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

Periprosthetic femur fracture (PFF) is a major complication following total hip arthroplasty (THA) that carries significant morbidity, mortality, and economic burden. Currently, uncemented stems are highly preferred in primary THA, but have been associated with higher risk of PFF compared to cemented stems. The use of collared stems in uncemented primary THA has shown promise in reducing PFF rates postoperatively. This retrospective study included 2,294 uncemented primary THAs using the posterior approach performed by two attending surgeons from January 2016 to December 2022. Both surgeons switched from a collarless femoral stem design to a collared design in May 2020. Data was collected regarding stem design, frequency of PFF, and requirement for revision surgery. Periprosthetic fractures were identified and confirmed using medical records and/or radiographic imaging. Fracture rates and percentages between collared and collarless stems were then analyzed. A Fisher's Exact Test was performed to determine if there was a significant association between collared and collarless stem use on PFF rates. A total of 2,294 uncemented primary THAs performed by 2 surgeons were eligible for analysis. 903 (39.4%) patients received a collared stem, and 1,391 (60.6%) patients received a collarless stem. In total, 14 (0.6%) PFFs occurred over the study period. There was 1 fracture (0.1%) out of 903 collared stems, and 13 fractures (0.9%) out of 1,391 collarless stems (p = 0.012). Collared stems were associated with a significant decrease in PFF rate when compared to collarless stems in uncemented primary THA. Future studies are encouraged to continue to investigate PFF and other complication rates with the use of a collared stem design

Aims. The risk of mechanical failure of modular revision hip stems is frequently mentioned in the literature, but little is currently known about the actual clinical failure rates of this type of prosthesis. The current retrospective long-term analysis examines the distal and modular failure patterns of the Prevision hip stem from 18 years of clinical use. A design improvement of the modular taper was introduced in 2008, and the data could also be used to compare the original and the current design of the modular connection. Methods. We performed an analysis of the Prevision modular hip stem using the manufacturer’s vigilance database and investigated different mechanical failure patterns of the hip stem from January 2004 to December 2022. Results. Two mechanical failure patterns were identified: fractures in the area of the distal fluted profile (distal stem fracture) and failure of the modular taper (modular fracture). A failure rate of 0.07% was observed for distal stem fracture, and modular fracture rates of 1.74% for the original and 0.013% for the current taper design. Conclusion. A low risk of mechanical failure for both fracture types was observed compared to other known complications in revision hip arthroplasty. In addition, the data show that a design change did significantly reduce the risk of a modular fracture. Cite this article: Bone Joint J 2024;106-B(2):151–157

The decision to undertake total hip replacement (THA) in a child is complex and daunting. This is augmented by the paucity of data on potential quality of life (QoL) improvement and functional outcomes. Therefore, the aim of this study was to ascertain whether outcomes after surgery are influenced by the nature of the primary diagnosis. This was a prospective, consecutive cohort study of patients under the age of 18 years undergoing THA by a single arthroplasty surgeon in collaboration with colleagues at a regional paediatric hospital. Patient electronic notes, radiographs and PROMS (EQ5D-Y, Oxford Hip Score (OHS) and modified Harris Hip Score(mHHS)) were reviewed. Twenty-two THAs were performed in patients less than 18 years (median 15 (range 10.7–17.9), with 7 patients undergoing bilateral surgery. Mean follow-up was 2 years. Thirteen of the THAs were undertaken for systemic conditions effecting multiple joints (Mucopolysaccharidoses, Mucolipidosis and Scwachman-Diamond syndrome) with the hip the worst affected joint and 9 for single joint disease (AVN, Perthes, dysplasia and idiopathic chondrolysis). PROMS scores showed reliable improvements with no differences between the two groups. Health related QoL was calculated from EQ5D-Y and indicated an overall improvement of 1.06(0.879–1.25). 6 patients were wheelchair users preop. All patients were independent walkers at follow-up. One patient underwent successful revision surgery for aseptic acetabular loosening. There were no other complications. THA in children leads to a significant positive impact on QoL as measured with validated PROMS scores. Patients with systemic conditions can benefit just as much as those with single joint disease. Further follow-up is required to understand the long-term outcomes

Aims. Periprosthetic joint infection (PJI) in total hip arthroplasty in the elderly may occur but has been subject to limited investigation. This study analyzed infection characteristics, surgical outcomes, and perioperative complications of octogenarians undergoing treatment for PJI in a single university-based institution. Methods. We identified 33 patients who underwent treatment for PJIs of the hip between January 2010 and December 2019 using our institutional joint registry. Mean age was 82 years (80 to 90), with 19 females (57%) and a mean BMI of 26 kg/m. 2. (17 to 41). Mean American Society of Anesthesiologists (ASA) grade was 3 (1 to 4) and mean Charlson Comorbidity Index was 6 (4 to 10). Leading pathogens included coagulase-negative Staphylococci (45%) and Enterococcus faecalis (9%). Two-stage exchange was performed in 30 joints and permanent resection arthroplasty in three. Kaplan-Meier survivorship analyses were performed. Mean follow-up was five years (3 to 7). Results. The two-year survivorship free of any recurrent PJI was 72% (95% confidence interval (CI) 56 to 89; 18 patients at risk). There were a total of nine recurrent PJIs at a mean of one year (16 days to eight years), one for the same pathogen as at index infection. One additional surgical site infection was noted at two weeks, resulting in a 69% (95% CI 52 to 86; 17 patients at risk) survivorship free of any infection at two years. There were two additional revisions for dislocations at one month each. As such, the two-year survivorship free of any revision was 61% (95% CI 42 to 80; 12 patients at risk). In addition to the aforementioned revisions, there was one additional skin grafting for a decubitus ulcer, resulting in a survivorship free of any reoperation of 54% (95% CI 35 to 73; ten patients at risk) at two years. Mean Clavien-Dindo score of perioperative complications was two out of five, with one case of perioperative death noted at six days. Conclusion. Octogenarians undergoing surgery for PJI of the hip are at low risk of acute mortality, but are at moderate risk of other perioperative complications. One in two patients will undergo a reoperation within two years, with 70% attributable to recurrent infections. Cite this article: Bone Joint J 2023;105-B(2):135–139

Trabecular metal (TM) augments are designed to support an uncemented socket in revision surgery when adequate rim fit is not possible. We have used TM augments in an alternative arrangement, to contain segmental defects to facilitate impaction bone grafting (IBG) and cementation of a cemented socket. However, there is a paucity of literature supporting the use of this technique. We present one of the largest studies to date, reporting early outcomes of patients from a tertiary centre. A single-centre retrospective analytical study of prospectively collected data was performed on patients who had undergone complex acetabular reconstruction using TM augments, IBG and a cemented cup. All patients operated between 2015 and 2019 were included. We identified 105 patients with a mean age of 74yrs. The mean follow-up was 2.3 years(1–5.5yrs). Our primary outcome measure was all-cause revision of the construct. The secondary outcome measures were, Oxford hip score (OHS), radiographic evidence of cup migration/loosening and post-op complications. Eighty-four out of 105 patients belonged to Paprosky grade IIb, IIc or IIIa. Kaplan-Meier survivorship for all-cause revision was 96.36% (CI, 90.58–100.00) at 2 years with 3 failures. Two were due to early infection which required two-stage re-revision. The third was due to post-operative acetabular fracture which was then re-revised with TM augment, bone graft and large uncemented cup. Pre-op and post-op matched OHS scores were available for 60 hips(57%) with a mean improvement of 13 points. Radiographic analysis showed graft incorporation in all cases with no evidence of cup loosening. The mean vertical cup migration was 0.5mm (Range −5 to 7mm). No other complications were recorded. This study shows that reconstruction of large acetabular defects during revision THA using a combination of TM augments to contain the acetabulum along with IBG to preserve the bone stock and a cemented socket is a reliable and safe technique with low revision rates and satisfactory clinical and radiographic results. Long term studies are needed to assess the possibility of preservation and regeneration of bone stock

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Social media is a popular resource for patients seeking medical information and sharing experiences. periacetabular osteotomy (PAO) is the gold-standard treatment for symptomatic acetabular dysplasia with good long-term outcomes. However, little is known regarding the perceived outcomes of PAO on social media. The aims of this study were to describe the perceived outcomes following PAO using three social media platforms: Facebook, Instagram, and X (formerly known as Twitter).

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This study aimed to investigate the incidence of ≥ 5 mm asymmetry in lower and whole leg lengths (LLs) in patients with unilateral osteoarthritis (OA) secondary to developmental dysplasia of the hip (DDH-OA) and primary hip osteoarthritis (PHOA), and the relationship between lower and whole LL asymmetries and femoral length asymmetry.

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This study reports the results of 38 total hip arthroplasties (THAs) in 33 patients aged less than 50 years, using the JRI Furlong hydroxyapatite ceramic (HAC)-coated femoral component.

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Obesity is associated with an increased risk of hip osteoarthritis, resulting in an increased number of total hip arthroplasties (THAs) performed annually. This study examines the peri- and postoperative outcomes of morbidly obese (MO) patients (BMI ≥ 40 kg/m²) compared to healthy weight (HW) patients (BMI 18.5 to < 25 kg/m²) who underwent a THA using the anterior-based muscle-sparing (ABMS) approach.

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Although there are various pelvic osteotomies for acetabular dysplasia of the hip, shelf operations offer effective and minimally invasive osteotomy. Our study aimed to assess outcomes following modified Spitzy shelf acetabuloplasty.

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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.

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Osteoporosis is common in total hip arthroplasty (THA) patients. It plays a substantial factor in the surgery’s outcome, and previous studies have revealed that pharmacological treatment for osteoporosis influences implant survival rate. The purpose of this study was to examine the prevalence of and treatment rates for osteoporosis prior to THA, and to explore differences in osteoporosis-related biomarkers between patients treated and untreated for osteoporosis.

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Our objective was describing an algorithm to identify and prevent vascular injury in patients with intrapelvic components.

Introduction. Patients undergoing primary total hip arthroplasty (THA) with prior lumbar spine fusion (LSF) are at high risk for instability with reported incidence of dislocation as high as 8.3%. The use of dual mobility cups in patients undergoing revision THA, another high risk group, has demonstrated decreased incidence of instability. Purpose of this study was to evaluate the risk of instability in patients undergoing primary THA with a history of prior LSF using dual mobility cups. Methods. This was a multi-center retrospective study with 93 patients undergoing primary THA using a dual mobility cup with prior history of instrumented LSF. The primary outcome investigated was instability. Secondary variables investigated included number of levels fused, approach, length of stay, and other complications. The minimum follow-up time was 1 year since the majority of dislocations occur during first year following the primary THA. Results. There were 56 females and 47 males with average age of 66 years (46–87) and average BMI of 30. Mean follow up was 31 months (range 12 – 124.2). Surgical approach included: posterior (63), direct lateral (15), anterior (11), direct superior (4). 44% had one level fusion, 29% with 2 levels, and 15% with 3 or more levels fused. There were no dislocations or infections in this study group. There was one intraoperative fracture and one DVT. Conclusions. Patients undergoing primary THA with prior LSF are a high risk group with an increased risk for instability due to the loss of normal spino-pelvic relationship. The use of dual mobility cups in a high risk group of patients in this study demonstrated excellent results with no incidence of dislocation. Despite the limitations in this study with varying approaches and multiple sites, the use of dual mobility cups to decrease the incidence of instability in patients with prior LSF appears promising. For any tables or figures, please contact the authors directly

We evaluated (1) wear rate, (2) prevalence and volume of osteolysis using 3D-CT scan, (3) other bearing-related complications, (4) HHS and survivorship free from revision at 15 years after THA using first-generation XLPE (1G XLPE). One-hundred sixty THAs were evaluated regarding bearing-related complication, HHS and survivorship. Among them, 112 hips underwent 3D-CT to analyze wear rate and osteolysis. All THAs were performed by single surgeon using cup of identical design, a 28-mm metal head and 1G XLPE (10 Mrad). Average age were 57 years and mean follow-up was 15.2 years. 3D-CT scan was performed at average of 13.0 years. Clinical evaluation included HHS and radiographic analysis was performed regarding stem alignment, cup anteversion and inclination angle, component stability, wear rate and osteolysis. Wear was measured using digital software. The prevalence and volume of osteolysis were also evaluated. Complications included XLPE dissociation/rim fracture, dislocation, periprosthetic fracture, infection, HO and any revision. Survivorship free from revision at 15 years was estimated. Average inclination and anteversion angle of cups were 40.7° and 20.6°. Mean stem alignment was 0.1° valgus. Average bedding-in and annual wear rate wear rate was 0.085 mm and 0.025 mm/yr. Eleven hips (10%) demonstrated osteolysis; pelvic osteolysis with average volume of 1.4 cm. 3. in six and femoral osteolysis with mean size of 0.4 cm. 2. in seven hips. Of 160 THAs, 5 hips (3%) dislocated. Overall, bearing-related complications occurred in 16 hips (10%). Other complications included postoperative periprosthetic fracture in 4 (3%), infection and HO in 3 hips, respectively. No hip demonstrated loosening, XLPE rim fracture/dissociation. Seven THAs (4%) were revised; recurrent dislocation in 5 and periprosthetic joint infection in 2 hips. Average HHS at last follow-up improved from 47.7 preoperatively to 91.2 points (p<0.001). Estimated survivorship free from revision at 15 years was 95.6 %. THA using 1G XLPE demonstrated low wear rate as well as low incidence of osteolysis at average follow-up of fifteen years. Longer-term studies will be necessary to determine if XLPE will continue to demonstrate this improved osteolysis characteristics

Aims. We investigated the long-term performance of the Tripolar Trident acetabular component used for recurrent dislocation in revision total hip arthroplasty. We assessed: 1) rate of re-dislocation; 2) incidence of complications requiring re-operation; and 3) Western Ontario and McMaster Universities osteoarthritis index (WOMAC) pain and functional scores. Patients and Methods. We retrospectively identified 111 patients who had 113 revision tripolar constrained liners between 1994 and 2008. All patients had undergone revision hip arthroplasty before the constrained liner was used: 13 after the first revision, 17 after the second, 38 after the third, and 45 after more than three revisions. A total of 75 hips (73 patients) were treated with Tripolar liners due to recurrent instability with abductor deficiency, In addition, six patients had associated cerebral palsy, four had poliomyelitis, two had multiple sclerosis, two had spina bifida, two had spondyloepiphyseal dysplasia, one had previous reversal of an arthrodesis, and 21 had proximal femoral replacements. The mean age of patients at time of Tripolar insertions was 72 years (53 to 89); there were 69 female patients (two bilateral) and 42 male patients. All patients were followed up for a mean of 15 years (10 to 24). Overall, 55 patients (57 hips) died between April 2011 and February 2018, at a mean of 167 months (122 to 217) following their tripolar liner implantation. We extracted demographics, implant data, rate of dislocations, and incidence of other complications. Results. At ten years, the Kaplan–Meier survivorship for dislocation was 95.6% (95% confidence interval (CI) 90 to 98), with 101 patients at risk. At 20 years, the survivorship for dislocation was 90.6% (95% CI 81.0 to 95.5), with one patient at risk. Eight patients (7.2%) had a dislocation of their constrained liners. At ten years, the survival to any event was 89.4% (95% CI 82 to 93.8), with 96 patients at risk. At 20 years, the survival to any event was 82.5% (95% CI 71.9 to 89.3), with one patient at risk. Five hips (4.4%) had deep infection. Two patients (1.8%) developed dissociated constraining rings with pain but without dislocation, which required re-operation. Two patients (1.8%) had periprosthetic femoral fractures, without dislocation, that were treated by revision stems along with exchange of the well-functioning constrained liners. Conclusion. Constrained tripolar liners used at revision hip arthroplasty provided favourable results in the long term for treatment of recurrent dislocation and for patients at high risk of dislocation. Cite this article: Bone Joint J 2019;101-B(6 Supple B):123–126

Introduction. Smoking, a modifiable factor, may adversely affect post-operative outcomes. Healthcare providers are increasingly denying smokers access to total hip arthroplasty (THA) until they stop smoking. Evidence supporting this is unclear. We assessed the effect of smoking on outcomes following THA. Patients and Methods. We performed a retrospective observational study involving 60,812 THAs (12.4%=smokers, 31.2%=ex-smokers, 56.4%=non-smokers) from the Clinical Practice Research Datalink. Data were linked with Hospital Episode Statistics and the Office for National Statistics to identify outcomes. The effect of smoking on post-operative outcomes (complications, medications, revision, mortality, PROMs) was assessed using adjusted regression. Results. Following THA, smokers had a significantly increased risk of lower respiratory tract infection (odds ratio (OR)=0.53; 95% CI=0.43–0.64), myocardial infarction (OR=0.41; CI=0.24–0.71), cerebrovascular disease (OR=0.54; CI=0.32–0.93), and ischaemic heart disease (OR=0.62; CI=0.43–0.91) compared with non-smokers. The risk of these complications in smokers was also significantly higher compared with ex-smokers. The risk of other complications, including DVT and wound infection, was similar between smoking groups. Compared with non-smokers (OR=0.55; CI=0.51–0.60) and ex-smokers (OR=0.85; CI=0.78–0.92), smokers had increased opioid usage at one-year post-surgery. Similar patterns were observed for weak opioids and paracetamol. One-year mortality rates were higher in smokers compared with non-smokers (hazard ratio (HR)=0.39, CI=0.30–0.50) and ex-smokers (HR=0.50, CI=0.39–0.65). Long-term revision rates were not increased in smokers. Smokers had significant improvement in PROMs compared with pre-operatively, with no clinically important difference in postoperative PROMs between smokers, non-smokers and ex-smokers. Discussion. Smoking was associated with more medical complications (namely vascular), higher analgesia usage, and increased mortality following THA. Most adverse outcomes were reduced in ex-smokers, therefore smoking cessation should be encouraged before arthroplasty. However, THA is clinically effective in smokers, who gain meaningful PROM improvement with no increased revision risk. Conclusion. Smokers should not be universally denied access to primary THA

The purpose of this study was to evaluate the functional and oncological outcome of recycled autograft reconstruction after a wide excision for primary malignant bone tumor around the hip. From 1998 to 2015, 67 patients with a primary malignant bone tumor involving proximal femur or periacetabular zone (P2) were included. There were 36 males and 31 females with a mean age of 34 years (13 to 58). Of these, 29 patients had grade I or II chondrosarcoma, 28 high-grade osteosarcoma, 6 Ewing's sarcoma and 4 undifferentiated pleomorphic sarcoma. Enneking stage of all 67 patients was stage II. Of the resection classification, proximal femur resection was performed in 29 patients, P1+P2 in 15, P2+P3 in 14, P1+P2+P3 in 4, P2 only in 4, and P2+proximal femur in 1. Extracorporeally irradiated recycled autograft and liquid nitrogen frozen autograft were performed in 44 and 23 patients, respectively. At a mean follow-up of 98 months (10 to 239), 48 patients (72%) were continuously disease-free, 12 (18%) died of disease and 7 (10%) were alive with disease. The tumors of these patients who had died of disease were usually located in pelvic bones (10/12). Of these 37 patients with pelvic tumors, 7 patients (22%) had local recurrence, four of them received external hemipelvectomy. Other complications included hip dislocation in 2 patients, nerve injury in 2 and deep infection in 2. However, the above complications were rarely occurred in the patients with proximal femur reconstruction. The mean Musculoskeletal Tumor Society functional score were 77% (53 to 93). Recycled autograft reconstruction for primary malignant bone tumor around the hip is a valid method with acceptable morbidity and a favorable functional outcome

We aimed to demonstrate the clinical safety of a novel anatomic cementless ceramic hip resurfacing device. Concerns around the safety of metal on metal arthroplasty have made resurfacing less attractive, while long term function continues to make the concept appealing. Biolox Delta ceramic is now used in more than 50% of all hip arthroplasties, suggesting that it's safety profile is acceptable. We wondered if a combination of these concepts might work?. The preclinical testing of anatomic hip resurfacing device developed by our group was presented last year. A twenty patient safety study was designed. Patients had to be between the ages of 18 and 70. The initial size range was restricted to femoral heads between 46 and 54, representing the common sizes of hip resurfacing. The primary outcomes were clinical safety, PROMs and radiological control. Secondary outcomes include CTRSA and metal ion levels. 20 patients were recruited, aged 30–69. 7 were women and 13 were men. There were no operative adverse events in their operations undertaken between September 2017 and February 2018. One patient had a short episode of atrial fibrillation on the second postoperative day, and no other complications. At three months the median oxford hip score had risen from 27 (range 14–38) to 46 (31–48). Cobalt and chromium levels were almost undetectable at 3 months. Fixation appeared satisfactory in all patients, with no migration detected in either component. CTRSA is in process. The initial safety of a novel cementless ceramic resurfacing device is demonstrated by this data. The 10 year, 250 case efficacy study will continue in 5 other European centres