Background: It is common sense that a hemiarthroplasty for the management of a fracture of neck of femur will inevitably lead to the erosion of the natural acetabulum. Therefore it appears appropriate to confine this treatment to patients with a short life expectancy to spare them the experience of this complication and consequent surgery, whereas younger and healthier patients would have to be offered a Total Hip Replacement for that reason. Occasional clinical experience of amazing longevity of hemiar-throplasties cast doubt on this way of thinking. Materials and Methods: A series of 699 hemiarthroplasties done in a Swiss orthopaedic department between 1983 to 2003, were studied with regard to revision surgery because of acetabular erosion. In addition to data from the MEM documentation system, acetabular biopsies retrieved on revision surgery were used for this analysis. The incidence of revision surgery for acetabular erosion was statistically compared with the incidence of primary Total Hip Replacement in the Norwegian Hip Register. Results: The incidence of acetabular erosion following hemiarthroplaty over 20 years in the Swiss series was determined for different age groups. In the most important age group of 70 to 79 years, in this series comprising 249 patients, this incidence was 3,2%. The incidence of Primary Total Hip Replacement for osteoarthritis in the Norwegian Hip Register over 20 years is 3,6% for the same age group. Conclusion: The incidence of acetabular erosion as a consequence of a hemiarthroplasty was surprisingly low in the Swiss series and did not exceed the incidence of Total Hip Replacement for primary osteoarthritis in a European national population. Acetabular erosion can’t be considered as an inevitable consequence of a hemiarthroplasty, but is to be seen as a complication confined to a certain group of patients

Abstract. Introduction. Bipolar hemiarthroplasty(BPHA) for displaced intracapsular neck of femur fractures(DICNOF) is a controversial topic as conflicting evidence exists. The most common reason for revision to total hip arthroplasty(THA) from BPHA is acetabular erosion. In our study, we sought to quantify the direction of migration of the bipolar head within the first 3 years post-operatively. Methods. A proportional index in the horizontal and vertical planes of the pelvis were used to quantify migration. This method removed the need to account for magnification and rotation of the radiographs. Results. There were a total of 35 patients (8males, 27females) included, with an average followup of 2.3years (816days). 7 did not migrate, these were all female. For the remainder, per year of insertion, the average horizontal migration was 0.005769439 and the average vertical migration was 0.004543352, suggesting superomedial movement. Discussion. BPHA has been shown to provide results similar to those of THA in patients with DICNOF. The main cause of revision to THA is migration thought to be from loss of cartilage volume from mechanical wear, that causes pain. We have quantified this migration as minimal. None of our patients required revision to THA and none sustained dislocation or loosening in this followup period. This would fit with the meta-analyses looking at BPHA, which shows bipolar articulations reduce the amount of wear. We also identified a trend that in the female population migration is less likely to occur. This would add evidence to the theory that mechanical factors are significant in the volumetric wear caused by hemiarthoplasty. Conclusion. BPHA was found to be safe and effective in our cohort of patients with minimal migration and no need for revision at an average of 2.3years. Our data is concurrent with the literature in theorising that BPHA reduces wear at the prosthesis-cartilage interface

Nine cases of acetabular erosion following insertion of the Monk "hard top" hip prosthesis for subcapital fractures are presented. All of these patients had significant symptoms and represented 5% of the total group. In our experience acetabular erosion has proved to be a significant complication of the Monk "hard top" prosthesis

The best treatment for a fractured neck of femur in an old person is considered by many to be replacement hemiarthroplasty which allows the patient to walk immediately on a stable, painless hip. The late results can be marred by acetabular erosion in which the metal head of the prosthesis erodes upwards into the acetabulum to give pain and disability. Here the trial of a new bipolar prosthesis with a dynamic self-aligning outer head is described in 161 fractured necks of femur. No acetabular erosion has been seen with its use over four years

Objective: to measure cartilage and bone acetabular erosion in patients treated with a bipolar hip hemiarthroplasty because of a femoral neck fracture. Material and methods:. - 34 patients, 31 female. average age 72.9 +/− 7.1 years (56–90). - Level of activity previous to fracture: 82.4% level III, 14.6% level II. - Displaced (Garden III and IV) fracture of femoral neck excluding pathologic fractures. - Hip hemiartrhoplasty with a JRI Furlong bipolar head (22.25 mm inner head), 30 patients with a Furlong HAP-coated uncemented stem and 4 patients with an auto-blocking-type Surgival cemented stem. - Follow-up: minimum 2 years, average 2.9 years (2–5). - Clinical evaluation: Merle-DAubigne-Postel six-point scale for pain and for function. - Radiological evaluation: measure of joint line width at superior-lateral quadrant (weight bearing area), perpendicular distance from prosthesis head to Kohler line. - Statistical analysis: Kolmogorov-Smirnov, ANOVA, Bonferroni, Pearson, and Spearman tests. Results – Pain: average score 4.5 +/− 1.3 after 1 year, 4.7 +/− 1.3 after 2 years, 4.6 +/− 1.4 after 3 years. - Function: average score 4.7 +/− 1.1 after 1 year, 4.7 +/− 1.4 after 2 years, 4.8 +/− 1.3 after 3 years. - Radiological joint line: disappeared in 13 patients (38.2%) after 1 year, in 14 (41.2%) after 2 years, in 54.5% of patients after 3 years. Average joint line width in the other patients: 0.9 mm (0.6–1.3) immediately after surgery, 0.6 mm (0.4–0.8) after 1 year, 0.5 mm (0.3–0.7) after 2 years, 0.5 mm (0.2–0.7) after 3 years (p< 0.05). - Distance from head to Kohler line: 5.7 +/− 3.8 mm (4.6–6.8) immediately after surgery, 4.6 +/− 3.7 mm (3.6–5.6) after 1 year, 4.3 +/− 2.9 mm (3.3–5.3) after 2 years, 4.0 +/− 3.3 mm (2.5–5.5) after 3 years (p< 0.05). There were 2 cases of acetabular protrusion. Conclusions 1. Bipolar heads in hemiarthroplasty do not avoid acetabular erosion. 2. The radiological progressive erosion does not correlate with clinical worsening of the patients

Using dried bones which could be tilted and rotated, we assessed the accuracy of published radiographic methods for measuring the migration of prosthetic acetabular components and compared the results with a new method. The new line linking acetabular margins was significantly more accurate for proximal migration than the teardrop, the sacroiliac line or the sacroiliac-symphysis line. For medial migration, a new line tangential to the brim and through the horizontal mid-point of the obturator foramen was more accurate than Kohler's line, the ilio-ischial line or the iliopubic line. In combination, the two new lines can give a more accurate assessment of acetabular erosion than previous methods, since they are less affected by the differences in rotation commonly found in a series of radiographs

We describe a technique to salvage a painful hemiarthroplasty due to erosion of the acetabular cartilage in the absence of loosening of the femoral component. A press-fit metallic acetabular component which matched the femoral component was used as a metal-on-metal articulation. The procedure offered a shorter operation time with less blood loss and no risk of femoral fracture as might have occurred during conventional revision to a total hip replacement. The patient made an unremarkable recovery with a good outcome at follow-up of 15 months.

Hip fractures pose a major global health challenge, leading to high rates of morbidity and mortality, particularly among the elderly. With an ageing population, the incidence of these injuries is rising, exerting significant pressure on healthcare systems worldwide. Despite substantial research aimed at establishing best practice, several key areas remain the subject of ongoing debate. This article examines the latest evidence on the place of arthroplasty in the surgical treatment of hip fractures, with a particular focus on the choice of implant, the use of cemented versus uncemented fixation, and advances in perioperative care.

Cite this article: Bone Joint J 2024;106-B(12):1372–1376.

There is a surge of patients on the waiting-list for primary total hip replacement (THR), due to unprecedented reduction of elective activity caused by COVID-19. A higher incidence of femoral head collapse (FC) and acetabular erosion (AE) leading to increase in pain and instability as well as requirement of more complex surgery and potentially higher risk to patients was noted in this period. Rapidly progressive Arthritis (RPA) of the hip is a known entity often described as progression of joint space narrowing greater than 2mm over one year time period. The study aims to identify any potential relationship between waiting time and establishment of femoral head collapse and/ or acetabular erosion. A retrospective review of arthroplasty surgeon's waiting list during COVID. Serial hip radiographs recorded between February 2020 and February 2022 were analysed. FC was quantified as a percentage of the femoral head radius, while AE was assessed by drawing two parallel lines, one through both tear drops and the other through superior most aspect of intact acetabulum, parallel to the inter tear-drop line and expressed as percentage of normal side. Only 105 patients out of 264 patients added to the waiting list had elective arthroplasty for hip/knee. Only 35 patients out of 90 listed for THR, had the surgery. 36 of 90 (40%) were found to have developed FC and fitted the criteria for RPA. Acetabular erosion was seen in 19 (21%). Therefore 53% (19 of 36) of those who developed FC progressed to AE. Incidence of collapse was higher in females (32%), with mean age of 62 (range 51–81), compared to 21% in males with mean age 59 (range 53–87). Mean extent of femoral head collapse was 20% (10 – 44%). A significant proportion of patients added to waiting list during COVID developed RPA of the hip with 40% having femoral head collapse and 21% progressing to acetabular erosion leading to a complex case-mix. Patients on long waiting lists need regular x-ray checks/PROMS since significant proportion progress to FC and Acetabular Erosion

Aims. Despite multiple trials and case series on hip hemiarthroplasty designs, guidance is still lacking on which implant to use. One particularly deficient area is long-term outcomes. We present over 1,000 consecutive cemented Thompson’s hemiarthroplasties over a ten-year period, recording all accessible patient and implant outcomes. Methods. Patient identifiers for a consecutive cohort treated between 1 January 2003 and 31 December 2011 were linked to radiographs, surgical notes, clinic letters, and mortality data from a national dataset. This allowed charting of their postoperative course, complications, readmissions, returns to theatre, revisions, and deaths. We also identified all postoperative attendances at the Emergency and Outpatient Departments, and recorded any subsequent skeletal injuries. Results. In total, 1,312 Thompson’s hemiarthroplasties were analyzed (mean age at surgery 82.8 years); 125 complications were recorded, necessitating 82 returns to theatre. These included 14 patients undergoing aspiration or manipulation under anaesthesia, 68 reoperations (5.2%) for debridement and implant retention (n = 12), haematoma evacuation (n = 2), open reduction for dislocation (n = 1), fixation of periprosthetic fracture (n = 5), and 48 revised stems (3.7%), for infection (n = 13), dislocation (n = 12), aseptic loosening (n = 9), persistent pain (n = 6), periprosthetic fracture (n = 4), acetabular erosion (n = 3), and metastatic bone disease (n = 1). Their status at ten years is summarized as follows: 1,180 (89.9%) dead without revision, 34 (2.6%) dead having had revision, 84 (6.6%) alive with the stem unrevised, and 14 (1.1%) alive having had revision. Cumulative implant survivorship was 90.3% at ten years; patient survivorship was 7.4%. Conclusion. The Thompson’s stem demonstrates very low rates of complications requiring reoperation and revision, up to ten years after the index procedure. Fewer than one in ten patients live for ten years after fracture. This study supports the use of a cemented Thompson’s implant as a cost-effective option for frail hip fracture patients. Cite this article: Bone Jt Open 2022;3(9):710–715

A modular hemiarthroplasty has a Metal-on-Metal (MoM) taper-trunnion junction, which may lead to increased wear and Adverse-Reaction-to-Metal-Debris (ARMD). To-date no wear related issues have been described in the elderly and less active that receives a hemiarthroplasty. This study aims to determine in vivo wear (i.e. serum metal ion levels) in hip hemiarthroplasty, and identify factors associated with increased wear. This is a prospective, IRB approved, single-centre, cohort study of patients that received an uncemented, modular hemiarthroplasty of proven design for the treatment of hip fracture between 2013–2015. All, alive, patients at 12-months post-implantation with AMTS≥6 were invited to participate. Of the 125 eligible patients, 50 accepted the invitation and were reviewed, including clinical/radiological assessment, metal-ion ([Chromium (Cr) and Cobalt (Co)]) measurement and Oxford Hip Score (OHS). Acetabular erosion was graded (0–3: normal-protrusio). Metal ion levels were considered high if ≥7ppb. The mean OHS was 37 (SD: 10). No acetabular erosion was detected in 21, whilst the remaining had either grade-1 (n=21) or grade-2 (n=8). The median Cr and Co levels were 2.9 (SD:9) and 2.2 (SD:4) respectively. There were 8 cases (16%) with high ion levels. To-date only 2 of them has an ARMD lesion, and none have been revised. Patients with metal ion levels had similar pre-fall mobility, taper- and head- size and OHS to those with low metal ion levels (p=0.2–0.7) However, all hips with high metal ion levels had evidence of acetabular erosion (≥1). Modular Hip hemiarthroplasties and their taper-trunnion junction are not immune to high wear and ARMD despite being implanted in a less active cohort. Acetabular erosion should alert clinicians, as it is associated with 20× increased-risk of taper wear, presumably due to the increased transmitted torque. Whether the use of modular hemiarthroplasties should remain is debatable

Worldwide, it is expected that 6.3 million patients will sustain a hip fracture in 2050. Hemiarthroplasty is commonly practiced for displaced femoral neck fractures. The choice between unipolar (UH) or bipolar (BH) hemiarthroplasty is still controversial. The objective of this study was to assess the effect on hip function of BH compared to UH for a displaced femoral neck fracture in elderly patients. We conducted a systematic review and meta-analysis of randomized controlled trials comparing BH to UH. Data sources were Medline, Embase, Cochrane Library and Web of Science. All data was pooled in Review Manager (RevMan) version 5.3 software. Selection of the studies included, data abstraction, data synthesis, risk of biais and quality of evidence evaluation was done independently by two authors. Our primary outcome was postoperative hip function. Secondary outcomes were health-related quality of life (HRQoL), acetabular erosion and postoperative complications. 13 randomized controlled trials (n=2256) were eligible for the meta-analysis. There was no difference in hip function scores (standardized mean difference of 0.33 [−0.09–0.75, n=864, I. 2. = 87%,]). Patients with bipolar heads had higher Health-Related Quality of Life scores than patients with unipolar heads (mean difference in EQ-5D scores of 0.12 [0.04–0.19, n=550, I. 2. = 44%]). The use of BH decreased the incidence of acetabular erosion (relative risk of 0.37 [0.17–0.83, n=525, I. 2. = 0%]). There was no relative risk difference for mortality, dislocation, revision and infection. Due to the high heterogeneity between the studies included, it is still unclear whether patients undergoing BH have better hip function than patients undergoing UH. Although, health-related quality of life (HRQoL) may be improved. Future research could be conducted to determine whether a BH offers a better quality of life than UH to geriatric patients undergoing surgery. More precise assessment scores could be developed to better evaluate postoperative outcomes

Hemiarthroplasty (HA) and total hip arthroplasty (THA) have both been well described as effective methods of management for displaced femoral neck fractures in the elderly. THA has superior functional outcomes and lower long-term revision rates, while HA is associated with lower dislocation rates and faster operative times. While HA remains an appropriate management option in low-demand patients, it is commonly complicated by acetabular erosion. However, there is no consensus about the preferred method of treatment in self-sufficient, physically active patients with normal cognition. The aim of this study was to evaluate the impact of age in geriatric patients with acetabular wear after bipolar HA. We retrospectively reviewed the records of all cases of femoral neck fractures treated with bipolar HA in our institution, during the period 2013 – 2020. According to the age at the time of fracture, patients were separated in 3 groups: Group A (age 70 – 75), group B (age 75 – 80) and group C (age > 80). Acetabular wear was defined as failure of the acetabulum, which needed revision to THA. A total of 1410 patients (861 females and 549 males, mean age 77,2 years) were included in the study. 359 patients were included in Group A, 592 in Group B and 459 in Group C. Mean follow-up was 3.2 years. There were no significant differences in sex distribution, injury side, fracture pattern, BMI, ASA score, bipolar head diameter and leg length discrepancy among the 3 groups. The incidence of acetabular wear and need for revision to THA was 6.13%, 4.22% and 1.96% respectively (p = 0.009). The higher rate of acetabular wear in patients less than 75 years suggests that THA is a more viable option for these patients. In group 75–80 years old decision for HA or THA should be made upon patient's activity status and biological age while above the age of 80 years old, Hemi seems to be the preferred solution

Arthroplasty is the most effective management of displaced intracapsular femoral neck fracture. Hemiarthroplasty (HEMI) is associated with acetabular erosion and loosening in mobile patients and total hip arthroplasty (THA) with instability. We sought to establish whether HEMI or THA gave better results in independent mobile patients with displaced intracapsular femoral neck fracture. Eighty-two patients were randomised into two groups. One arm received a modular HEMI, the second a THA using the same femoral stem. Patients were followed for a mean of three years after surgery. After HEMI, eight patients died, two were revised to THA and there is intention to revise three. One patient had a periprosthetic fracture. Mean walking distance was 1.08 miles and Oxford Hip Score (OHS) 22.5. Twenty patients (64.5% of survivors) had radiological evidence of acetabular erosion. After THA, four patients died, three dislocated, one required revision. Mean walking distance was 2.23 miles and OHS was 18.8. HEMI is associated with a higher rate of revision than THA and potential revision because of acetabular erosion. THA after three years displayed superior walking distances (p=0.039) and lower OHS (p=0.033). THA is a preferable option to HEMI in independent mobile elderly patients with displaced intracapsular femoral neck fracture

Introduction: Arthroplasty is the most effective management of displaced intracapsular femoral neck fracture. Hemiarthroplasty (HEMI) is associated with acetabular erosion and loosening in mobile active patients and total hip arthroplasty (THA) with instability. We sought to establish whether HEMI or THA gave better results in independent mobile patients with displaced femoral neck fracture. Method: Eighty-one patients were randomised into two groups. One arm received a modular HEMI, the second a THA using the same femoral stem. Patients were followed for a mean of three years after surgery. Results: After HEMI, eight patients died, two were revised to THA and there is intention to revise three. One patient had a Peri-prosthetic fracture. Mean walking distance was 1.08 miles and Oxford Hip Score (OHS) 22.5. Twenty patients (64.5% of survivors) had radiological evidence of acetabular erosion. After THA, three patients died, three dislocated, one required revision. Mean walking distance was 2.23 miles and OHS was 18.8. There was no radiological evidence of polyethylene wear. Patients with THAs after three years walked further (p=0.039) and had a lower OHS (p=0.033). Discussion: HEMI is associated with a higher actual and potential revision rate than THA because of acetabular erosion, higher OHS after three years and shorter walking distances. THA is a preferable option to HEMI in independent mobile elderly patients with displaced intracapsular femoral neck fracture

The management of displaced femoral neck fractures in independent, healthy patients remains controversial. Acetabular erosion is a time dependant phenomenon and our aim was to assess the long-term outcome of the Universal Head bipolar with an Exeter stem. 49 consecutive cemented bipolar hemiarthroplasties were performed in 49 patients between 1992 and 2000. Mean age was 71.6 (range 54–91). There were 13 male and 36 female. 23 patients were alive at final follow up. 17 patients were assessed in outpatients with clinical and radiographic assessment. 2 patients had a telephone questionnaire and 4 patients were lost to follow up or were unable to attend clinic. Kaplan-Meier Survivorship analysis was performed. Median follow up was 7.1 years (range 5–13.3 years). 26 patients had died by the time of final follow up. 5/14 patients (36%) with an ASA score of 3 died within 30 days. There was one dislocation and one periprosthetic fracture. There were no deep infections. There were no revisions for aseptic loosening or acetabular erosion. 75.6% of surviving patients returned to their pre-injury mobility level at 1 year. 5 year cumulative survival was 60% (95% confidence interval 46–74%). There was a statistically significant reduction in cumulative survival for ASA grades 3 and 4 compared to 1 and 2 (p=0.004). Cemented bipolar hemiarthroplasty for femoral neck fractures is a good alternative to Total Hip Arthroplasty for independent, healthy patients. There is no evidence of acetabular erosion. Careful patient selection is necessary as patients with high ASA scores have greater mortality rates regardless of surgical prosthesis

Background. Extendable proximal femoral replacements(PFR) are used in children with bone tumours in proximity to the proximal femoral physis, previously treated by hip disarticulation. Long-axis growth is preserved, allowing limb salvage. Since 1986, survival outcomes after limb salvage and amputation have been known to be equal. Method. Retrospective review of all patients <16years undergoing extendable PFR at Royal National Orthopaedic Hospital (UK) between 04/1996 and 01/2006, recording complications, failures, procedures undertaken and patient outcomes. Results. 8 patients (mean age 8.9±3 years) underwent extendable PFR for Ewing's Sarcoma(5), Osteosarcoma(1), Chondrosarcoma(1) and rhabdomyosarcoma(1). 2 primary PFRs failed (infection of unknown source & local recurrence, both at 26months); 2 required revision for full extension (1 became infected at revision, requiring 2 stage revision). 3 patients had the original prosthesis in situ at last follow-up (mean 7.2;range 3–10.5years). 1 patient had no implant complications, but died (neutropaenic sepsis) 63 days after implant insertion. 2 were treated for recurrence but disease free at last review. 5 were continuously disease free. 5 patients were lengthened a mean 3.7cm; 2 were not lengthened.1 had incomplete data. 5 patients suffered subluxation/dislocation (mean 15.6months), 3 recurrently. Each underwent a mean 1.6 open & 1.4 closed procedures for the displaced joint. 3 patients had 4 open reductions and acetabuloplasties and 2 patients were converted to THR, with 3 major complications: 2 sciatic nerve palsies and 1 (THR) infection. The 5th patient was due for acetabuloplasty but had hip disarticulation for recurrence. Acetabular erosion occurred in 3; 2 were revised to THR (3.5 & 6.8years). 3 patients suffered peri-prosthetic supracondylar fracture (treated conservatively). 5 patients were revised to THR (mean 5.9years): 2 for dislocation, 2 for acetabular erosion & 1 for infection. 1 underwent amputation and another died. Only 1 surviving implant was not converted to THR: this patient had progressive acetabular erosion at 10.5 years & will eventually require THR. The amputee had poor hip function prior to disarticulation but went on to become an international Paralympic sportsman and had very good function 11.4 years post-disarticulation. 3 patients had fixed hip adduction deformity. 1 was isolated and treated with adductor tenotomy, whilst 2 were associated with knee flexion deformity (one required in-patient physiotherapy; the other prosthetic shortening). Conclusions. Extendable PFR permits limb salvage with psychological & functional benefits, but complications are common and some are specific to PFR. Surgery for these may result in further complications. Patients should be warned of the high conversion rate to THR. All the above should be borne in mind when selecting patients. As illustrated above, functional outcome is sometimes better with amputation

We reviewed the seven- to ten-year results of our previously reported prospective randomised controlled trial comparing total hip replacement and hemiarthroplasty for the treatment of displaced intracapsular fracture of the femoral neck. Of our original study group of 81 patients, 47 were still alive. After a mean follow up of nine years (7 to 10) overall mortality was 32.5% and 51.2% after total hip replacement and hemiarthroplasty, respectively (p = 0.09). At 100 months postoperatively a significantly greater proportion of hemiarthroplasty patients had died (p = 0.026). Three hips dislocated following total hip replacement and none after hemiarthroplasty. In both the total hip replacement and hemiarthroplasty groups a deterioration had occurred in walking distance (p = 0.02 and p < 0.001, respectively). One total hip replacement required revision compared with four hemiarthroplasties which were revised to total hip replacements. All surviving patients with a total hip replacement demonstrated wear of the cemented polyethylene component and all hemiarthroplasties had produced acetabular erosion. There was lower mortality (p = 0.013) and a trend towards superior function in patients with a total hip replacement in the medium term

The use of endoprosthesis implants is frequent for tumours involving the proximal third of the femur and not amenable to primary arthroplasty or internal fixation. In this population, these implants are preferentially cemented given poor bone quality associated with systemic diseases and treatments. Loosening is a common complication of these implants that have been linked to poor bone quality, type of implants and importantly cementing technique. Thus, these techniques vary between different surgeons and based mainly on previous experience. One of the most successful cementing techniques in the arthroplasty literature is the French paradox. This technique involves removing the cancellous bone of the proximal femoral metaphysis and selects the largest stem to tightly fit the created cavity delineated by cortical bone. Cementing the implant results in a very thin cement layer that fills the inconsistent gaps between the metal and the bone. To our knowledge, no previous report exists in the literature assessing loosening in proximal femur replacement using the French paradox cementing technique. In this study, we sought to examine (1) rates of loosening in proximal femur replacement, and (2) the oncological outcomes including tumour recurrence and implant related complications. A retrospective study of 42 patients underwent proximal femur replacement between 1990 and 2018 at our institution. Of these, 30 patients met our inclusion criteria. Two independent reviewers have evaluated the preoperative and the most recent postoperative radiographs using the International Society of Limb Salvage (ISOLS) radiographic scoring system and Gruen classification for femoral stem loosening. Additionally, the acetabulum was evaluated for erosion according to the criteria of Baker et al. The mean age of this cohort was 60.5 (19–80), with 60% being males. The primary origin was metastatic in 17 (56.7%) patients, bone sarcoma in 10 (33.3%) patients and soft tissue sarcoma in 3 (10%) patients. Pathological fractures were present in 11 (36.7%) patients. Seven (23.3%) patients had prior intramedullary nailing. Preoperative radiotherapy was used in 8 (26.7%) and postoperative radiotherapy in 17 (56.7%) patients. The mean clinical follow-up was 25.2±26.3 months and the mean radiographical follow-up was 24.8±26 months. The mean ISOLS score for both reviewers was found to be 89±6.5% and 86.5±6.1%, respectively. Additionally, the first reviewer found two patients to be possibly loos (6.7%) compared to one (3.3%) patient for the second reviewer. No components scored as probably or definitely loose and non-required revision for either loosening or metal failure. Furthermore, both reviewers showed no acetabular erosion in 25 (83.3%) and 24 (80%) patients, respectively. On the other hand, the overall rate of complications was 36.6% with 11 complications reported in 30 patients. Local recurrence occurred in five (16.6%) patients. Prosthetic Dislocation was the most frequent complications with eight dislocations in four patients. Despite complications, our results showed no radiographic evidence of stem loosening. Cementing proximal femur prosthesis with a tight canal fit and with a thin cement mantle appears to be a viable option at short and medium term

Introduction. Total hip arthroplasty (THA) is the most common surgery performed for complications of bipolar arthroplasty. The present study evaluated the functional results and complications associated with this surgery. Patients and Methods. Forty eight hips (48 patients) who had conversion of bipolar arthroplasty to THA between 1998 June and 2013 June, and who were followed-up for more than one year were evaluated. Twenty one hips had conversion surgery to THA using a Fitmore cup with metal-on-metal articulation (28 mm head). Six hips had surgery using the SecurFit cup and three hips, using the Lima LTO cup with ceramic-on-ceramic articulation (28 mm or 32 mm head). Eighteen hips had surgery using a large head metal-on-metal bearing: –MMC (seven hips), ACCIS (six hips) and Magnum (five hips). The average time of follow-up duration was 3.9 years (range, 1.0–11.3). There were 22 men and 26 women between the ages of 28 and 80 years (average, 68.9 years) at the time of conversion surgery. Conversion arthroplasty was performed for acetabular erosion without femoral stem loosening in 19 hips, acetabular cartilage erosion with femoral stem loosening in 13 hips, periprosthetic fracture in 12 hips, and recurrent dislocation in four hips. Results were evaluated using Harris hip score (HHS) and Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) score. The radiographs were analyzed for evidence of acetabular and femoral osteolysis or loosening. The complications were evaluated. Results. The time interval between hemiarthroplasty and conversion total hip prosthesis was 6.7 years on average (range, 5 months to 12 years). Pain was the leading sign in all patients. Average HHS improved from 42 preoperatively (range, 34–67) to 86 (range, 65 – 97) postoperatively. The average total WOMAC score improved from 47 (range, 32–67) to 22 (range, 9–44) postoperatively. All the patients operated for groin pain reported significant improvement in their symptoms. Radiological evaluation showed good bony ingrowth and stability of all the femoral components. None of the acetabular component showed migration, loosening, wear, or osteolysis at last follow-up. Complications occurred in five hips. One dislocation and one recurrent dislocation were encountered in isolated acetabular revision hips; whereas one single dislocation, one recurrent dislocation, and one trochanteric nonunion occurred in the hips with revision of both components. All dislocations were occurred in hips with a femoral head size of 28 mm. Dislocations were managed by closed reduction, and none of the patients required revision for dislocation. Conclusions. Conversion THA after symptomatic bipolar arthroplasty can offer reliable pain relief and functional improvement. The perioperative complications approximate those of revision THAs