J 2018;100-B:725–32

Aims

Tranexamic acid (TXA) has been shown to significantly reduce transfusion rates in primary total hip arthroplasties (THAs), but high-quality evidence is limited in the revision setting. The purpose of the current study was to compare the rate of blood transfusions and symptomatic venous thromboembolic events (VTEs) in a large cohort of revision THAs treated with or without intravenous (IV) TXA.

Aims. Our objective was describing an algorithm to identify and prevent vascular injury in patients with intrapelvic components. Methods. Patients were defined as at risk to vascular injuries when components or cement migrated 5 mm or more beyond the ilioischial line in any of the pelvic incidences (anteroposterior and Judet view). In those patients, a serial investigation was initiated by a CT angiography, followed by a vascular surgeon evaluation. The investigation proceeded if necessary. The main goal was to assure a safe tissue plane between the hardware and the vessels. Results. In ten at-risk patients undergoing revision hip arthroplasty and submitted to our algorithm, six were recognized as being high risk to vascular injury during surgery. In those six high-risk patients, a preventive preoperative stent was implanted before the orthopaedic procedure. Four patients needed a second reinforcing stent to protect and to maintain the vessel anatomy deformed by the intrapelvic implants. Conclusion. The evaluation algorithm was useful to avoid blood vessels injury during revision total hip arthroplasty in high-risk patients. Cite this article: Bone Jt Open 2022;3(11):859–866

Aims. Large acetabular bone defects encountered in revision total hip arthroplasty (THA) are challenging to restore. Metal constructs for structural support are combined with bone graft materials for restoration. Autograft is restricted due to limited volume, and allogenic grafts have downsides including cost, availability, and operative processing. Bone graft substitutes (BGS) are an attractive alternative if they can demonstrate positive remodelling. One potential product is a biphasic injectable mixture (Cerament) that combines a fast-resorbing material (calcium sulphate) with the highly osteoconductive material hydroxyapatite. This study reviews the application of this biomaterial in large acetabular defects. Methods. We performed a retrospective review at a single institution of patients undergoing revision THA by a single surgeon. We identified 49 consecutive patients with large acetabular defects where the biphasic BGS was applied, with no other products added to the BGS. After placement of metallic acetabular implants, the BGS was injected into the remaining bone defects surrounding the new implants. Patients were followed and monitored for functional outcome scores, implant fixation, radiological graft site remodelling, and revision failures. Results. Mean follow-up was 39.5 months (36 to 71), with a significant improvement in post-revision function compared to preoperative function. Graft site remodelling was rated radiologically as moderate in 31 hips (63%) and strong in 12 hips (24%). There were no cases of complete graft site dissolution. No acetabular loosening was identified. None of the patients developed clinically significant heterotopic ossification. There were twelve reoperations: six patients developed post-revision infections, three experienced dislocations, two sustained periprosthetic femur fractures, and one subject had femoral component aseptic loosening. Conclusion. Our series reports bone defect restoration with the sole use of a biphasic injectable BGS in the periacetabular region. We did not observe significant graft dissolution. We emphasize that successful graft site remodelling requires meticulous recipient site preparation. Cite this article: Bone Jt Open 2022;3(12):991–997

Instability is a common indication for revision total hip arthroplasty (THA). However, even after the initial revision, some patients continue to have recurrent dislocations. This study investigates those at risk for recurrent dislocation after revision THA for instability at a single institution. Between 2009 and 2019, 163 patients underwent revision THA for instability at a single institution. Thirty-three of these patients required re-revision THA due to recurrent dislocation. Cox proportional hazard models with death as a competing event were used to analyze risk factors, including prosthesis sizing and alignment. Paired t-tests or Wilcoxon signed rank tests were used to assess patient outcomes (Veterans RAND 12 (VR-12) physical score, VR-12 mental score, Harris Hip Score, and hip disability and osteoarthritis outcome score for joint replacement). Duration of follow-up until either re-revision or final follow-up was a mean of 45.3 ± 38.2 months. The 1-year cumulative incidence for recurrent dislocation after revision was 8.7%, which increased to 19.6% at 5 years and 32.9% at 10 years postoperatively. In the multivariable analysis, high ASA score [HR 2.71], being underweight (BMI<18 kg/m. 2. ) [HR 36.26] or overweight/obese (BMI>25 kg/m. 2. ) [HR 4.31], use of specialized liners [HR 5.51–10.71], lumbopelvic stiffness [HR 6.29], and postoperative abductor weakness [HR 7.20] were significant risk factors for recurrent dislocation. Increasing the cup size decreased the dislocation risk [HR 0.89]. The dual mobility construct did not affect the risk for recurrent dislocation in univariate or multivariable analyses. VR-12 physical and HHS (pain and function) scores improved postoperatively at midterm. Patients requiring revision THA for instability are at risk for recurrent dislocation. Higher ASA scores, abnormal BMI, use of special liners, lumbopelvic stiffness, and postoperative abductor weakness are significant risk factors for re-dislocation

The number of revision total hip arthroplasties (THA) is increasing. This procedure is associated with a higher complication rate than primary THA, and so it is important for patients to have realistic expectations. The aim of this systematic review was to gather and summarise the available evidence on patients’ expectations following revision THA. A literature search was conducted in PubMed, PsycINFO, Cochrane, Google Scholar and Web of Science from inception to December 2021. Methodological quality was assessed by two independent reviewers using the National Heart, Lung and Blood Institute (NIH) study quality assessment tool for observational cohort and cross-sectional studies. The search strategy generated 3132 references of which 4 articles met the inclusion criteria. Methodological quality scores ranged from 7–10. Patients have high expectations concerning future walking ability, pain and implant longevity. Implant longevity expectations vary according to the longevity of the primary implant. A significant positive correlation was found between fulfilled expectations of pain and walking ability and patient satisfaction (r = .46 – .47). Only one study assessed fulfilment of patient expectations. Great variability was seen in operationalisation and assessment of expectations. Patients undergoing revision THA appear to have high expectations with regards to future outcomes. Whilst results are promising, there is a paucity of high-quality data in this area. Further research is needed, which places emphasis on developing a sound theoretical framework for expectations, allowing for the consistent implementation of valid measurement tools

Introduction. Total joint arthroplasty rates have increased dramatically in recent decades. However, a comprehensive analysis of trends in revision total hip arthroplasty has not been performed recently to address the changing volume, costs, and location of these complex cases. We sought to identify trends in volume of these procedures, geographic distribution changes, and cost trends using a national sample. Materials and methods. The National Inpatient Sample, a representative sample of all hospital discharges within the United States, was used to determine the volume of revision total hip arthroplasty (THA) from 1993 to 2014. Procedures were identified by ICD-9 codes corresponding to revision THA. Annual incidence of revision THA was compared to annual incidence of primary THA to determine whether relative growth of revisions differed proportionally from the primary procedure. State-specific data was analyzed where available to develop geographic trend maps in the incidence of revision THA procedures using the estimated state population for years under review. Trends were also reviewed for hospital location (urban versus rural; teaching versus non-teaching) and total hospital charges. Analysis of trends was performed using linear regression models. Results. Volume of revision THA increased slower than primary THA from 1993 to 2014. Revision THA volume increased from 28,429 in 1993 to 48,295 in 2014. However, the relative proportion of revision compared to primary THA during this time period decreased from 21.3% in 1993 to 13.0% in 2014. While revision THA grew significantly at 925 additional procedures per year (p <0.001), the revision/primary proportion declined at a rate of −0.4 percentage points annually (p <0.001). Nationally, only one state demonstrated statewide incidence rate of revision THA >100 / 100,000 residents in 2001, while 31 of 36 states reporting in 2014 demonstrated statewide incidence rate of revision THA >100 / 100,000 residents. Revision THA shifted dramatically away from rural and urban non-teaching hospitals to urban teaching hospitals. In the year 2000, 52.3% of revision THA was performed in urban teaching hospitals, which had increased to 71.2% by 2014. Only 5.2% of revision THA was performed in rural hospitals in 2014. Similarly, hospital charges for revision THA increased significantly from a mean of $32,007 in 2000 to $83,927 in 2014. Discussion. Dramatic changes in the geographic distribution, hospital type, and cost of revision THA have occurred over the past two decades. The importance of this cannot be overstated, especially within the context of shifting payment models including mandated and voluntary bundles that have been applied to total joint arthroplasty procedures. With the burden of these costly, complex surgical cases falling predominantly on urban teaching hospitals, there must be a mechanism for adequately valuing these procedures to allow surgeons to be able to properly care for these patients. For any tables or figures, please contact the authors directly

Aims. Custom triflange acetabular components (CTACs) play an important role in reconstructive orthopaedic surgery, particularly in revision total hip arthroplasty (rTHA) and pelvic tumour resection procedures. Accurate CTAC positioning is essential to successful surgical outcomes. While prior studies have explored CTAC positioning in rTHA, research focusing on tumour cases and implant flange positioning precision remains limited. Additionally, the impact of intraoperative navigation on positioning accuracy warrants further investigation. This study assesses CTAC positioning accuracy in tumour resection and rTHA cases, focusing on the differences between preoperative planning and postoperative implant positions. Methods. A multicentre observational cohort study in Australia between February 2017 and March 2021 included consecutive patients undergoing acetabular reconstruction with CTACs in rTHA (Paprosky 3A/3B defects) or tumour resection (including Enneking P2 peri-acetabular area). Of 103 eligible patients (104 hips), 34 patients (35 hips) were analyzed. Results. CTAC positioning was generally accurate, with minor deviations in cup inclination (mean 2.7°; SD 2.84°), anteversion (mean 3.6°; SD 5.04°), and rotation (mean 2.1°; SD 2.47°). Deviation of the hip centre of rotation (COR) showed a mean vector length of 5.9 mm (SD 7.24). Flange positions showed small deviations, with the ischial flange exhibiting the largest deviation (mean vector length of 7.0 mm; SD 8.65). Overall, 83% of the implants were accurately positioned, with 17% exceeding malpositioning thresholds. CTACs used in tumour resections exhibited higher positioning accuracy than rTHA cases, with significant differences in inclination (1.5° for tumour vs 3.4° for rTHA) and rotation (1.3° for tumour vs 2.4° for rTHA). The use of intraoperative navigation appeared to enhance positioning accuracy, but this did not reach statistical significance. Conclusion. This study demonstrates favourable CTAC positioning accuracy, with potential for improved accuracy through intraoperative navigation. Further research is needed to understand the implications of positioning accuracy on implant performance and long-term survival. Cite this article: Bone Jt Open 2024;5(4):260–268

Aims. Two-stage exchange revision total hip arthroplasty (THA) performed in case of periprosthetic joint infection (PJI) has been considered for many years as being the gold standard for the treatment of chronic infection. However, over the past decade, there have been concerns about its safety and its effectiveness. The purposes of our study were to investigate our practice, collecting the overall spacer complications, and then to analyze their risk factors. Methods. We retrospectively included 125 patients with chronic hip PJI who underwent a staged THA revision performed between January 2013 and December 2019. All spacer complications were systematically collected, and risk factors were analyzed. Statistical evaluations were performed using the Student's t-test, Mann-Whitney U test, and Fisher's exact test. Results. Our staged exchange practice shows poor results, which means a 42% mechanical spacer failure rate, and a 20% recurrent infection rate over the two years average follow-up period. Moreover, we found a high rate of spacer dislocation (23%) and a low rate of spacer fracture (8%) compared to the previous literature. Our findings stress that the majority of spacer complications and failures is reflecting a population with high comorbid burden, highlighted by the American Society of Anesthesiology grade, Charlson Comorbidity Index, and Lee score associations, as well as the cardiac, pulmonary, kidney, or hepatic chronic conditions. Conclusion. Our experience of a two-stage hip exchange revision noted important complication rates associated with high failure rates of polymethylmethacrylate spacers. These findings must be interpreted in the light of the patient’s comorbidity profiles, as the elective population for staged exchange has an increasing comorbid burden leading to poor results. In order to provide better results for this specific population, our conclusion suggests that comparative strategy studies are required to improve our therapeutic indication. Cite this article: Bone Jt Open 2022;3(6):485–494

Dual-mobility (DM) bearings are effective to mitigate dislocation in revision total hip arthroplasty (THA). However, data on its use for treating dislocation is scarce. Aim of this study was to compare DM bearings, standard bearings and constrained liner (CL) in revision THA for recurrent dislocation and to identify risk factors for re-dislocation. We reviewed 100 consecutive revision THAs performed for dislocation from 2012 and 2019. 45 hips (45%) received a DM construct, while 44 hips (44%) and 11 hips (11%) had a standard bearing and CL, respectively. Rates of re-dislocation, re-revision for dislocation and overall re-revision were compared. Radiographs were assessed for cup positioning, restoration of centre of rotation, leg length and offset. Risk factors for re-dislocation were determined by cox regression analysis. Modified Harris hip scores (mHHS) were calculated. Mean follow-up was 53 months (1 to 103). DM constructs were used more frequently in elderly patients (p=0.011) and hips with abductor deficiency (p< 0.001). The re-dislocation rate was 11.1% for DM bearings compared with 15.9% for standard bearings and 18.2% for CL (p=0.732). Revision-free survival for DM constructs was 83% (95% CI 0.77 – 0.90) compared to 75% (95% CI 0.68 – 0.82) for standard articulations and 71% (95% CI 0.56 – 0.85) for CL (p=0.455). Younger age (HR 0.91; p=0.020), lower comorbidity (HR 0.42; p=0.031), smaller heads (HR 0.80; p=0.041) and cup retention (HR 8.23; p=0.022) were associated with re-dislocation. Radiological analysis did not reveal a relationship between restoration of hip geometry and re-dislocation. mHHS significantly improved from 43.8 points to 65.7 points (p<0.001) with no differences among bearing types. Our findings suggest that DM bearings do not sufficiently prevent dislocation in revision THA for recurrent dislocation. Reconstruction of the abductor complex may play a key role to reduce the burden in these high-risk patients

Previous reports on the outcomes of isolated head and liner exchange in revision total hip arthroplasty have found high rates of instability following these surgeries. Most reports have studied constructs using ≤28mm femoral heads. The purpose of this study was to determine if modern techniques with the use of larger head sizes can improve the rate of instability after head and liner exchange. We identified 138 hips in 132 patients who underwent isolated head and liner exchange for polyethylene wear/osteolysis (57%), acute infection (27%), metallosis (13%), or other (2%). All patients underwent revision with either 32mm (23%), 36mm (62%), or 40mm (15%) diameter heads. Crosslinked polyethylene was used in all revisions. Lipped and/or offset liners were used in 104 (75%) hips. Average follow up was 3.5 (1.0–9.1) years. Statistical analyses were performed with significance set at p<0.05. Revision-free survivorship for any cause was 94.6% and for aseptic causes was 98.2% at 5 years. 11 (8%) hips experienced a complication with 7 (5%) hips requiring additional revision surgery. Following revision, 4 (3%) hips experienced dislocation, 5 (4%) hips experienced infection, and 1 (1%) hip was revised for trunnionosis. No demographic or surgical factors significantly affected outcomes. Our study shows that isolated head and liner exchange using large femoral heads and modern liners provides for better stability than previous reports. The most common complication was infection. We did not identify specific patient, surgical or implant factors that reduced the risk of instability or other complication

Revision total hip arthroplasty (rTHA) in the presence of femoral defects can be technically challenging. Reconstruction with long stems is widely accepted as the standard. However long stems can be difficult to insert and can compromise distal bone stock for future revisions. The aims of this study were to identify whether there was a difference in survival and outcomes following rTHA using a long versus standard or short femoral stem. A comprehensive systematic review was performed according to PRISMA guidelines using the MEDLINE, EMBASE, Chochrane Library and Web of Science databases. Inclusion criteria were (i) adult patients >18 years; (ii) randomised controlled trials, joint registry, or cohort studies; (iii) single or staged rTHA for Paprosky 1–3B femoral defects. Exclusion criteria were (i) mixed reporting without subgroup analysis for revision stem length; (ii) ex-vivo studies. Screening for eligibility and assessment of studies was performed by the authors. Out of 341 records, 9 studies met criteria for analysis (including 1 study utilising joint registry data and 1 randomised controlled trial). Across studies there were 3102 rTHAs performed in 2982 patients with a mean age of 67.4 years and a male: female ratio of 0.93. Revision prostheses were long-stemmed in 1727 cases and short or standard in 1375 cases with a mean follow up of 5 years (range, 0-15 years). On subgroup analysis the use of a long cemented stem compared to a long cementless prosthesis was associated with fewer complications and periprosthetic fracture in older patients. Survivorship was 95% with short stems compared to 84% with long stems at 5 years. Moderate quality evidence suggests that in rTHA with Paprosky type 1-3B femoral defects, the use of a short or standard stem can achieve comparable outcomes to long stems with fewer significant complications and revisions. Using a shorter stem may yield a more straightforward surgical technique and can preserve distal bone stock for future revision