The study of spinopelvic anatomy and movement has received great interest as these characteristics influence the biomechanical behavior (and outcome) following hip arthroplasty. However, to-date there is little knowledge of what “normal” is and how this varies with age. This study aims to determine how dynamic spino-pelvic characteristics change with age, with well-functioning hips and assess how these changes are influenced by the presence of hip arthritis. This is an IRB-approved, cross-sectional, cohort study; 100 volunteers (asymptomatic hips, Oxford-Hip-sore>45) [age:53 ± 17 (24-87) years-old; 51% female; BMI: 28 ± 5] and 200 patients with end-stage hip arthritis [age:56 ± 19 (16-89) years-old; 55% female; BMI:28 ± 5] were studied. All participants underwent lateral spino-pelvic radiographs in the standing and deep-seated positions to determine maximum hip and spine flexion. Parameters measured included lumbar-lordosis (LL), pelvic incidence, pelvic-tilt (PT), pelvic-femoral angles (PFA). Lumbar flexion (ΔLL), hip flexion (ΔPFA) and pelvic movement (ΔPT) were calculated. The prevalence of spinopelvic imbalance (PI–LL>10?) was determined. There were no differences in any of the spino-pelvic characteristics or movements between sexes. With advancing age, standing LL reduced and standing PT increased (no differences between groups). With advancing age, both hip (4%/decade) and lumbar (8%/decade) flexion reduced (p<0.001) (no difference between groups). ΔLL did not correlate with ΔPFA (rho=0.1). Hip arthritis was associated with a significantly reduced hip flexion (82 ±;22? vs. 90 ± 17?; p=0.003) and pelvic movements (1 ± 16? vs. 8 ± 16?; p=0.002) at all ages and increased prevalence of spinopelvic imbalance (OR:2.6; 95%CI: 1.2-5.7). With aging, the lumbar spine loses its lumbar lordosis and flexion to a greater extent that then the hip and resultantly, the hip's relative contribution to the overall sagittal movement increases. With hip arthritis, the reduced hip flexion and the necessary compensatory increased pelvic movement is a likely contributor to the development of hip-spine syndrome and of spino-pelvic imbalance

Background. Online video is increasingly becoming a key source for people to satisfy their information needs. YouTube is one of the post popular websites used for information exchange, with more than one billion unique visitors every month. Questions/purposes. In an attempt to participate in personal health decisions related to hip arthritis, patients may access YouTube for further information. As YouTube is a non peer-reviewed platform and little is known about the quality of available videos. We therefore asked the following research questions: (1) What is the information quality of YouTube videos related to the diagnosis of hip arthritis and (2) what information for the treatment of hip arthritis can be found on YouTube?. Methods. YouTube search was performed on December 23, 2014 for videos related to the diagnosis and the treatment of hip arthritis. The following search terms were used: (1) hip arthritis, (2) hip arthritis symptoms, (3) hip arthritis diagnosis, (4) hip arthritis treatment and (5) hip replacement. After exclusion of videos that did not meet the inclusion criteria, 133 videos were analyzed. In order to qualitatively assess the YouTube video content for to the diagnosis and the treatment of hip arthritis, two new grading systems with a scale of 0 to 12 points were developed. Videos were grouped into poor quality (grade 0–3), moderate quality (grade 4–7) and excellent quality (grade 8–12), respectively. Videos were categorized into the following: educational-physician, educational- non physician, commercial, technique, personal testimony or other. Results. The vast majority of YouTube videos lack essential information for an appropriate diagnosis of hip arthritis. Eighty-four percent (n=112) were graded as being of poor quality, 14 percent (n=19) of moderate quality and only 2 percent (n=2) of excellent quality, respectively. The information quality of educational-physician videos for the diagnosis of hip arthritis was significantly higher (p < 0.001) than for educational-non physician videos. YouTube is a poor information source for the treatment of hip arthritis. In 86 percent (n=114), videos provided poor information quality. Eleven percent (n=15) of videos had a moderate quality and only 3 percent (n=4) an excellent quality, respectively. The quality of information for the treatment of hip arthritis was significantly higher (p = 0.005) than the quality of information for the diagnosis of hip arthritis. Conclusions. The present review of YouTube video material demonstrates that hip arthritis diagnosis and treatment information is overall insufficient. The exchange of video-based information is going to grow rapidly within the next years and videos going to become the primary source of information. The medical community should take chance of the opportunity the define gold standards for comprehensive and innovative evidence-based educational videos addressing the diagnosis and treatment of hip arthritis

Aim: The evaluation and guantification of radiologic parameters observed in the late stages of hip arthritis. Materials and Methods : The present study concerns the retrospective evaluation of the preoperative X-rays of 80 patients affected from primary hip arthritis only on one side in an advanced stage, that were treated in our department with total hip arthroplasty. From the present study we excluded patients with hip arthritis secondary to trauma, rheumatoid arthritis or congenital hip dislocation. The onset of the symptoms ranged between six months and twenty years (mean time5, 6 years). We evaluated the following parameters:. Neck-shaft angle. The thickening of the Calcar. The Bone loss-sedimentation of the head of the femur. The cortex thickness at the level of the lesser trochanter. The distance-on the axis of the femur’s neck-between the rotation center of the hip and the point where the above axis crosses the transtrochanteric line. These parameters were measured from two idependent observers. Every single measurement was done twice from both observersjn order to estimate the interobserver and the intraobserver error. The measurements were done in both hips of the patients-the affected and the healthy one-on an A-P pelvis radiogramm. Results: From the above measurements, it results that in hip arthritis the neck-shaft angle changes (it becomes varous).The calcar was found thickened in the affected hip in a mean value of 1,45mm. The thickness of the cortex at the level of the lesser trochanter was found greater in the non-affected side in a mean value of 0,7mm. The bone loss of the femur head was approximately 2,5mm. The distance between the rotation center of the hip and the point at which the neck axis crosses the transtrochanteric line was found greater in the non-affected side, in a mean value of 3,12mm. Conclusions: The modifications observed in hip arthritis that concern the load transmission across the neck of the femur result in changes that can be radiologically identified and measured. In the first place the thickness of the calcar is influenced, as it does the distance between the rotation center of the hip and the trochanteric line. In the advanced stages of hip arthritis the sedimentation (bone loss) of the femur head can also be measured

INTRODUCTION. In total hip arthroplasty, preoperative planning is almost indispensable. Moreover, 3-dimensional preoperative planning became popular recently. Anteversion management is one of the most important factors in preoperative planning to prevent dislocation and to obtain better function. In arthritic hip patients osteophytes are often seen on both femoral head and acetabulum. Especially on femoral head, osteophytes are often seen at posterior side and its surface creates smooth round contour that assumes new joint surface. (Fig. 1). We can imagine new femoral head center tracing that new joint surface. OBJECTIVES. In the present study, the posterior osteophytes are compared in osteoarthritic patients and other patients. MATERIALS & METHODS. Anteversion and new anteversion which was reduced by osteophyte formation were assessed in 28 hip CAT scans, (22 arthritic hips, 6 avascular necrotic hips). RESULTS. Only in arthritic patients, osteophytes on posterior side were observed. The anteversion was 33.7+/− 13.0 degree in arthritic patients, which was reduce to 29.7+/−13.1 degree. The mean difference was 4.0+/−4.7 degree reduction. In AVN patients the mean anteversion was 21.4 +/− 9.40 in AVN patients. No reduction was observed in AVN patients. DISCUSSION. Osteophytes are often created to make the biomechanical situation better. This phenomenon is possiblly explained that those posterior osteophytes have been formed for proper reduction of excessive anteversion

Purpose of the study: Joint puncture-wash-out is generally recommended for septic arthritis in children, but the debate is still open concerning the proper attitude for the hip joint. The purpose of this work was to examine our failure cases after treatment of septic hip arthritis using the puncture-wash-out option. We wanted to know whether first-intention primary arthrotomy might be a valid option. Material and methods: We reviewed retrospective 29 cases of septic hip arthritis treated initially by puncture-wash-out between January 1996 and June 2003. We excluded all cases of first intention arthrotomy. The series included 19 boys and ten girls aged four years three months on average at time of diagnosis (age range 8 months to 9 years). Mean follow-up was one year five months (range 1 month the 4 years). Mean delay to diagnosis was two days (range 0–6 days). In addition to intravenous antibiotics, the 29 hips were drained and washed out with saline solution under general anesthesia until a clear wash-out was obtained. Surgical revision (arthrotomy) was required for seven patients within 3 to 21 days. Results: Outcome was assessed at days 2, 5, and 10. Assessment variables were pain relief, normal blood tests, and apyrexia. Seven children required surgical revision for arthrotomy due to persistent clinical or biological disorders. Cure was achieved after all seven arthrotomies. At last follow-up, there was no difference, clinically or radiographically, between the children treated by puncture-wash-out or by arthrotomy. The factors which appeared to be the most significant to distinguish the two groups were, at admission: time to diagnosis and management greater than four days and C-reactive protein > 100. On day 5, the most significant factors were persistent joint pain and C-reactive protein > 100. Discussion: These results suggest that puncture-wash-out remains a simple and reliable treatment but that it has its limitations: a synovial biopsy cannot be obtained, visual examination of the joint cartilage is not possible, trepanation of the metaphysis is not possible. Our factors favoring poorer outcome are similar to those reported in the literature to which can be added age less than one year. When these factors are present, first-intention arthrotomy should be discussed

Pyogenic arthritis of the hip in childhood despite improved antibiotic therapy remains a serious disorder which demands early diagnosis and prompt treatment. The most serious complication of the pyogenic arthritis of the hip in childhood and especialy in newborns and infants is the avascular necrosis of the femoral head which can lead to partial or complete destruction of the capital femoral epiphysis or the growth plate or both. This destruction may lead to hip joint deformity, leg length discrenpancy and dysfunction. The PURPOSE of this study was an effort to determine the factors which affect the outcome of the hip joint in pyogenic arthritis.In the present study included 37 children, 24 boys and 13 girls, with 37 involved hips. Their ages ranged from 10 days to 1 year old in 17 children and from 1y–11 years old in 20 children. All patients were hospitalized and treated in our Orthopaedic Department with proven pyogenic arthritis. All children were suspected to have pyogenic arthritis of the hip from the history, clinical features, laboratory and imaging findings and were confirmed with positive aspiration in 35 patients. In two negative aspirations the pyogenic arthritis was confirmed of the performed surgical interventions. The treatment consisted of I.V. and oral administration of appropriate antibiotics and cast immobilization for about six weeks. In 23 only patients was performed immediate incision and surgical drainage with debridement of the hip joint, wipping the panus of the cartilage. The length of the follow up was 2–9 years. The hips were classified according to radiographic findings into 3 groups. TYPE I (31 Patients, 84%) Normal overgrown femoral head. TYPE II (3 Patients, 8%) Deformed femoral head. TYPE III (3 Patients, 8%) Partial or complete destruction of the proximal femoral epiphysis. The evaluation and analysis of the results revealed primarily that the delayed diagnosis lead in delayed treatment especialy in neonates and infants. Other factors which have unfavorable outcome in the pyogenic hip arthritis are the multiple location, osteomyelitis of the hip region and the causative organism. Of course the rapid diagnosis followed of immediate aspiration with surgical drainage and early administration of apropriate antibiotics lead to good or excellent results

Pyogenic arthritis of the hip in childhood despite improved antibiotic therapy remains a serious disorder which demands early diagnosis and prompt treatment. The most serious complication of the pyogenic arthritis of the hip in childhood and especialy in newborns and infants is the avascular necrosis of the femoral head which can lead to partial or complete destruction of the capital femoral epiphysis, the growth plate or both. This destruction may lead to hip joint deformity, leg length discrenpancy and dysfunction. The PURPOSE of this study was an effort to determine the factors which affect the outcome of the hip joint in pyogenic arthritis. The present study included 37 children, 24 boys and 13 girls, with 37 involved hips. Their ages ranged from 10 days to 1 year old in 17 children and from 1y-11 years old in 20 children. All patients were hospitalized and treated in our Orthopaedic Department during 1983–1995 with proven pyogenic arthritis. All children were suspected to have pyogenic arthritis of the hip from the history, clinical features, laboratory and imaging findings and were confirmed with positive aspiration in 35 patients. In two negative aspirations the pyogenic arthritis was confirmed after surgical intervention. The treatment consisted of I.V. and oral administration of appropriate antibiotics and cast immobilization for about six weeks. In only 23 patients was immediate incision and surgical drainage performed with debridement of the hip joint, and removal of the panus on the cartilage. The length of the follow up was 7–16 years. The hips were classified according to radiographic findings into 3 groups. TYPE I (31 Patients, 84%) Normal overgrown femoral head. TYPE II (3 Patients, 8%) Deformed femoral head. TYPE III (3 Patients, 8%) Partial or complete destruction of the proximal femoral epiphysis. The evaluation and analysis of the results revealed primarily that delay in diagnosis lead to delayed treatment particularly in neonates and infants. Other factors which have an unfavorable outcome in the pyogenic hip arthritis are the multiple location, osteomyelitis of the hip region and the causative organism. Rapid diagnosis followed by immediate aspiration with surgical drainage and early administration of an appropriate antibiotics lead to good or excellent results

Introduction. We propose that Total Hip Replacement with correction of fixed flexion deformity of the hip and exaggerated lumbar lordosis will result in relief of symptoms from spinal stenosis, possibly avoiding a spinal surgery. A sequence of patients with this dual pathology has been assessed to examine this and suggest a possible management algorithm. Materials and methods. A retrospective study of 19 patients who presented with dual pathology was performed and the patients were assessed with regards to pre and post-operative symptoms, walking distance, and neurological status. Results. There were 17 patients with improvement in the spinal stenotic symptoms following hip replacement to an extent that none required spinal surgery. There were two patients who had spinal surgery after THR, at varying lengths following hip replacements as their spinal stenotic symptoms worsened over time, and had lateral spinal stenosis on MRI. Discussion. In advanced hip osteoarthritis, a fixed flexion deformity may develop at the hip leading to an exaggerated lumbar lordosis in erect posture. In the presence of co-existing spinal stenosis, the exaggerated lumbar lordosis may worsen the spinal stenotic symptoms while standing and walking. Cadaveric & Radiological studies have shown that canal narrowing occurs with increased lordosis/ extension in the lumbar spine. Our findings suggest that when central lumbar spinal stenosis coexists with bilateral hip arthritis and FFD at the hip, THR should be offered first. Successful hip surgery for arthritis correcting significant fixed flexion deformity would lessen the lumbar lordosis, thus correcting the excessive pathological narrowing. If a patient is fit enough, simultaneous bilateral THR via an anterior type of approach makes surgical correction of FFD easier. Although it has been suggested in the literature that patients with spinal stenosis have a increased risk of neurological impairment following THR, we did not find any clear association

The renewed interest in the clinically proven low wear of the metal-on-metal bearing combined with the capacity of inserting a thin walled cementless acetabular component has fostered the reintroduction of hip resurfacing. As in other forms of conservative hip surgery, i.e. pelvic osteotomies and impingement surgery, patient selection will help minimize complications and the need for early reoperation. Patient Selection and Hip Resurfacing. Although hip resurfacing was initially plagued with high failure rates, the introduction of metal on metal bearings as well as hybrid fixation has shown excellent survivorships of 97 to 99% at 4 to 5 years follow-up. However, it is important to critically look at the initial published results. In all of these series there was some form of patient selection. For example, in the Daniel and associates publications, only patients with osteoarthritis with an age less than 55 were included with 79% of patients being male. Treacy and associates stated that: “the operation was offered to men under the age of 65 years and women under the age of 60 years, with normal bone stock judged by plain radiographs and an expectation that they would return to an active lifestyle, including some sports”. However in the materials and methods, although the mean age is 52 years, the range is from 17 to 76 years including some patients with rheumatoid arthritis as well as osteonecrosis. Obviously, some form of patient selection is needed; but how one integrates them is where the Surface Arthroplasty Risk Index (SARI) is useful. With a maximum score of 6, points are assigned accordingly: femoral head cyst >1cm: 2 points; patient weight <82kg: 2 points; previous hip surgery: 1 point; UCLA Activity level >6: 1 point. A SARI score >3 represented a 4 fold increase risk in early failure or adverse radiological changes and with a survivorship of 89% at four years. The SARI index also proved to be relevant in assessing the outcome of the all cemented McMinn resurfacing implant (Corin¯, Circentester, England) at a mean follow-up of 8.7 years. Hips which had failed or with evidence of radiographic failure on the femoral side had a significantly higher SARI score than the remaining hips, 3.9 versus 1.9. Finally, one must consider the underlying diagnosis when evaluating a patient for hip resurfacing. In cases of dysplasia, acetabular deficiencies combined with the inability of inserting screws through the acetabular component may make initial implant stability unpredictable. This deformity in combination with a significant leg length discrepancy or valgus femoral neck could compromise the functional results of surface arthroplasty, and in those situations a stem type total hip replacement may provide a superior functional outcome. In respect to other diagnoses (osteonecrosis, inflammatory arthritis), initial analyses have not demonstrated any particular diagnostic group at greater risk of earlier failure. The only reservation we have is in patients with compromised renal function since metal ions generated from the metal-on-metal bearing are excreted through the urine and the lack of clearance of these ions may lead to excessive levels in the blood. Surgical Technique. Because resurfacing has not been within the training curriculum of orthopaedic surgeons for the last 2 decades, there will most likely be a learning curve in the integration of this implant within clinical practice. This data was confirmed for hip resurfacing when looking at the Canadian Academic Experience where in the first 50 cases of five arthroplasty surgeons only a 3.2% failure rate was noted of which 1.6% were due to neck fracture. Femoral neck fracture can occur because of significant varus positioning as well as osteonecrosis of the femoral head due to either disruption of the blood supply or over cement penetration. Finally, abnormal wear patterns leading to severe soft tissue reactions are being increasingly recognized and are related to either impingement or vertically placed acetabular components. Although impingement has long been recognized after total hip arthroplasty to limit range of motion and in extreme cases to hip instability, the risk after hip resurfacing may be greater since the femoral head-neck unit is preserved. Beaulé and associates have reported that 56% of hips treated by hip resurfacing have an abnormal offset ratio pre-operatively, with the two main diagnostic groups presenting deficient head-neck offset being osteonecrosis and osteoarthritis both of which have been associated with femoroacetabular impingement in the pre arthritic state. Conclusion. Although patients with a high activity level are likely to put their hip arthroplasties at risk for earlier failure, limiting a patient's activity because of fear of revision with a stem type hip arthroplasty has been shown to negatively impact the quality of life at long term follow-up. Thus hip resurfacing arthroplasty plays a significant role in the treatment of hip arthritis by permitting a return to full activities or what the patient perceives as his/her full capacities to do so, permitting them to enjoy a better quality of life without fearing a major hip revision

Abstract: Many former high level Gaelic Athletic Association (GAA) players present later in life with disabling hip arthritis requiring surgery. Many of these have evidence of the recently recognised condition of femoro-acetabular impingement (FAI). This condition results from abnormal abutment of the femoral head-neck junction with the acetabulum resulting in pain and progressive hip dysfunction. The prevalence is estimated at 10–15% in the general population, however it appears to be more common in young athletic males, and patients in their 20’s and 30’s with increased sporting activity. There has been an increase in the number of current players presenting with often poorly understood hip symptoms. We aimed to determine its prevalence in current top flight GAA players and in a cohort of past players. 92 current players and 8 retired players from the 1970’s were recruited. Questionnaires were distributed at training sessions and via e-mail. These consisted of a general questionnaire aimed at symptoms of interest, the Oxford Hip Scale and the Tegner Activity Level Scale. Over half of current players experience hip symptoms with the majority being groin and hip pain but also a significant number complained of stiffness. Up to half of those with symptoms trained at reduced intensity and a further 20% missing training on a regular basis. 5 players in particular ceased playing for a period of between 3 and 36 months. Only 59 of 92 current players scored zero on the Oxford Hip Scale indicating a significant proportion have problems on a daily basis. The mean oxford hip score was 5.43 with a range of 0–29. The average Tegner Activity score was 10 despite having a number of players with significant symptoms indicating their desire to continue to play. 12 of the 92 underwent surgical procedures varying from Gilmore’s groin repairs and adductor tenotomies to hip arthroscopy. It is evident that there is a link between hip symptoms in current players and FAI. Many hip conditions were previously unrecognized and thus left untreated, resulting in premature retirement of players. We therefore propose that it is vital that players are assessed for FAI at a young age and that training regimes should be altered and closely monitored in order to prevent the exacerbation of such a serious condition

Introduction

Interactions between hip, pelvis and spine, as abnormal spinopelvic movements, have been associated with inferior outcomes following total hip arthroplasty (THA). Changes in pelvis position lead to a mutual change in functional cup orientation, with both pelvic tilt and rotation having a significant effect on version. Hip osteoarthritis (OA) patients have shown reduced hip kinematics which may place increased demands on the pelvis and the spine.

Sagittal and coronal planes assessments are commonly done as these can be adequately studied with anteroposterior and lateral radiographs. However, abnormal pelvis rotation is likely to compromise the outcome as they have a detrimental effect on cup orientation and increased impingement risk. This study aims to determine the association between dynamic motion and radiographic sagittal assessments; and examine the association between axial and sagittal spinal and pelvic kinematics between hip OA patients and healthy controls (CTRL).

Introduction

Osteoarthritis (OA) of the hip is an important cause of pain and morbidity. The mechanisms and pathogenesis of OA'sdevelopment remain unknown. Minor acetabular dysplasia and subtle variations in proximal femoral morphology are increasingly being recognized as factors that potentially compromise the joint biomechanically and lead to OA. Previous studies have shown that risk of hip OA increased as the femoral head to femoral neck ratio (HNR) decreased. Previous work has described the evolutionary change in inferior femoral neck trabecular density and geometry associated with upright stance, but no study has highlighted the evolutionary change in HNR. The aim of this study was to examine evolutionary evidence that the hominin bipedal stance has lead to alterations in HNR that would predispose humans to hip OA.

A femoral head/neck ratio (HNR) of less than 1.27 is associated with an increased risk of arthritis. The aim of this study was to establish whether there is evolutionary evidence that the homonin, bipedal stance has led to alterations in HNR that predispose humans to osteoarthritis (OA).

Specimens provided by The Natural History Museums of London, Oxford and the Department of Zoology, University of Oxford were grouped according to gait pattern, HAKF (Hip and knee flexed), Arboreal (ability to stand with hip and knee joints extended) and homonin/bi-pedal. Specimens included those from Devonion, Triassic, Jurrasic, Cretaceous, Miocene, Paleolithic, Pleistocene periods to modern day. Three-dimensional skeletal geometries were segmented using CT images and HNR measurements were taken from coronal views. These were compared with the HNR of 119 asymptomatic human volunteers and 210 patients that had a hip joint replacement for primary OA.

Species of the HAKF group had the smallest HNR (1.10, SD:0.09). Species of the Arboreal group had significantly higher HNR (1.63, SD:0.15) in comparison to the Bipedal group (1.41, SD:0.04) (p=0.006), Human (1.33, SD:0.08) and the OA group (1.3, SD:0.09).

The range of movement associated with arboreal habitat caused an associated change in HNR. This study would suggest that the HNR peaked in the Miocene period with species that ambulated on both ground and trees. More recent homonin gait appears to have developed a smaller HNR and humans have the smallest amongst their close ancestors. Evolutionary theory would suggest that modern environmental pressures might pre-dispose future hominin evolution to OA, secondary to a further reduction in HNR.

Aims: This study evaluated the outcome of bilateral hip and knee arthroplasty in the same patient with special regards to schedule planning, postoperative complications and follow-up. Methods: Since 1985 more than 6000 THA and 5500 TKA were implanted in one large center, of which 8% were rheumatoid patients. Quadruple THA and TKA were performed in a total of 58 (0.1%) of which 88% were RA. Mean follow-up of knees was 8.5 years (1–17), of hips 9.5 years (1–18). On average 67% of implants were uncemented. In 21% of the cases all four prostheses were implanted within one year and over 50% within five years. Results: Taking revision of components as failure there were three infections (CLS hip, GSB and LCS knee), two aseptic loosenings (Endler cup, GSB knee), two recurrent hip dislocations, three knee bearing exchanges (LCS, INNEX), and four patella component removal (GSB, PCA). Discussion and Conclusion: Quadruple arthroplasty in the lower extremity did not show an increased failure rate compared with single arthroplasty in this center. The results of this study support the indication for quadruple procedure with early postoperative rehabilitation and full weight bearing. Data suggest a procedure with hips before knees and at least three weeks between any arthroplasty operations.

Aims

Periacetabular osteotomy (PAO) is an established treatment for acetabular dysplasia. It has also been proposed as a treatment for patients with acetabular retroversion. By reviewing a large cohort, we aimed to test whether outcome is equivalent for both types of morphology and identify factors that influenced outcome.

Legg-Calve-Perthes and slipped capital femoral epiphysis may result in alterations of the proximal femoral morphology, leading to the development of secondary hip osteoarthritis as a young adult. Hip surface arthroplasty presents special technical challenges in these patients because of the abnormal anatomy of the head and neck. We reviewed the radiographic and clinical results of patients with a history of either LCP or SCFE, who underwent hip resurfacing between 1996 and 2002. Twenty-three patients (25 hips, 14 with LCP and 11 with SCFE) underwent metal-on-metal surface arthroplasty. The average age at the time of surgery was 38.1 years and 87% of the patients were male. The mean time to follow-up was 26.9 months. UCLA pain, walking, function, and activity scores improved significantly in both groups as well as the SF-12 physical component scores. One patient with LCP required bilateral conversion to THA at 55 months postoperatively secondary to femoral component loosening. There were no dislocations or femoral neck fractures in this series. Of 11 patients who presented leg length discrepancies preoperatively, limb length was postoperatively equalized in six patients, 3 were maintained with the same amount of discrepancy, and 2 decreased their discrepancy by at least 1 cm. In Charnley Class A patients, there was no difference in femoral offset between the operated and the disease-free, contralateral hip after reconstruction.

Despite the challenges in performing hip resurfacing in this patient population, the results to date have been encouraging. Even with the limitations of resurfacing in restoring leg length and offset, the clinical results of this group of patients are comparable to those of the other etiologies.

Introduction and Aims: Legg-Calve-Perthes disease and slipped capital femoral epiphysis are hip disorders that may result in the alteration of proximal femoral anatomy and subsequent osteoarthritis. LCP often results in a flattened head and short femoral neck; SCFE residual deformity is a retroverted head upon a wide femoral neck. Because of the low head to neck ratio and short neck length in these patients, surface arthroplasty is especially technically difficult.

Method: We examined a cohort of patients with either LCP or SCFE who underwent surface replacement of the hip to assess clinical results and identify pre-operative radiographic factors unique to this group. All patients with arthritis of the hip secondary to either LCP or SCFE, who underwent surface replacement between 1996–2002, were included. Proximal femoral anatomy was assessed by measuring the neck and head length, flattening of the head, anterior head offset and lateral head offset. Hip ROM was measured and SF-12 and UCLA Hip scores were calculated.

Results: Fourteen patients with LCP and 11 patients with SCFE had undergone surface replacement with an average age of 38 years; the mean time to follow-up was 26.2 months. Pre-operative radiographs revealed a head-neck ratio of 1.3 in the LCP group and 1.2 in the SCFE group. The amount of head offset was 9.4mm anterior and 6.4mm lateral in the LCP group; and 8.8mm and 4.4mm in the SCFE group. Neck and head length was 42mm in the LCP patients and 56.5mm in the SCFE patients; this measured 46 and 53mm post-operatively. No revisions had been performed in either group. The UCLA scores, SF-12 scores, and hip ROM did not differ from a cohort of patients who had undergone resurfacing for other reasons. No femoral neck fractures occurred in either group.

Conclusion: Despite technically difficult surgeries for hip resurfacing in these patients because of a flattened head and short neck in LCP, and wide femoral neck with retroverted heads in SCFE, the results to date have been good. By taking extra care to avoid notching the neck on the anterior and lateral tension sides, satisfactory results can be achieved.

Introduction: Necrotic fatty marrow is yellow, thick, and turbid like pus and the fat cell is counted as white blood cell in automated cell counting. When necrotic fatty marrow leaks into the hip joint through a crack in the cartilage of the osteonecrotic femoral head, a misdiagnosis of pyogenic infection can be made. The authors report cases of osteonecrosis of the femoral head, in which a misdiagnosis of pyogenic infection was made during the operation.

Materials and Methods: Between September 1997 and December 2001, pyogenic arthritis was suspected during the operation in seven patients who were operated on due to advanced osteonecrosis of the femoral head. The markers of infection including white blood cell count, erythrocyte sedimentation rate, and C reactive protein in preoperative laboratory examination were normal in all of the seven patients. Total hip arthroplasty was scheduled for all patients. When the hip joint capsule was incised, joint fluid gushed out in all patients. The appearance, white blood cell count in automated cell counting, microscopic findings, and the results of culture of the joint fluid were evaluated.

Results: The joint fluid was yellow, thick and turbid like pus. A pyogenic arthritis was suspected and the joint fluid was sent to the laboratory for automated blood cell count, smear and culture. The count of white blood cells ranged from 5800 to 18000 in automated cell counting. No microorganism was identified on joint fluid smear. On microscopic cell counting using a hemocytometer, white blood cells were rarely seen and the majority of cells which were counted as white blood cells, were necrotic fat cell. Total hip arthroplasty was performed immediately after microscopic examination of the joint fluid. No microorganism was identified in cultures of the joint fluid. There was no evidence of infection after total hip arthroplasty at a minimum of two-year followup.

Discussion: When necrotic fatty marrow leaks into the hip joint, the joint fluid looks like pus and white blood cell counts of the joint fluid is increased in automated cell counting because fat cells are counted as white blood cells. In this situation, microscopic examination of the joint fluid is necessary. If the white blood cell count is not increased in microscopic cell counting, replacement arthroplasty can be performed without risk of infection.

Aims. Total hip arthroplasty (THA) in patients with post-polio residual paralysis (PPRP) is challenging. Despite relief in pain after THA, pre-existing muscle imbalance and altered gait may cause persistence of difficulty in walking. The associated soft tissue contractures not only imbalances the pelvis, but also poses the risk of dislocation, accelerated polyethylene liner wear, and early loosening. Methods. In all, ten hips in ten patients with PPRP with fixed pelvic obliquity who underwent THA as per an algorithmic approach in two centres from January 2014 to March 2018 were followed-up for a minimum of two years (2 to 6). All patients required one or more additional soft tissue procedures in a pre-determined sequence to correct the pelvic obliquity. All were invited for the latest clinical and radiological assessment. Results. The mean Harris Hip Score at the latest follow-up was 79.2 (68 to 90). There was significant improvement in the coronal pelvic obliquity from 16.6. o. (SD 7.9. o. ) to 1.8. o. (SD 2.4. o. ; p < 0.001). Radiographs of all ten hips showed stable prostheses with no signs of loosening or migration, regardless of whether paralytic or non-paralytic hip was replaced. No complications, including dislocation or infection related to the surgery, were observed in any patient. The subtrochanteric shortening osteotomy done in two patients had united by nine months. Conclusion. Simultaneous correction of soft tissue contractures is necessary for obtaining a stable hip with balanced pelvis while treating hip arthritis by THA in patients with PPRP and fixed pelvic obliquity. Cite this article: Bone Jt Open 2021;2(9):696–704

Proximal femoral focal deficiency is a congenital disorder of malformation of the proximal femur and/or the acetabulum. Patients present with limb length discrepancy and clinical features along a spectrum of severity. As these patients progress through to skeletal maturity and on to adulthood, altered biomechanical demands lead to progression of arthropathy in any joint within the lower limb. Abnormal anatomy presents a challenge to surgeons and conventional approaches and implants may not necessarily be applicable. We present a case of a 62-year-old lady with unilateral proximal femoral focal deficiency (suspected Aitken Class A) who ambulated with an equinus prosthesis for her entire life. She presented with ipsilateral knee pain and instability due to knee arthritis but could not tolerate a total knee arthroplasty due to poor quadriceps control. A custom osteointegration prosthesis was inserted with a view to converting to the proximal segment to a total hip replacement if required. The patient went on to develop ipsilateral symptomatic hip arthritis but altered acetabular anatomy required a custom tri-flange component (Ossis, Christchurch, New Zealand) and a custom proximal femoral component to link with the existing osseointegration component (Osseointegration Group of Australia, Sydney, Australia) were designed and implanted. The 18 month follow up of the custom hip components showed that the patient had Oxford hip scores that were markedly improved from pre-operatively. Knee joint heights were successfully restored to equal when the patient's prosthesis was attached. The patient describes feeling like “a normal person”, walks unaided for short distances and can ambulate longer distances with crutches. Advances in design and manufacture of implants have empowered surgeons to offer life improving treatments to patients with challenging anatomy. Using a custom acetabular tri-flange and osseointegration components is one possible solution to address symptomatic ipsilateral hip and knee arthropathy in the context of PFFD in adulthood