Continued controversy exists between cemented versus uncemented hemiarthroplasty for an intracapsular hip fracture. To assist in resolving this controversy, 400 patients were randomised between a cemented polished tapered stem hemiarthroplasty and an uncemented Furlong hydroxyapatite coated hemiarthroplasty. Follow-up was by a nurse blinded to the implant used for up to three years from surgery. Results indicate no difference in the pain scores between implants but a tendency to an improved regain of mobility for those treated with the cemented arthroplasty (1.2 score versus 1.7 at 6 months, p=0.03). There was no difference in early mortality but a tendency to a higher later mortality for the uncemented implants (29% versus 24% at one year, p=0.3). Later peri-prosthetic fracture was more common in the uncemented group (3% versus 1.5%). Revision arthroplasty was required for 2% of cemented cases and 3% of uncemented cases. Surgery for an uncemented hemiarthroplasty was 5 minutes shorter but these patients were more likely to need a blood transfusion (14% versus 7%). Three patients in the cemented group had a major adverse reaction to bone cement leading to their death. These results indicated that a cemented stem hemiarthroplasty give marginally improved regain of mobility in comparison to a contemporary uncemented hemiarthroplasty. An uncemented hemiarthroplasty still has a place for those considered to be at a high risk of bone cement implantation syndrome

Introduction. The longevity of total hip replacements in young active patients is a cause for concern as increased cyclical loading can result in early loosening of implants resulting in multiple revisions during the patient's lifetime. The study presented demonstrates excellent survival of the HAC-coated femoral stems in young active individuals. Patients/Materials & Methods. 33 Patients under 50 years of age underwent 38 total hip arthroplasties using the JRI Furlong HAC-coated femoral stem. The retrospective evaluation of the prospectively collected data of the cohort at 17 to 25 years is presented. Results. Of the surviving 34 arthroplasties, 1 hip underwent revision of the stem for peri-prosthetic fracture after 21 years and 1 patient was lost to follow-up. Using aseptic loosening as the end-point, 12 hips (31.5%) needed acetabular revisions but none needed revision of the femoral stem demonstrating 100% survival at a mean of 21 years (95% confidence interval 89% to 100%). Discussion. The excellent survival of the femoral stems can be attributed to various factors. The HAC-coating is present throughout the length of the Furlong stem resulting in bonding along the entirety of the implant. This, further supplemented by the modulus of elasticity of titanium helps the whole proximal femur to function as one unit minimizing the impact of varus or valgus mal-positioning. Furthermore, following osteo-integration, a sealing effect is created in the proximal femur preventing distal migration of the wear particles, which are known to cause osteolysis. The 12 patients that needed revisions for aseptic loosening in our study were confined to the acetabular side. This is a lesser invasive procedure compared to extraction and reconstruction of femoral stems. Conclusion. In young patients with high demands, the Furlong HAC–coated femoral stem gives excellent long-term results

Background: Total Hip Replacements in younger active patients continues to pose a major challenge. Surface replacement techniques, designed to preserve bone stock do not yet have proven long term results. Early cemented designs in this population had high failure rates. Concept of fixation of total hip prosthesis by bony in-growth rather than by cement is an attempt to decrease the incidence of loosening. Ceramic joint surfaces produce minimal wear debris. Objectives: A medium term follow-up of clinical and radiological results of the JRI Furlong hydroxyapatite coated prosthesis with ceramic bearing surfaces in young active patients. Methods: A retrospective analysis of 43 JRI Furlong Hip Replacements (mean age 32 Yrs) in 33 patients is presented. The minimum follow-up was 60 months. Functional assessment was done using the Harris Hip Score. Radiolucency around the femoral stem according to Gruen (zone 1-7) and the acetabulum as described by Charnly and De Lee (zone 1–3) is documented. A fully coated femoral component along with the press –fit HA coated CSF cup with a 28mm ceramic insert was used. All cups were routinely augmented with screws. Results: The mean Harris Hip score was 90 (46–96). 4 patients had a score less than 80. 84.2% were completely pain free. Acetabular radioleucencies were noted in 32 hips (72 %).28 cups had radiolucent lines (RLL) in zone 2, 2 cups in zone 1 and 1 cup in zone 3. In 10 patients (23%) the lucent area measured > 2mm at the cup bone interface. No hips had RLL in more than two zones. 4 stems had RLL > 2 mm involving the Gruen zone 7. 90 % showed a distinct osteoblastic reaction at the tip of the femoral component. There was no calcar resorption, endosteal cavitation or ectopic ossification. There were no instances of ceramic fractures and no hips were revised. Discussion: The JRI Furlong hip gives good functional results in young patients in the medium term. Although of concern, there was no co-relation between the presence of acetabular RLL and functional outcome. The RLLs were not thought to be progressive. The RLLs can be explained by backside wear or by fretting of the screws by the ceramic liner. Long term follow up of the CSF cup will be required to determine if these radio-lucent lines are an early sign of failure at the interface or whether they simply represent stable in- growth of fibrous tissue in this highly stressed region

Objective. In many institutions, serial casting and splinting requires many weeks of treatment and frequently results in surgery. This study evaluated the results of neonatal clubfoot correction with the Furlong method. This method was created by Furlong M.B. and Lawn G.W. in New York and was published in Archives of Pediatrics in 1960. Materials and Methods. This study reviews 95 neonates with 128 severe clubfeet (initial Pirani score 4,0 or more). Patients with arthrogrypotic clubfeet and other syndromes were not included. Age at presentation ranged from 4 hours to 18 days. All patients had no previous treatment. The cast application with extra space above the foot was performed as follows: a special elastic pad was placed on the dorsal aspect of the foot and fixed with a cotton bandage. Then plaster cast was applied with knee flexion 110–120 degrees. After the cast was set, the elastic pad was removed, leaving a reserve space on the dorsal aspect of the foot. The cast was changed every 3–7 days. Typical corrective maneures were performed. Foot displacement into dorsiflexion occured spontaneously as an active motion and also with manipulations. Abduction braces or knee-flexed splints were applied after the complete foot correction. Pirani score and foot dorsiflexion angle were documented during each step of correction. Results. A detailed rating system (with radiologic criteria) was used for result evaluatiion. Correction was successful in all but 5 patients. 90 % required less than 6 casts. There were 12 recurrences and they were related with compliance with the abduction brace, but not with age or number of casts required for correction. Only 13 patients required surgery (6 posterior releases, 6 posteromedial releases and 1 complete subtalar release). Mean follow-up was 12 years. 23% of feet were evaluated as excellent, 71 %- as good and 6%- as poor results. Conclusion. The Furlong method is succesful in obtaining initial correction in the idiopathic clubfoot patient. This method corrects the neonatal congenital clubfoot in 85% without any surgery

We followed up 82 patients who under went 92 Furlong Hydroxyapatite coated uncemented femoral stem, and threaded acetabular component. All hips had a 28mm ceramic heads. These hips were inserted between the periods 1989–1992. The mean age of the patients at the time of surgery was 54(31–67). At the ten year follow up there were 64 patients with 70 hips. 5 hips were revised. 3 for acetabular component loosening, 2 for infection. 8 patients died from unrelated causes, 3 refused to attend but filled in the Oxford hip score by mail, 2 were lost to follow up. At 10 years follow-up the mean age was 64(41–77) years. The Oxford, and the Harris hip scores were used to Asses the patients clinically, and a standard AP pelvis X-Ray showing both hips was performed. Clinically we found that the mean Harris hip score was 90 (51 – 100), the mean Oxford hip score 20 (12 – 45). Radiographic assessment showed good component fixation with uniform bone growth around the components. The average angle of the Acetabular component was 52 (40– 60). 21 hips showed polyethylene wear in the acetabular component, 5 had more than 2mm wear, and 1 had more than 3mm of poly wear. 36 (52%) of the hips showed proximal calcar remodelling. We conclude that the Furlong HA coated THR is an excellent THR for the young patient who has a higher activity demand with a cumulative survival rate of 94.29% (CI ±5.2)

We followed up 83 patients who under went 92 Furlong Hydroxyapatite coated femoral stem, threaded acetabular component, and 28mm ceramic heads. These hips were inserted between the periods 1989–1992 The Average age of the patients at the time of surgery was 54 years with an age range 31–67. And were followed up at 5,7,10 years respectively. At the ten year follow up there were 64 patients with 70 hips. 5 hips were revised. 3 for acetabular component loosening, 2 for infection. 8 died from unrelated causes, 3 refused to attend but filled in the Oxford hip score by mail, 2 were lost to follow up. At the time of follow-up the average age was 64 years with an age range ( 41 – 77). The Oxford, and the Harris hip scores were used to Asses the patients clinically, and a standard AP pelvis X-Ray showing both hips was performed. Clinically we found. The average Harris hip score 90 ( 51 – 100), the average Oxford hip score 20 ( 12 – 45 ). Radiographic assessment showed good component fixation with uniform bone growth around the components. The average angle of the Acetabular component was 52 ( 40– 60 ). 4 cups showed loose zones mainly in zone1. 21 hips showed polyethylene wear 6 had more than 2.5 mm wear. 52% of the hips showed proximal calcar remodelling, only 7 stems showed loose zones mainly in zone 1. We conclude that the Furlong HA coated THR is an excellent THR for the young patient who has a higher activity demand with a survival rate of 93.9% excluding deaths and patients who refused to attend at ten years follow up

Introduction: There are more than 60 different hip prostheses currently available for total hip replacement (THR). Cemented prostheses make up about 90 to 95% of current total UK market. The cost of THR prosthesis varies widely with some prostheses cost 5 times more than others. Furlong Stainless steel cemented is a low-cost prosthesis that has been used in few hospitals in UK and Europe. There is no published data to report its survival and performance. Aim: To evaluate the outcome of a low-cost THR prosthesis (Furlong stainless steel) that has been in use in our hospital since 1993. Patients and Methods: we retrospectively reviewed 142 THR performed between 1993 and 2001. The average age was 72 and osteoarthritis was the primary pathology in 92%. Operations were performed by different grades of surgeons. 25 patients were dead at the time of the study. Results: 4 cases underwent revision (2.8%) with survival rate of 97.2%. 6 cases of dislocation, 17 cases of heterotopic calcifications, 5 cases of DVT and one neurological injury. 88% reported no pain and 79.6% were satisfied. Conclusions: The results of this study compare favourably with Furlong Titanium cemented prosthesis and other popular THR prostheses (e.g. Charnley). It is rational to continue using this prosthesis, which appears to be cost effective

Since 1986 the JRI Furlong hydroxyapatite coated femoral stem has been in use at our institution. We present the results of the first 100 hips performed on 86 patients by or under the direct supervision of one surgeon (JANS). The Furlong stem was used in conjunction with a ceramic head and CCI cemented UHDP cup. AT the time of surgery the mean age of the patients was 69 (range 45–94 years). One patient has undergone excision arthroplasty for suspected infection at which time the femoral component was found to be well bonded. At latest review, all patients were accounted for. 48 patients had died with no death directly related to surgery and no revisions or planned revision of the femoral component at the time of death. Of the 38 surviving patients (44 hips), the mean Merle d’Aubigné & Postel score was 5.8 for pain, 5.7 for movement and 4.9 for function at 13 to 16.5 years follow up (mean 14.0). No femoral component showed radiological evidence of loosening. Five acetabular components have been revised for aseptic loosening with the femoral component found to be well bonded at the time of revision and therefore left in situ. In this series of hydroxyapatite coated femoral stems the overall revision rate is 1% with no cases of aseptic loosening. This hydroxyapatite coated prosthesis, at long term follow up has superior survival figures to other types of femoral components

Cementless total hip replacements (THR) have a theoretical advantage over cemented designs in that bone lysis and probably aseptic loosening are less common complications. NICE guidelines suggest that prosthesis should have an aseptic loosening rate of < 10% at 10 years. Long-term follow-up of the Joint Replacement Instrumentation (JRI) Hydroxyapatite coated (HAC) Furlong system is gradually emerging following its first clinical application in 1985. A retrospective study was performed to identify all patients having undergone a primary JRI HAC THR under a single Consultant at Barnsley Foundation Hospital NHS Trust between 1985 and 1995. This identified 124 joints in 106 patients (52% males). All living patients were sent a modified Oxford Hip Score questionnaire; case notes were also reviewed to identify any revision surgeries. Median age at operation was 54.0 years. 17 patients (16%) had died at the time of this study. Median follow-up was 13.7 years (range 9.4–18.5 years). For 30 patients (24.2%) it was impossible to gather data on the survival of the hip. Mean survival of all hips followed up was 16.2 years. Twenty-four hips (19.4%) required revision surgery; the median time to this surgery was 10.2 years, mean 8.2 years. Reasons included aseptic loosening of the stem in one patient at 12.7 years, aseptic loosening of the cup in 7 patients (range 10.2–17.4 years), worn polythene insert in 4 patients, infective loosening in 3 patients and recurrent dislocations in 2 patients. The remainder of revisions were for unknown reasons. The Oxford Hip Score postal questionnaire was returned by 79% of patients. Mean score was 12.6/45 but 88% of patients reported overall satisfaction with the hip. In summary, there were no revision surgeries at ten-year follow-up for aseptic loosening

Aims. 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. Methods. We describe the survival, radiological, and functional outcomes of 33 patients (38 THAs) at a mean follow-up of 27 years (25 to 32) between 1988 and 2018. Results. Of the surviving 30 patients (34 THAs), there were four periprosthetic fractures: one underwent femoral revision after 21 years, two had surgical fixation as the stem was deemed stable, and one was treated nonoperatively due to the patient’s comorbidities. The periprosthetic fracture patients showed radiological evidence of change in bone stock around the femoral stem, which may have contributed to the fractures; this was reflected in change of the canal flare index at the proximal femur. Two patients (two hips) were lost to follow-up. Using aseptic loosening as the endpoint, 16 patients (18 hips; 48%) needed acetabular revision. None of the femoral components were revised for aseptic loosening, demonstrating 100% survival. The estimate of the cumulative proportion surviving for revisions due to any cause was 0.97 (standard error 0.03). Conclusion. In young patients with high demands, the Furlong HAC-coated femoral component gives excellent long-term results. Cite this article: Bone Jt Open 2024;5(4):286–293

Introduction. Primary mechanical stability is important with uncemented THR because early migration is reduced, leading to more rapid osseointegration between the implant and bone. Such primary mechanical stability is provided by the design features of the device. The aim of this study was to compare the migration patterns of two uncemented hip stems, the Furlong Active and the Furlong HAC stem; the study was designed as a randomised control trial. The implants were the Furlong HAC, which is an established implant with good long term results, and the Furlong Active, which is a modified version of the Furlong HAC designed to minimise stress concentrations between the implant and bone, and thus to improve fixation. Materials and methods. The migration of 43 uncemented femoral components for total hip replacement was measured in a randomised control trial using Roentgen Stereophotogrammetric Analysis (RSA) over two years. Twenty-three Furlong HAC and twenty Furlong Active stems were implanted into 43 patients. RSA examinations were carried out post-operatively, and at six months, 12 months and 24 months post-operatively. The patients stood in-front of a purpose made calibration frame which contained accurately positioned radio-opaque markers. From the obtained images, the 3-D positions of the prosthesis and the host bone were reconstructed. Geometrical algorithms were used to identify the components of the implant. These algorithms allowed the femoral component to be studied without the need to attach markers to the prosthesis. The migration was calculated relative to the femoral coordinate system representing the anterior-posterior (A-P), medial-lateral (M-L) and proximal-distal (P-D) directions respectively. Distal migration was termed subsidence. Results. Both stems subsided significantly during the first six months following surgery but almost all stems did not progressively subside thereafter. The Furlong Active stem experienced approximately three times the amount of subsidence of the Furlong HAC stem; this difference was significant (p = 0.02). There was one subsidence outlier (four standard deviations from the mean) for the Furlong Active stem between one and two years post-operatively. Both the stems migrated laterally and rotated into valgus. Lateral migration was greater for the Furlong Active stem; at 12 and 24 months there was a significant migration of the Furlong Active head laterally of 0.51 mm (p = 0.012) and 0.58 mm (p = 0.013) respectively. There was no significant difference in clinical scores between the implants at any RSA examination post-operatively. Discussion. The initial fixation of the Furlong Active stem was not as good as the established stem making it less likely to integrate effectively with the bone. In this study, the theoretical design of a hip replacement to minimise the stress concentration between the implant and bone and thus improve fixation actually resulted in worse implant fixation. Stems designed theoretically to improve fixation may not achieve this. Therefore we recommend that new devices should be tested using Roentgen Stereophotogrammetric Analysis. Acknowledgments This work was funded by the Furlong Charitable Research Foundation

INTRODUCTION: This prospective randomized study investigated short-term outcomes of cemented vs. HA-coated hip arthroplasty in elderly osteoporotic patients with femoral neck fractures. METHODS: Forty consecutive patients with femoral neck fractures (AO/OTA fracture type B2 and B3) were randomized to receive either an AHS prosthesis (Group A, n = 22, cemented implant) or a Furlong prosthesis (Group B, n = 18, HA-coated implant). Inclusion criteria were: female age ≥75, fracture resulting from minor trauma, ability to communicate and bone mineral density (BMD) T-score at the contralateral hip lower than −2.5 SD. Subjective assessment was evaluated according to a rating system 0-(unsatisfactory) to 10(satisfactory). Average follow-up was 29 months for Group A and 27 months for Group B. RESULTS: Average patient age was 75 ± 5 in both groups. There were no differences in ASA scores between the two groups. Surgical time was 77 ± 12 minutes for Group A, and 72 ± 13 minutes for Group B (ns). Harris hip score was 46 ± 36 in Group A and 62 ± 33 in Group B. (p < 0.05). SF-36 was 35 ± 32 in Group A and 54 ± 32 in Group B (ns). Subjective assessment was 5 ± 4 in Group A and 7 ± 3 in Group B (ns). The incidence of death during the follow-up period was 33% in Group A and 15% in Group B. (p < 0.05). One Group A patient underwent revision due to implant loosening. A Furlong prosthesis was successfully implanted in this patient. DISCUSSION: Although femoral neck fractures in elderly osteoporotic patients are usually treated with cemented arthroplasty, our comparative study showed better results with the Furlong prosthesis, even if statistical significance was reached in only two parameters. The outcomes obtained with the Furlong prosthesis are due to the ability of the HA-coating to bind with osteoporotic bone, thus establishing a stable fixation. Fixation failed in only one cemented implant, but our case number was limited and the follow-up short. Post-op mortality at the time of follow-up was high. This was not unexpected, given the age level and health status of the study groups. This study shows that the HA-coated Furlong prosthesis is a viable option for the treatment of elderly osteoporotic femoral neck fracture patients

Introduction: The benefits of total hip replacement in patients with juvenile idiopathic arthritis are well documented. However only few results of uncemented total replacement with subsequent problems of loosening and revision surgery have been published. We report a minimum 2 year follow-up of uncemented total hip replacement in this group of patients. Material s& Methods: Between 1995 and 2003, 56 patients under the age of 29 years underwent 81 uncemented total hip replacements. 41 were females and 15 were males.1 patient died and 1 lost for follow -up. The average length of follow up was 6 years (range 2 to 10 yrs). In 67% of the patients the follow up period was 5 yrs or longer. The average age of onset of the disease was 5 yrs (range 1 to 19 yrs). The mean age at surgery was 18 yrs (range 11 to 29 yrs). Both hips were involved in 25 patients of which 18 were women and 7 were men. The mean interval between the onset of arthritis and surgery was 11 yrs. The mean interval between symptoms of hip involvement and hip replacement was 4.7 yrs. In 49% of patients the onset of arthritis was systemic, 22.6% polyarticular, 15.09% pauciarticular and 13.21% seronegative. Prior soft tissue release was performed in 6 hips(4).2 patients had previous supra-condylar femoral osteotomy for deformity correction.2 patients had total knee replacements(bilateral 1, unilateral 1). Usually a posterior approach was employed. A variety of prosthesis were used, Furlong HAC stem in 40 patients, SROM in 23 patients and CAD CAM in 17 patients. On the acetabular side, Furlong CSFHDP in 31 patients, Furlong ceramic in 15 patients, SROM cup in 21 patients, Duraloc cup in 9 patients and Muller support ring in 4 patients. The hips were graded before surgery and at follow-up using the scoring system of the Hospital for Special Surgery (Salvati and Wilson 1973). Results: The mean improvement of HSS score for pain, ROM, mobility and function are 6.3, 3.1, 3.5 and 4.1 respectively. There was a mean improvement of 17.0 in the total HSS score. One patient had subsidence of both the CAD CAM stems at present waiting for revision. Radiolucent zones around the proximal sleeve SROM stem was noted in one patient requiring stem revision. Stress shielding of calcar was noted in 3 patients (CAD CAM 2, Furlong 1) and osteolysis around the cup in 1 patient. All patients with Furlong stem had very good osseointegration and there was no need of any revision. All patients with SROM stems also had very good osseointegration except one for which stem revision was done. Conclusion: This study shows a lower revision rate and better radiographic appearance compared to previous reports with similar follow up of THA in Juvenile Idiopathic Arthritis

We describe the clinical and radiological results of 38 total hip replacements (THR) using the JRI Furlong hydroxyapatite-ceramic (HAC) – coated femoral component in patients younger than 50 years. The mean age at the time of operation was 42 years and the mean length of follow-up was ten years. All patients receiving a Furlong HAC THR were entered into the study regardless of the primary pathology including patients who had undergone previous hip surgery. The mean Harris hip sc ore improved from 44 before operation to 92 at the last post-operative review. After 12 years the cumulative survival for the stem was 100%. No femoral component was revised. Our results show that the Furlong HAC implant gives excellent long-term results in young patients with high demands

Introduction. The ideal method of fixation for femoral components in total hip arthroplasty (THA) is unknown. While good results have been reported for cemented and uncemented components, there is relatively little published prospective data with twenty years or more of follow up. Results of the Furlong femoral component have been presented at an average of 17 years follow up. We have extended this follow up period to an average of 22.5 years with a minimum of 22 years and a maximum of 25 years. Methods. This study included all patients treated using the Furlong femoral component between 1986 and 1991. Patients were reviewed preoperatively and then at 6, 12, 26 and 52 weeks post operatively and annually thereafter. They were assessed clinically and radiographically and the Merle d'Aubigne Postel hip score was calculated at each visit. A Visual Analog Score (VAS) was also recorded to assess patient satisfaction with their procedure. A Kaplan Meier survival analysis was performed. Results. Sixty patients (72 hips) were included (15 males, 45 females). Bilateral procedures were performed in 12 patients. Mean age was 82.9 years (70 to 100 years). Mean follow-up was 22.5 years (20 to 25). The Merle d'Aubigne Postel hip score at final follow up was 5.5 (pain), 3.8 (mobility) and 3.3 (function) for function. Seven patients required revision surgery. Survival of the femoral component with revision for any reason as the end point was 90.3%. There were no planned revisions up to the time of final follow up. Conclusion. The Furlong prosthesis results in improvement of pain in the long term. Survival of this component is comparable to the best results for primary THA with any means of fixation

The optimum design for the femoral component for cementless Total Hip Replacement is not known. We conducted an ethically approved, randomised and prospective trial to compare two radically different designs of fully hydroxyapatite (HA) coated femoral stems. We compared the original JRI Furlong stem with the Wright Anca fit stem which is more anatomical in design. The paper discusses the merits and disadvantages of these two stems. The same acetabular component was used in both samples. The only variable was the stem shape. All patients placed on the senior author's waiting list for primary THR were asked if they would enter the trial. There were no restrictions for selection to the sample. Patients were then randomised for one of the two stems. All surgery was performed by or under the direct supervision of the senior author. The periprosthetic and perioperative fracture rates for the two stems were found to be significantly different at three years into the study and the trial was stopped. 337 patients had been entered into the trial, 211 females and 126 males. 191 patients had the JRI furlong hip implanted (57%) and 146 are in the Anca sample (43%). The number of perioperative fractures in the Furlong group was 13 (6.8%)and in the Anca sample 22 (15.1%). This is statistically significant. The possible reasons for this difference are discussed. Anatomical fit cementless stems require a more careful technique to avoid fracture during implantation and the shorter stemmed Anca hip proved less stable in the presence of a fracture necessitating further surgical intervention. It is still not certain whether the anatomical shape has long term advantages that may outweigh this initial disadvantage and the cohort of patients continues to be followed up

The optimum design for the femoral component for cementless Total Hip Replacement is not known. We conducted an ethically approved, randomized and prospective trial to compare two radically different designs of fully hydroxyapatite(HA) coated femoral stems. We compared the original JRI Furlong stem with the Wright Anca fit stem which is more anatomical in design. The paper discusses the merits and disadvantages of these two stems. The same acetabular component was used in both samples. The only variable was the stem shape. All patients placed on the senior authors’ waiting list for primary THR were asked if they would enter the trial. There were no restrictions for selection to the sample. Patients were then randomised for one of the two stems. The surgery was undertaken by one surgeon, in one centre, in matched patients and using the same well-tried CSF acetabular cup and bearings. 335 patients had been entered into the trial, 228 females and 126 males. 191 patients had the JRI furlong hip implanted (57%) and 146 are in the Anca sample (43%). The number of perioperative fractures in the Furlong group was 13(6.8%)and in the Anca sample 22 (15.3%). The periprosthetic and perioperative fracture rates for the two stems were found to be significantly different at three years into the study and the trial was stopped. The possible reasons for this difference are discussed

Introduction: We report the results of activity and functional outcome of matched pair analysis comparing hip resurfacing with total hip replacement with a minimum follow up of 22 months. Materials and Methods: 14 matched pairs were selected in terms of age (within 4 years), sex and diagnosis, of which 10 pairs were females and 4 pairs were males The mean age was 49.7(19 – 63). The Birmingham hip resurfacing was used in all patients in the resurfacing group and the Furlong HAC stem in all cases in the THR group with the CSF cup in most cases. The mean follow up in BHR group was 5.2 years (1.7 – 9.2) and 2.4 years (1.8 – 3.6) in THR group. Functional outcome was measured using Harris Hip score, WOMAC, SF 36 and the UCLA and Tegner activity scores. Results: The mean Harris Hip score, SF 36, WOMAC, UCLA and Tegner activity scores in the BHR group were 86.8, 77.3,49.7, 6.1 and 3.6 respectively. In the Furlong group the Harris Hip score, SF36, WOMAC, UCLA and Tegner activity scores were 82.9, 79.0,29.5, 5.6 and 3.2 respectively. There was no statistical difference in the mean scores between the two groups. With regard to functional activity, 21% of patients in both the groups scored 8 or more on the UCLA activity scale. 21% of patients in the BHR and 14% in the Furlong group scored 3 or more on the Tegner activity scale. Conclusion: In our study, hip resurfacing was not associated with a significant increase in activity level or functional outcome compared with total hip replacement

The optimum design for the femoral component for cementless Total Hip Replacement is not known. We conducted an ethically approved, randomized and prospective trial to compare two radically different designs of fully hydroxyapatite (HA) coated femoral stems. We compared the original JRI Furlong stem with the Wright Anca fit stem which is more anatomical in design. The paper discusses the merits and disadvantages of these two stems. The same acetabular component was used in both samples. The only variable was the stem shape. All patients placed on the senior authors’ waiting list for primary THR were asked if they would enter the trial. There were no restrictions for selection to the sample. Patients were then randomised for one of the two stems. All surgery was performed by or under the direct supervision of the senior author in one center. The surgical approach to the hip, Hardinge antero lateral, was the same in all cases. In all cases the same well-tried JRI CSF acetabular cup and bearings were used. Patients were x-rayed post operatively and reviewed and x-rayed at six weeks and then yearly. 360 patients had been entered into the trial, 219 females and 141 males. 203 patients had the JRI furlong hip implanted (56%) and 157 were in the Anca sample (44%). The periprosthetic and perioperative fracture rates for the two stems were found to be significantly different at three years into the study and the trial was stopped. The number of perioperative fractures in the Furlong group was 17(8.4%)and in the Anca sample 24 (15.3%). This is statistically significant. The possible reasons for this difference are discussed. Anatomical fit and wedge shaped cementless stems require a more careful technique to avoid fracture during implantation and the shorter stemmed Anca hip proved less stable in the presence of a fracture necessitating further surgical intervention. It is still not certain whether the anatomical shape has long term advantages that may outweigh this initial disadvantage and the cohort of patients continue to be followed up

Introduction. Dislocated hip hemiarthroplasties (HA) are associated with a 45% revision rate and 40% mortality rate. Implant selection for HA operations vary with no universally accepted implant choice. The WHiTE3 trial suggested older designs such as the Thompson has equitable outcomes to more modern and expensive implants such as the Exeter V40+Unitrax. Our multi-centre consecutive series of NOFs patients treated with HA assesses the impact of surgical and patient factors on dislocation risk. Methods. Medical and radiographic records for patients treated between 1. st. January 2009 and 30. th. September 2017 with a HA at three acute hospitals were reviewed. Implant and dislocation data were recorded. Patient demographics, comorbidities and operation details were extracted from the medical records and NHFD. Patients were excluded if there were no postoperative radiographs or when HA had been performed as a revision procedure. Results. We identified 4305 consecutive patients with 189 excluded. There was no difference in patient characteristics between the hospitals or implant types (p>0.05). Four HA implants were used during the study period; Thompson, Austin-Moore, Furlong and Exeter V40+Unitrax. 63 dislocations were identified (1.5%), median time to dislocation was 24 days. Dislocation rates for Thompson HAs were significantly higher (p=0.004) at 3.7%. No association was demonstrated with cemented versus uncemented, bipolar versus monopolar, fixed versus variable offsets, operating surgeon grade and dislocation rates (p>0.05). Patient factors (preoperative AMTS, postoperative AMTS, preoperative mobility and ASA grade) had no effect on dislocation (p>0.05). Discussion. Our study which is reflective current implant choices, demonstrates that Thompson implants for HA after NOFs have a significantly higher dislocation rates than other common prostheses, and their continued use should be reconsidered. This effect has not been demonstrated in previous studies. Patient, implant construct and surgeon factors had little bearing on the subsequent dislocation rate