Purpose of the study: Although the association between femoroacetabular impingement and degenerative hip disease has been well established, there is no way to detect a subgroup of hips with radiographic signs of impingement which will progress to degeneration. In addition, the majority of publications on the topic have been conducted in populations of patients with an overtly degenerative hip, where the incidence of signs of impingement is higher. There has not been any study searching for the presence of signs of impingement in a symptom free population. For this reason, we searched for signs of femoroacetabular impingement in a general population and attempted to find correlations with degenerative hip disease. Material and method: We examined 200 computed tomography (CT) series of the pelvis performed for reason other than an orthopaedic indication. Four hundred hips were thus analysed with the Amira 4.1 3D software. We measured the classical coxometric parameters, orientation of the acetabulum, alpha angle, and presence or not of a bulge at the head-neck junction. Cartilage thickness was also mapped using a precise protocol. Cartilage thickness less than 0.25mm was considered for the purpose of this study to indicate degenerative disease. All data were processed with SPPS 17.0. Results: There were 103 men and 97 women, mean age 58 years and 59 years respectively. The mean alpha angle was 55.7. Retroversion was noted in 20% of hips and 28% exhibited an anterior bulge at the head-neck junction. The mean cartilage thickness at the anterosuperior part of the hip was 37mm. Degenerative disease was present in 28 patients (14%) whose mean cartilage thickness at the anterosuperior portion of the joint was 21 mm. There was no significant correlation between cartilage thickness and acetabular orientation, alpha angle, presence of a bulge at the head-neck junction. Only age was significantly correlated with degenerative disease r=−0.158 [p< 0.0]. Discussion: Among the parameters currently considered to be risk factors for degenerative disease of the hip joint, age alone was statistically linked with reduced cartilage thickness in our symptom-free population. This would suggest that the essential mechanism underlying degenerative disease remains to be discovered. Conclusion: Our findings suggest we should be prudent when proposing corrective surgery for femoroacetabular impingement. Such surgery should be reserved for symptomatic patients

Introduction: Historically, it has been accepted that pain associated with arthritis of the hip is usually located in the groin and thigh with radiation to the anterior knee. However pain below the knee, and into the foot was not believed to be associated with arthritis of the hip. Patients complaining of thigh pain that extends below the knee are often considered to have a degenerative lumbar spine as the cause for their lower limb symptoms, and hip arthroplasty may not be offered. We examined the severity and location of pain in patients attending for arthroplasty and assessed how this altered following surgery. Methods: 200 consecutive patients undergoing primary total hip arthroplasty completed a questionnaire regarding the location and severity of pain in the leg and also an Oxford hip score to assess functionality. These were completed approximately 4 weeks preoperatively and again at a 3-month review clinic. Results: 57% (114/200) of patients complained of pain below their knee preoperatively. Only 9% (10/114) of these patients continued to complain of pain postoperatively, and of these patients their mean pain score decreased by 44% (9 to 5). Only 1% (2/200) of all patients complained solely of pain in the knee or more distally, and both of these had complete relief of pain 3 months postoperatively. Conclusion: A significant number of patients with degenerative hip disease have pain below the knee. Patients who complain of pain in their back, buttock or thigh, which extends below the knee, may still benefit from total hip replacement. Careful consideration should be taken before labelling the pain as being referred from degenerative back disease

Total hip arthroplasty (THA) is one of the most successful and commonly performed surgical interventions worldwide. Based on registry data, at one-year post THA, implant survivorship is nearly 100% and patient satisfaction is 90%. A novel, porous coated acetabular implant was introduced in Europe and Australia in 2007. Several years after its introduction, warnings were issued for the system when used with metal-on-metal bearings due to adverse local tissue reaction, with one study reporting a 24% failure rate (Dramis et al. 2014). A subsequent 2018 study by Teoh et al. showed that the acetabular system had a survival rate of 98.9% at five years when used with conventional polyethylene or ceramic bearing surfaces. The current study was conducted to determine the safety and effectiveness of the acetabular system using standard highly-crosslinked polyethylene (XLPE) and ceramic liners at five-year follow-up. Our hypothesis was that the acetabular system would exhibit survivorship comparable to other acetabular components on the market at five-year follow-up.

A prospective, non-randomized study was conducted from February 2009 to June 2017 at eight sites in Canada and the USA. One hundred fifty-five hips were enrolled and 148 hips analyzed after THA indicated for degenerative arthritis. At five-year follow-up, 103 subjects remained for final analysis. All patients received a zero, three, or multi-hole R3 acetabular shell with Stiktite porous coating (Smith & Nephew, Inc., Memphis, TN, USA). Standard THA surgical techniques were employed, with surgical approach and either of a XLPE or ceramic bearing surface chosen at the discretion of the surgeon. The primary outcome was revision at five-years post-op with secondary outcomes including the Harris Hip Score (HHS), Hip Disability and Osteoarthritis Outcome Score (HOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), radiographic analysis, and post-operative adverse events. Data and outcomes were analyzed using summary statistics with 95% confidence intervals, t-tests, and Wilcoxon Rank tests.

At five-year follow-up the overall success rate was 97.14% (95% CI: 91.88–100). When analyzed by liner type, the success rate was 96.81% (95% CI: 90.96–99.34) for polyethylene (n=94) and 100% (95% CI: 71.51–100) for ceramic (n=11), with no significant difference between either liner type (p=1). There were three revisions during the study (1.9%), two for femoral stem revision post fracture, and one for deep infection. The HHS (51.36 pre-op, 94.50 five-year), all 5 HOOS sub-scales, and WOMAC (40.9 pre-op, 89.13 five-year) scores all significantly improved (p < 0 .001) over baseline scores at all follow-up points. One (0.7%) subject met the criteria for radiographic failure at one-year post-op but did not require revision. Six (1.8%) of the reported adverse events were considered related to the study device, including four cases of squeaking, one bursitis, and one femur fracture.

Results from this five-year, multicenter, prospective study indicate good survivorship for this novel, porous coated acetabular system. The overall survivorship of 97.14% at five-year follow-up is comparable to that reported for similar acetabular components and aligns with previous analyses (Teoh et al. 2018).

The use of total hip arthroplasty in adolescents for end-stage degenerative hip disease is controversial with few reported outcomes in the literature. The purpose of the study was to report the outcomes of total hip arthroplasty in a cohort of adolescents managed by a multidisciplinary team of paediatric and adult orthopaedic surgeons from a single centre. A multidisciplinary clinic consisting of paediatric and adult hip surgeons was established in 2013 to identify, treat and prospectively follow adolescents who would potentially beneift from a total hip arthoplasty. To date 29 consecutive adolescent patients (20 female, 9 male, 32 hips) with end stage degenerative hip disease have undergone cementless primary total hip arthroplasty. Mean age at decision to treat was 15.7 years (age 11.4–18.5). Ten different underlying paediatric specific pathologies were documented including DDH, cerebral palsy, JIA, skeletal dysplasias, SCFE and idiopathic chondrolysis. Three patients had bilateral staged procedures. Clinical baseline and outcomes were measured using Oxford Hip Score (OHS), WOMAC score and ASKp scores. Radiographic follow-up was conducted at 6 weeks, 6 months and yearly thereafter. Post-operative complications were recorded. Twenty-five hips were eligible for minimum 2-year follow-up scoring at a mean 2.7 years (2.0–3.6 years). No intraoperative complications occurred. One case of recalcitrant postoperative psoas tendonitis occured. OHS improved from 25 (7–43) to 41 (23–48). WOMAC improved from 48 (12–8) to 12 (1–44), and ASKp improved from 78% (33–98%) to 93% (73–100%). Radiographic review revealed acceptable alignment of all components with no signs of loosening or wear. No revision of components was required. One patient died at 6 months post op from an unrelated condition. The early term results of total hip arthroplasty in adolescents from our multidisciplinary program are encouraging. Improvements in quality of life to normal values were seen as were hip scores consistent with satisfactory joint function. Depite the range of complex and varied causes of arthritis seen in this population the establishment of combined paediatric and adult orthopaedic surgical teams appears to be a successful model to manage end-stage degenerative hip disease in adolescents

Purpose: Rapidly destructive degeneration of the hip joint is a condition whose relations with habitual degenerative hip disease are poorly understood. This uncommon condition is observed in 5 to 10% of patients with degenerative hips and almost always requires arthroplasty; The objectives of this retrospective study were to determine the distinctive radiological and clinical features of this condition and assess long-term outcome after total hip arthroplasty in these patients. Material and methods: The study concerned 100 total hip arthroplasties performed between 1984 and 1088 in 67 men and 11 men, mean age 71 years with rapidly destructive degeneration of the hip joint. All arthroplasties were implanted via the transtrochanteric approach with cemented Charnley-Kerboul implants. Mean follow-up was seven years ten months. Results: There were seven complications: two nonunions of the trochanter, three extensive periprosthetic ossifications, one recurrent case of dislocation, and one late infection by blood stream dissemination. At last follow-up, 95 hips exhibited excellent or very good function (Poste-Merle-d’Aubigné classification). Fixation was stable for 94 ace-tabular implants and 97 femoral implants. Six acetabular implants and three femoral implants had loosened. These femoral loosenings were always associated with acetabular loosening. Four hips required revision surgery: one for non-union of the trochanter, one for septic loosening, and two for asepctic loosening. Discussion: This study confirmed the radiological definition and the clinical features of this condition and demonstrated the reliability of the pathology examination of the femoral head and the articular capsule. Among the different hypotheses put forward to explain this condition, we cannot retain the presence of joint over-use, or use of anti-inflammatory drugs, nor infirm a micro-crystalline or vascular origin. Nevertheless, the vascular phenomena observed in the femoral head are comparable to those observed in joint lesions subsequent to ischaemia. Total hip arthroplasty causes considerable blood loss, estimated at 2706 ml (haematocrit 35%), apparently much higher than during arthroplasties using an identical technique for patients with the usual form of degenerative hip disease. Excepting this fact, complications, clinical outcome and arthroplasty longevity were not different than those generally observed

Purpose: We report the operative technique and preliminary results for percutaneous osteosynthesis in the supine position with computed tomography guidance for acetabular fractures without joint displacement. Material and methods: This prospective study conducted in a single unit included a consecutive non-randomised series of 55 patients who underwent surgery for an unstable pelvic injury between June 1996 and December 2000 under computed tomography guidance. In ten cases, the radiographic and computed tomographic analysis demonstrated a coronal fracture of one of the columns without joint displacement accessible for anteroposterior screw fixation. There were eight men and two women, mean age 35 years. Surgery: the ten patients were operated on in the supine position, in the scanner room under the same aseptic conditions as in the operation room. The reference computed tomography slice was the Corse slice. The femoral vasculo-nervous bundle was identified. A threaded guide wire was inserted perpendicuallary to the fracture line, anteriorly to posteriorly (Cap Corse technique). A perforated screw with a 7.3 mm diameter was used to fix the fracture. Minimal post-surgical surveillance was 48 hours. Weight bearing was not authorised for six weeks to three months. Al patients were followed prospectively, and mean follow-up ws 16 months (12–36). Results: Traction was lifted immediately after surgery in all cases. All the patients got up the day after surgery. Mean hospital stay was less than five days postoperatively in all cases. There were no complications (vascular, neurologic, infectious) and no secondary displacement. At last follow-up, he Postel Merle d’Aubigné score was 18 for eight patients, 16 for one and 14 for one. Two patients showed radiographic signs of degenerative hip disease. Discussion: This percutaneous osteosynthesis method using computed tomographic guidance is reliable (100% well positioned screws) and avoids the need for traction in bed. Morbidity is low (no complications). Even though these eight patients did not present clinical and radiographic signs of osteoarthritis, this technique did not avoid the risk of degenerative hip disease in two patients. Conclusion: An alternative to traction, percutaneous osteo-synthesis with computed tomographic guidance performed in the supine position for acetabular fractures is a cost-effective procedure

Introduction & aims. Total hip replacement is an excellent treatment option for people with late stage degenerative hip disease. In addition to marked reduction in pain and improvement in sleep, most people regain range of motion, physical ability and quality of life. This study aimed at the functional outcomes of large diameter heads in THR patients. Method. This study is an analysis of a cohort of patients undergoing total hip replacement performed at our hospital from November 2011 to July 2013. A total of 70 hips, 40 males and 30 females, were operated upon with large diameter femoral heads. The mean age was 50.38 years (range 40–59 years). In our cohort, 32 patients had AVN of femur head, 19 had post traumatic secondary degeneration, 10 had RA, 6 had AS and 3 patients had OA of hip. The follow-up data included local complications, Harris Hip Score, medical complications, readmission, activity status and use of a walking aid. Results. Harris hip score at final follow up was, 33 cases had excellent, 26 cases had good result. None of the patient had fair or poor result. Two cases of superficial infection were observed. One case of dislocation was observed in post operative period which was reduced under GA and patient was given abduction brace. The mean follow up was 16.31 months ranging from 6 to 32 months. During the follow up, we had mortality of two patients. One died at 14 months due to myocardial infarction and the cause of other died due to CVA at 10 months follow up. Conclusions. Lower dislocation rate and better range of motion in majority of cases reinforces the advantage of large diameter head in THR in young and active patients. For any figures or tables, please contact authors directly (see Info & Metrics tab above).

The aim of this study is to evaluate the efficacy of the use of the dynamic hip orthosis in subjects who are affected with degenerative hip diseases, even those who are waiting for a total hip replacement, and in subjects who had undergone a hip replacement because of a proximal femur fracture. For each patient we’ve prepared a card in which we’ve reported personal data, comorbidities, pharmacological and rehabilitative treatments, VAS, WOMAC, Barthel Index, GDS and a evaluation of the compliance. We’ve evaluated those patients periodically. Until now, and considering the follow up is not ended, we can say that the dynamic hip orthosis can be addressed to patients with mild to moderate hip osteoarthritis and in elderly who’ve been undergone surgery for a proximal femur fracture because it reduces pain, it facilitates a safer gait and it accelerates the functional recovery. However it is important the dynamic hip orthosis to become a part of an individualized rehabilitative project

Introduction: Poor long-time results in patients with Legg-Calvé-Perthes disease (LCP) are most often due to degenerative hip disease. The purpose of this study was to investigate if patients with LCP have an increased rate of total hip replacement (THR) compared to sex- and age-matched persons. Material and Methods: 167 LCP patients presented to our institution from 1941 to 1962. All patients were treated conservatively by a Thomas splint. Retrospectively medical records and radiographs were retrieved. Data from the Danish Hip Replacement Register and the Registries of the National Board of Health were collected to get information regarding the number of the patients who had a THR. Radiographs of sex- and age-matched controls for the follow-up group were obtained from The Copenhagen City Heart Study. The following criteria for exclusion were applied. emigrated persons,. persons lost to follow-up and. patients with previous surgery to pelvis or lower limbs. 135 patients (156 hips) were enrolled in this study and 32 patients (35 hips) were excluded. Results: 20 hips out of 156 hips in patients with LCP have had a THR. Mean age at operation for the women was 50 years and 44 years for the men. None of the sex- and age-matched persons have had a THR. Conclusion: LCP patients had a significantly higher risk of THR surgery compared to sex- and age-matched control persons, (p< 0.00 [OR= 49.0 (CI 8.2-infinite)])

Purpose: Wear of prosthetic implants, especially the metal-polyethylene head-cup couple, and dissemination of wear particles throughout the organisms the dominant long-term complication of total hip arthroplasty. We determined serum concentrations of chromium, cobalt, nickel, and molybdenum in patients bearing a total hip prosthesis with a chromium-cobalt metal-poly-ethylene head-cup couple. The purpose of our work was first to compare the levels observed with those found in a control population and then to study variations in these levels as a function of clinical and radiological signs commonly searched for during the follow-up of patients with a total hip arthroplasty. Material and methods: During a period of 30 months, a total hip arthroplasty (PVL®) was implanted in 53 patients suffering from degenerative hip disease. Forty-eight patients were assessed at a minimum follow-up of 32 months with physical examination and standard x-rays as well as serum assay of the specified metals using mass spectrometry on whole blood samples. The control group was composed of 56 patients scheduled for total hip arthroplasty. Results: At a mean follow-up of 44 months, 17% of the patients had a fair or poor functional score and 37% had radiological signs suggestive of femoral stem loosening. There was a significant increase in the serum level of cobalt compared with the control group. This increase was greater in patients with radiological signs of loosening. Discussion: The metal-on-metal couple does not appear to be the only couple which increases serum metal levels. Serum metal assay could be a diagnostic tool useful for following patients with total hip prostheses

Femoroacetabular impingement is defined as abnormal abutment between the femoral head, or the femoral head-neck junction, and the acetabulum. It is now established that FAI is a major etiological factor in the development of osteoarthritis (OA) of the hip. FAI is increasingly recognized as a cause of hip pain in young active individuals. Clinical features of FAI include pain in the groin but this may also be felt in the gluteal region, trochanteric region, or in the thigh. Symptoms most commonly begin as an intermittent discomfort, often during or following periods of repetitive hip motion e.g. running, walking, progressing to more constant and intense pain. Stiffness is common, with reductions in the range of hip flexion, and internal rotation in particular. Patients may also complain of clicking, popping, or snapping sensations in the affected hip. Operative treatment of FAI is principally aimed at removing cam lesions and increasing femoral head-neck offset (osteochondroplasty), and treating associated soft tissue lesions such as labral tears. Acetabular recession with labral reattachment is increasingly used for pincers lesions but great care is needed to ensure that the overall coverage of the hip is not reduced. As proficiency with arthroscopic techniques has improved, arthroscopic osteochondroplasty and labral debridement/repair has become increasingly popular for the treatment for FAI, with promising functional results in a range of studies. 150 consecutive patients who underwent hip arthroscopy for CAM type FAI with minimum 1 year follow up were prospectively studied. Patient satisfaction, non-arthritic hip score, re-operations and conversion to arthroplasty were analysed. There were a total of 90 males and 60 females. The average age group was 32 years (27 to 46 years). All patients underwent osteoplasty of the CAM lesion and stabilisation/ repair of the labral tears. A comparison of pre procedure non arthritic hip scores with the scores at latest follow up (minimum 1 year, maximum 3 years) showed a significant improvement (56 vs 86; p <0.01). There were 2 re operations for unresolved symptoms and 1 conversion to arthroplasty for continued pain associated with significant loss of articular cartilage. Perineal numbness was noted in 9 patients all of which resolved. No other major complications were noted in this series. Hip impingement symptoms resolved in all cases and a good (20 %) to excellent (75%) outcome was reported. Arthroscopic management of CAM type FAI is associated with subjective and objective improvement in hip function at early follow up. Longer follow-up is necessary to analyse the ability of this procedure to arrest progression of degenerative hip disease

We report the review of performance and problems of Metasul Hip System with metallic sliding face during mean time of 11 years or longer. Subjects and methods: Twenty-three joints in 22 patients. 17 females and 5 males treated using cementless Metasul THA in our hospital from November of 1995 to April of 1998 were selected as subjects. The mean age at the time of surgery was 59 years, and disease included degenerative hip disease in 16 joints, femoral head necrosis in 5 joints, and rheumatoid arthritis in 2 joints. Mean follow-up period was 11 years and 3 months. We have investigated clinical results (JOA score), stem fixation by radiography (Engh), setting angle of socket, and presence or absence of osteolysis by CT, and the poor cases after surgery and problems were clarified. Results: Clinical results (JOA score) were improved from preoperative mean of 41.3 points to mean of 89.3 points at the time of investigation. Stem fixation examination by radiography (Engh) for bone ingrown resulted in 95% in ingrown and 5% in ingrown suspension, showing excellent fixation. The abduction angle of the socket was 38.8±4.5 degrees, and the anteversion angle was 14.6±7.7 degrees, revealing that precise surgery was conducted. There were no joints which showed loosening in stem or socket, but CT imaging showed osteolysis in 5 joints (22%) in the stem side and 12 joints (52%) in the acetabular side. Dislocation in Poly Liner occurred in 4 cases which needed revision surgery with accumulated survival rate of 82.6. Summary: When cementless Metasul Hip System was used, fixation of stem/metal shell was excellent, but there were problems in thickness and fixation of Poly Liner. Due to augmentation of activity, backside wear occurred, and osteolysis or dislocation of the liner was induced. THA System such as M2a which improves these defects using metallic liner may be promising hereafter

Purpose of the study: The purpose of this work was to report the outcome at minimum ten years follow-up of cemented Muller total hip arthroplasty (THA) with a metal-on-metal bearing and a CLS cup. Material and methods: From June 1995 to August 1997, 110 THA were implanted in 102 patients for degenerative hip disease. At last follow-up, 23 patients had died, four were lost to follow-up, and 67 were reviewed. Mean age was 56 years (29–71). BMI: 26.2 (17.9–33.6). Mean follow-up was 12 years (10–13). The same operative technique was used for all implantations: transgluteal approach, Palacos Gentamycine. ®. cement, straight femoral stem, Muller prosthesis made of Protasul. ®. 10, with a Metasul. ®. head and a CLS cup with a polyethylene sandwich Metasul. ®. insert. Outcome was assessed clinically with the Merle score, radiographically searching for signs of loosening using the Harris criteria for the femoral component and the Hodgkinson criteria for the acetabular component. Migration was measured with the Nunn method for the cup and the Sutherland method for the femur. Dobbs actuarial survival was determined. Results: Nine patients (9THA) underwent revision for acetabular migration (n=4), cup fracture by cam effect (n=1), psoas syndrome (n=2), retarded hypersensitivity (n=1), infection (n=1). At last follow-up, the clinical outcome was good or very good (n=64), fair (n=2), poor (n=1). Radiologically, for the femur: lucent lines (n=0), osteolysis (n=4), migration (n=0); for the cup: lucent line < 1mm stable and non migrating (n=3), global lucent line with migration > 5mm (radiological loosening) (n=1). No correlation between clinical and radiographic outcomes. Survival was 89.4±7.6% for revision outside infection and 92.6±6.9% for aseptic loosening. Discussion: The failures at ten years were all acetabular, but related to various causes. Defective fixation could be related to the implant design or to the use of a hard-on-hard bearing increasing peripheral stress. Hypersensitivity and a cam effect related directly to using the metal-on-metal bearing. The psoas syndrome was not related to the type of cup. Conclusion: Use of a metal-on-metal bearing, which theoretically improves wear, leads to other constraints in terms of fixation, technique, and context which must be taken into consideration to improve outcomes

Purpose: Insertion of the femoral stem during total hip arthroplasty provokes a bridge between the proximal femoral forces leading to well-documented bone resorption. A review of the literature concerning the behaviour of the contralateral femur and the spine reveals conflicting data. Some authors report variable bone mineral density of the lumbar spine while the contralateral neck, studied with non-cemented prostheseis in all cases, shows a significant fall in bone density. All patients in these studies needed an unloading period to achieve definitive fixation of the hip prosthesis. The purpose of this study was to assess bone behaviour in the contralateral femur and the lumbar spine after unilateral cemented total hip arthroplasty with immediate postoperative weight bearing. Material and methods: The study series included 52 patients who underwent unilateral cemented total hip arthroplasty for degenerative hip disease. All were followed with standard x-rays and DPX of the contra-lateral hip and the lumbar spine. These examinations were performed one month before surgery then on D8, M3, M6, one year and two years. Bone mineral density (BMD) was measured in the femoral neck cortical and the L2–L4 trabecularlar bone. Patients were verticalised and encouraged to walk with full weight bearing on the average on day 3 to 4 after surgery. Results: DPX did not demonstrate any significant decrease in BMD in any of the patients included in this study, neither in the lumbar spine nor in the contralat-eral femoral neck. Discussion: Several studies in the literature point out the difficulty in recovering bone mass lost after a period of immobilisation or unloading. This bone loss could reach 10% of the bone mass even for short periods of unloading. Furthermore, minimal bone loss, to the order of 2.5% could accelerate the transformation of osteopenia into osteoporosis and increase the risk of fractures. The importance of minimising periods of unloading in older patients is thus evident

Purpose. Elevated blood metal ions are associated with the early failure of the Hip Resurfacing Arthroplasty. The aim of this study was to analyse our prospective database of Hip Resurfacing Arthroplasty patients, to independently review the outliers with elevated blood metal ions and to determine whether a screening program would be of value at our institution. Method. In 2004 a ten year prospective longitudinal study was set up to evaluate the clinical effectiveness and safety of Metal on Metal Hip Resurfacings in young, active adults with degenerative hip disease. Six hundred and four patients have enrolled in this multi-surgeon prospective study with strict inclusion criteria for Hip Resurfacing Arthroplasty. All have received the same implant design. All have completed validated functional outcome questionnaires at baseline, three and six months, then annually. A sub-cohort of 196 patients underwent whole blood chromium and cobalt analysis at the same time periods. Metal on metal bearings have a running in period of a minimum of six months before a steady state wear pattern is attained. We chose five parts per billion for Cobalt or Chromium as our threshold value. This value corresponds to the workplace exposure limit in the United Kingdom to Cobalt in whole blood. Therefore patients with ion levels greater than five parts per billion after six months were recalled for independent review, including further metal ion analysis. Results. Twenty two patients were recalled. Twenty one patients (32 Hip Resurfacing Arthroplasties) were reviewed. At latest review 11 patients (15 Hip Resurfacing Arthroplasties; eight females) had levels greater than five parts per billion. Mean follow up was 59.8 months (47–78). Mean age at surgery was 48.7 years (37–55). Median femoral component size was 50 millimetres (42–54). Mean acetabular anteversion was 18.3 degrees (−5.2 43.0). Mean acetabular inclination was 46.1 degrees (33.1–57.1). Mean cobalt and chromium levels were 8.82 parts per billion (3.49 18.42) and 9.15 parts per billion (3.79 24.33). Patients with ion levels greater than five parts per billion were associated with inferior functional scores (p= 0.018), inferior hip flexion (p=0.01) and mal-positioned acetabular components (p=0.023). All symptomatic patients were female. Conclusion. It is reassuring that the majority do not have elevated metal ions (185/196; 94.4%). That said, blood metal ion screening of Hip Resurfacing Arthroplasties aids in the early detection of problematic cases. Comprehensive clinical review should follow as patient safety is paramount. The early detection of problematic cases is advantageous to the surgeon and patient. Revision surgery for an established pseudotumour has been found to be technically challenging, often with a poor outcome

Aims

The aims of the study were to report for a cohort aged younger than 40 years: 1) indications for HRA; 2) patient-reported outcomes in terms of the modified Harris Hip Score (HHS); 3) dislocation rate; and 4) revision rate.

Introduction: In the last years, the use of second generation cementless anatomical stems has generated an increasing interest in primary total hip arthroplasty. They are believed to offer long term stability through appropriate stress transfer and bone remodelling in the proximal femur. We conducted a monocentric prospective study on a homogeneous series of total hip replacements performed with a cementless anatomic, hydroxyapatite-coated stem. The purpose of the study was to evaluate the contribution of this implant in terms of clinical and radiological results at a minimum 5-year follow-up. Material and Methods: The continuous homogeneous series included 176 THA performed between September 1997 and December 1998 by a single surgeon with the same implant system (SPS femoral stem and Hilock acetabular cup, Symbios Orthopédie SA). Indications were restricted to primary or secondary degenerative hip diseases. Revisions were excluded. Patients were reviewed for clinical performance (Harris hip score), satisfaction, and radiological outcome. The radiological analysis (implant migration, Ara and Engh scores, Brooker classification) was performed by an independent surgeon unaware of the clinical performance outcome. The survival curve was determined with the Kaplan-Meier method at 95% confidence interval, using exclusively implant revision as the criteria for failure. Results: The follow-up rate in the series was 93.2%. The five-year implant survival was 98.8%. Two revisions were recorded: one for early instability due to excessive joint laxity after surgery, one due to recurrent dislocation following improper cup positioning during surgery. The clinical improvement was obvious, as the Harris hip score improved significantly (p< 0.0001) from 32.9±1.2 preoperatively to 93.1±0.8 at five years follow-up. Pain was the item exhibiting the largest improvement with only 10.2% of patients complaining of mild pain at last follow-up. The radiological analysis revealed a high stability of the femoral implant with Ara and Engh scores reaching 5.0±0.2 and 20.7±0.5 respectively. The migration remained low at 2.4 mm ±0.3 (p=0.02) and had no incidence on the clinical outcome. Heterotopic ossifications at various grades were observed in a large proportion of patients (65.1%). The polyethylene wear rate was 0.075 mm/yr in the series, below most values commonly reported for Ø28mm PE inserts. Discussion: The survival rate of the SPS stem is comparable with that of other published series at same follow-up. Both the stem and cup implants used provided good clinical and radiological results at five years. The objectives of good integration and stability of the cementless anatomical stem appeared to be met, despite a significant rate of heterotopic ossifications. The excellent clinical and radiological results recorded at five years should be confirmed at longer follow-up

Purpose: We report our results of revision procedures for severe acetabular loosening with saddle prostheses. The series concerned six patients, mean age 67 years age range 58–82 years, who initially presented rheumatoid disease (n=3), degenerative hip disease (n=3, one secondary to trauma), and radiation-induced hip disease (n=1). These patients had undergone one to three procedures for reconstruction with a bone graft and metal implants. Material and methods: Failure was the indication for salvage with a saddle prosthesis due to massive loss of acetabular bone stock, complicated in five cases by an unstable hemipelvis due to transverse nonunion. An allograft was screw fixed in the iliac wing in two cases to stabilise the saddle prosthesis. Weight bearing was allowed early after surgery in all cases except two. The hip was immobilised in four cases for three to six weeks in a bermuda cast or with traction (n=4). Follow-up was 2 to 5 years. Results: There was only one complication: stress fracture of the iliac bone at two years which did not heal. Bone graft with ostheosynthesis was proposed. Pain relief was nearly total in all cases. Four patients could walk without crutches and two walked with two crutches or an ambulator due to associated disease or alar fracture. The fixation was at 60 – 95° with abduction at 10–30°. All patients were satisfied and two felt the result was very superior to simple ablation of the prosthesis which they had experienced. Radiograpically, there was no evidence of ascension of the saddle but the risk remains at this short follow-up due to the rates described in the literature. One major migration was observed as was one stress fracture of a weak iliac bone which required removal of the implant. Discussion: This difficult technique provides a better result and thus would be indicated for young patients able to sustain the intervention. It would be logical to associate a supporting bone graft on the iliac bone to prevent stress fracture and migration of the saddle. The saddle prosthesis appears to be the last resort after failure or insufficient results after prior reconstruction. The leading cause of failure is nonunion with hemipelvis mobility. This suggests the intervention should be considered before reaching this stage of well tolerated ace-tabular loosening

Purpose: Bone remodelling and osteolysis around total hip prostheses remains an ineluctable corollary of prosthetic loosening. Alendronate (biphosphonate) has proven its efficacy for the treatment of osteoporosis of the lumbar spine and the femoral neck. There has been some in vitro work pointing out its contribution to the inhibition of osteolysis induced by particles. One in vivo study has demonstrated its interest in prevention of osteolysis around non-cemented total hip arthroplasties. The purpose of our work was to study the efficacy of this drug in the prevention of periprosthetic osteolysis around cemented total hip arthroplasties using biphotonic absortiometry (DPX). Material and methods: The series included 38 patients who underwent unilateral total hip arthroplasty for degenerative hip disease. After double blinded randomisation, 20 patients were given 10 mg Alendronate per day with 600 mg calcium and 18 patients were given a placebo with 600 mg calcium for two years. All patients were followed with standard x-rays and DPX of the operated hip. Examinations were performed on the fourth postoperative day and on the third, sixth, twelveth and twenty-fourth postoperative month. The analysis concerned the periprosthetic zones defined by Gruen. Results: DPX demonstrated significant reduction in bone mineral density (BMD) in all patients included in the study. This reduction was the same for the two groups early in the study and reached a maximum at three months; a divergence was observed thereafter. For the placebo group, the loss reached a plateau up to the sixth month after which the BMD started to rise progressively remaining at 12.7% reduction at two years (p< 0.002). In the ALN group, there was no plateau, BMD increased directly to reach 6.9% bone loss at two years (p< 0.003). Discussion:The use of Alendronate enabled a significant reduction of periprosthetic bone loss at two years post-op. Our results are the first to our knowledge demonstrating a beneficial effect in vivo of the use of Alen-dronate on bone behaviour around cemented total hip arthroplasties. Conclusion: Taking into account the short follow-up in this series, and its small size, other studies are indispensable to confirm this beneficial effect in vivo. The action of Alendronate could facilitate revision surgery by preserving bone stock

Purpose of the study: This retrospective analysis compared surgical treatments of femoral neck fractures in patients aged over 80 years. Material and methods: Two hundred femoral neck fractures (Garden 3 and 4) were treated in three different manners: total prosthesis with a retaining cup (74 patients), intermediary prosthesis (58 patients), and osteosynthesis (68 patients). Indications were the same, but the periods of treatment were successive. Study variables were: mortality, number of revisions, duration of hospital stay, discharge to home or rehabilitation center, cost per hospital day. Follow-up was at least two years. The chi-square test was applied with p< 0.05. Results: Mortality was similar for the three groups: eight deaths during stay in orthopedic unit (4%), three after total prosthesis (4%), three after osteosynthesis (5%) and two after intermediary prosthesis (3%). The difference was nonsignificant (p=0.24). Among the total prostheses, five dislocations (6.7%) required anesthesia despite the retaining cup. The rate of dislocation was 12% for intermediary prostheses and to avoid recurrence four revisions were needed to totalize an intermediary prosthesis with a retaining cup. Among the osteosynthesis cases, the rate of revision was 25%; transformation to a total prosthesis was necessary for 17% and material removal with resection of the head and neck was necessary in 8%. One total prosthesis and one intermediary prosthesis had to be removed because of infection. Resection of the head and neck for infection also occurred in one patient with an intermediary prosthesis. The rate of revision for an orthopedic problem was significantly less (p< 0.01) in the total prosthesis group. At last follow-up, or before death, patients with a total prosthesis were more independent and returned to their home significantly more often than patients treated with osteosynthesis. The economic cost of these interventions were not significantly different, the cost of the implant being insignificant compared with the cost of hospitalization and reeducation of this very elderly population. Discussion: Total hip arthroplasty is a recognized treatment for painful degenerative hip disease. Historically, the total prosthesis was not considered as a first-intention treatment for fractures of the femoral neck in elderly subjects due to the risk of intraoperative blood loss, the risk of infection, and the risk of dislocation if a hip stabilization mechanism was not applied. This study demonstrated that, in light of the complications observed with the other methods, progress in anesthesia and use of implants avoiding dislocation can be proposed as first-intention treatment for total prosthesis patients who suffer a fracture of the femoral neck