Postoperative dislocation following total hip arthroplasty (THA) remains a significant concern with a reported incidence of 1% to 10%. The risk of dislocation is multifactorial and includes both surgeon-related (i.e. implant position, component size, surgical approach) and patient-related factors (i.e. gender, age, preoperative diagnosis, neurologic disorders). While the majority of prior investigations have focused on the importance of acetabular component positioning, recent studies have shown that approximately 60% of “dislocators” following primary THA have an acceptably aligned acetabular component. Therefore, the importance of the relationship between the spine and pelvis, and its impact on functional component position has gained increased attention.

Kanawade and Dorr et al. have shown patients can be categorised into having a stiff, normal, or hypermobile pelvis based on their change in pelvic tilt when moving from the standing to seated position. The degree of change in functional position of both the acetabular and femoral components is impacted by the degree of pelvic motion each patient possesses. In the “normal” pelvis, as a patient moves from the standing to seated position the pelvis typically tilts posteriorly, thus increasing the functional anteversion of the acetabular component. However, patients with lumbar degeneration or spine pathology often have a decrease in posterior pelvic tilt in the seated position, thus potentially increasing their risk of dislocation. Bedard et al. noted an 8.3% dislocation risk in patients with a spinopelvic fusion after THA vs. 2.9% in those without.

There is the potential that preoperative, dynamic imaging can be used to predict the ideal component position for each individual patient undergoing THA. However, this assumes that a patient's preoperative pelvic motion will be the same following implantation of a total hip prosthesis, and that a patient's pelvic motion will remain consistent over time postoperatively. A recent study has shown that the impact of THA on pelvic motion can be highly variable, thus potentially limiting the utility of preoperative dynamic imaging in predicting a patient's ideal component position. Future investigations must focus on preoperative factors that can be used to predict postoperative pelvic motion and how pelvic motion changes over time following implantation of a total hip arthroplasty.

Cite this article: Bone Joint Res 2023;12(5):306–308.

Hip resurfacing arthroplasty is a technically challenging procedure, and orientation of the femoral component is critical to avoid implant failure. Recently, numerous articles have shown that the use of computer-assisted navigation decreases the learning curve for beginners in hip resurfacing and to improve the surgeon’s ability to produce consistent results. The purpose of this study was to evaluate the learning curve of computer-assisted navigation in the hands of an experienced hip resurfacing surgeon.

This retrospective study was compromised of 100 metal-on-metal total hip resurfacings in 94 patients. The resurfacings were performed by a single fellowship-trained surgeon, with hip resurfacing experience of more than 250 hip resurfacings without navigation. Data collected included gender, age at the time of surgery, BMI, operative time, postoperative complications, and digital planning. Standard nteroposterior (AP) radiographs taken in the preoperative and postoperative period were evaluated to measure neck-shaft and stem-shaft angles, respectively. There were 24 females and 70 males, who had a mean age of 49 years (range, 19 to 68 years). The 100 hips were arranged chronologically by operative date and broken down into four groups of 25. Data also was gathered on 25 non-navigated hip resurfacings to serve as a matching group.

There were no significant differences found between the four groups and matching groups with respect to patient variables, including age, BMI, or gender. There were also no significant differences found among the groups with respect to OR time (p = 0.565). The mean OR time for all 100 navigated hips was 101 minutes, compared to a mean of 104 minutes for the matching group (p = 0.924). Using linear regression analysis, the only variable that was found to influence OR time was BMI (p < 0.001). The mean actual stem-shaft angle (SSA) of the groups became more valgus over time, with group 1 having an SSA of 139; group 2, an SSA of 140; group 3, an SSA of 142; and group 4, an SSA of 144. Compared to the preoperative neck-shaft angle, the postoperative stem-shaft angle for 89% of the femoral components was inserted in a valgus position, with 96% of those in group 4 being inserted in a valgus position. The matching non-navigated group had only 80% of the cases with the stem-shaft angle inserted in valgus.

The data presented here demonstrates that providing an imageless computer-assisted navigation system to an experienced hip resurfacing surgeon offered the benefits of navigated surgery including increased accuracy, with no learning curve effect. Computer-assisted navigation can help the learning curve of a technically demanding procedure in inexperienced surgeons, as described by the literature, while placing real-time feedback and consistent repeatability into the hands of an experienced surgeon.

Musculoskeletal disorders have been recognised as common occupational risks for all orthopaedic surgeons. The nature of tasks performed by hip surgeons often requires both forceful and repetitive manoeuvres, potentially putting them at higher risk of musculoskeletal injuries compared to other orthopaedic sub-specialities. This study aimed to investigate the prevalence of musculoskeletal conditions among hip surgeons and evaluate the association between their workplace and lifestyle factors and musculoskeletal health. An online questionnaire consisting of 22 questions was distributed to UK-based consultant hip surgeons via email and social media platforms. This survey was completed by 105 hip surgeons. The mean age of the respondents was 49 years (range 35–69), with an average of 12 years (range 1–33) in service. 94% were full-time and 6% worked part-time. 49% worked at a district general hospital, 49% at a tertiary centre and 4% at a private institution. 80% were on the on-call rota and 69% had additional trauma commitments. 91% reported having one or more, 50% with three or more and 13% with five or more musculoskeletal conditions. 64% attributed their musculoskeletal condition to their profession. The most common musculoskeletal conditions were base of thumb arthritis (22%), subacromial impingement (20%), degenerative lumbar spine (18%) and medial or lateral epicondylitis (18%). 60% stated that they experienced lower back pain. Statistical analysis showed that being on the on-call rota was significantly (P<0.001) associated with a higher musculoskeletal burden. Regular resistance and/or endurance training and BMI<30 were statistically significant protective factors (P<0.001). Over the last few decades, most of the hip-related literature has focused on improving outcomes in patients, yet very little is known about the impact of hip surgery on the musculoskeletal health of hip surgeons. This study highlights a high prevalence of musculoskeletal conditions among UK-based hip surgeons. Hip surgeons have a pivotal role to play in the ongoing recovery of elective orthopaedics services. There is a pressing need for the identification of preventative measures and improvement in the surgical environment of our hip surgeons

Recent registry data from around the world has strongly suggested that using cemented hip hemiarthroplasty has lower revision rates compared to cementless hip hemiarthroplasty for acute femoral neck hip fractures. The adoption of using cemented hemiarthroplasty for hip fracture has been slow as many surgeons continue to use uncemented stems. One of the reasons is that surgeons feel more comfortable with uncemented hemiarthroplasty as they have used it routinely. The purpose of this study is to compare the difference in revision rates of cemented and cementless hemiarthroplasty and stratify the risk by surgeon experience. By using a surgeons annual volume of Total Hip Replacements performed as an indicator for surgeon experience. The Canadian Joint Replacement Registry Database was used to collect and compare the outcomes to report on the revision rates based on surgeon volume. This is a large Canadian Registry Study where 68447 patients were identified for having a hip hemiarthroplasty from 2012-2020. This is a retrospective cohort study, identifying patients that had cementless or cemented hip hemiarthroplasty. The surgeons who performed the procedures were linked to the procedure Total Hip Replacement. Individuals were categorized as experienced hip surgeons or not based on whether they performed 50 hip replacements a year. Identifying high volume surgeon (>50 cases/year) and low volume (<50 cases/year) surgeons. Hazard ratios adjusted for age and sex were performed for risk of revision over this 8-year span. A p-value <0.05 was deemed significant. For high volume surgeons, cementless fixation had a higher revision risk than cemented fixation, HR 1.29 (1.05-1.56), p=0.017. This pattern was similar for low volume surgeons, with cementless fixation having a higher revision risk than cemented fixation, HR 1.37 (1.11-1.70) p=0.004 We could not detect a difference in revision risk for cemented fixation between low volume and high volume surgeons; at 0-1.5 years the HR was 0.96 (0.72-1.28) p=0.786, and at 1.5+ years the HR was 1.61 (0.83-3.11) p=0.159. Similarly, we could not detect a difference in revision risk for cementless fixation between low volume and high volume surgeons, HR 1.11 (0.96-1.29) p=0.161. Using large registry data, cemented hip hemiarthroplasty has a significant lower revision rate than the use of cementless stems even when surgeons are stratified to high and low volume. Low volume surgeons who use uncemented prostheses have the highest rate of revision. The low volume hip surgeon who cements has a lower revision rate than the high volume cementless surgeon. The results of this study should help to guide surgeons that no matter the level of experience, using a cemented hip hemiarthroplasty for acute femoral neck fracture is the safest option. That high volume surgeons who perform cementless hemiarthroplasty are not immune to having revisions due to their technique. Increased training and education should be offered to surgeons to improve comfort when using this technique

Recent registry data from around the world has strongly suggested that using cemented hip hemiarthroplasty has lower revision rates compared to cementless hip hemiarthroplasty for acute femoral neck hip fractures. The adoption of using cemented hemiarthroplasty for hip fracture has been slow as many surgeons continue to use uncemented stems. One of the reasons is that surgeons feel more comfortable with uncemented hemiarthroplasty as they have used it routinely. The purpose of this study is to compare the difference in revision rates of cemented and cementless hemiarthroplasty and stratify the risk by surgeon experience. By using a surgeons annual volume of Total Hip Replacements performed as an indicator for surgeon experience. The Canadian Joint Replacement Registry Database was used to collect and compare the outcomes to report on the revision rates based on surgeon volume. This is a large Canadian Registry Study where 68447 patients were identified for having a hip hemiarthroplasty from 2012-2020. This is a retrospective cohort study, identifying patients that had cementless or cemented hip hemiarthroplasty. The surgeons who performed the procedures were linked to the procedure Total Hip Replacement. Individuals were categorized as experienced hip surgeons or not based on whether they performed 50 hip replacements a year. Identifying high volume surgeon (>50 cases/year) and low volume (<50 cases/year) surgeons. Hazard ratios adjusted for age and sex were performed for risk of revision over this 8-year span. A p-value <0.05 was deemed significant. For high volume surgeons, cementless fixation had a higher revision risk than cemented fixation, HR 1.29 (1.05-1.56), p=0.017. This pattern was similar for low volume surgeons, with cementless fixation having a higher revision risk than cemented fixation, HR 1.37 (1.11-1.70) p=0.004 We could not detect a difference in revision risk for cemented fixation between low volume and high volume surgeons; at 0-1.5 years the HR was 0.96 (0.72-1.28) p=0.786, and at 1.5+ years the HR was 1.61 (0.83-3.11) p=0.159. Similarly, we could not detect a difference in revision risk for cementless fixation between low volume and high volume surgeons, HR 1.11 (0.96-1.29) p=0.161. Using large registry data, cemented hip hemiarthroplasty has a significant lower revision rate than the use of cementless stems even when surgeons are stratified to high and low volume. Low volume surgeons who use uncemented prostheses have the highest rate of revision. The low volume hip surgeon who cements has a lower revision rate than the high volume cementless surgeon. The results of this study should help to guide surgeons that no matter the level of experience, using a cemented hip hemiarthroplasty for acute femoral neck fracture is the safest option. That high volume surgeons who perform cementless hemiarthroplasty are not immune to having revisions due to their technique. Increased training and education should be offered to surgeons to improve comfort when using this technique

Introduction. Acetabular component orientation is an important determinant of outcome following total hip arthroplasty (THA). Although surgeons aim to achieve optimal cup orientation, many studies demonstrate their inability to consistently achieve this. Factors that contribute are pelvic orientation and the surgeon's ability to correctly orient the cup at implantation. The goal of this study was to determine the accuracy with which surgeons can achieve cup orientation angles. Methods. In this in vitro study using a calibrated left and right sawbone hemipelvis model, participants (n=10) were asked to place a cup mounted on its introducer giving different targets. Measurements of cup orientation were made using a stereophotogrammetry protocol to measure radiographic inclination and operative anteversion (OA). A digital inclinometer was used to measure the intra-operative inclination (IOI) which is the angle of the cup introducer relative to the floor. First, the participant stated his or her preferred IOI and OA and positioned the cup accordingly. Second, the participant had to position the cup parallel to the anteversion of the transverse acetabular ligament (TAL). Third, the participant had to position the cup at IOI angles of 35°, 40° and 45°. Fourth, the participant used the mechanical alignment guide (45° of IOI and 30° of OA) to orient the cup. Each task was analysed separately and subgroup analysis included left versus right side and hip surgeons versus non-hip surgeons. Results. For the first task, hip surgeons preferred smaller IOI and larger OA than non-hip surgeons, but there was no significant difference in accuracy between both groups. When aiming for TAL, both surgeon groups performed similar, but accuracy on the non-dominant side was significantly better compared with the dominant side (mean deviation 0.6° SD 2.4 versus −2.6° SD 2.3) (p=0.004). When aiming for a specific IOI target of 35°, 40° or 45°, non-hip surgeons outperformed hip surgeons (mean deviation form target IOI 1.9° SD 2.7 versus −3.1° SD 3.8) (p<0.0001) with less variance (p=0.03). Contrary to version, accuracy on the dominant side was significantly better compared with the non-dominant side (mean deviation −0.4° SD 3.4 versus −2.1° SD 4.8). When using a mechanical guide, surgeons performed similar (0.6° SD 1.2 versus −0.4° SD 2.1 for inclination p=0.11 and −0.5° SD 2.6 versus −1.8° SD 3.3 for version p=0.22) and these values did not differ significantly from the actual IOI and OA of the mechanical guide. When using a mechanical guide, there was no difference in accuracy between the dominant and non-dominant side. Conclusion. There was no difference in accuracy between hip surgeons and non-hip surgeons when they aimed for their preferred IOI and OA or used a mechanical guide. When aiming for a specific IOI target, non-hip surgeons outperformed hip surgeons. Hip surgeons overestimate IOI and underestimate OA, presumably because this helps to achieve the desired radiographic cup orientation. Regarding accuracy, the non-dominant side was better for version and the dominant side for inclination. When aiming for a specific IOI and OA target, using a mechanical guide is significantly better than freehand cup orientation

Hypermobility Spectrum Disorder (HSD or hEDS) is attributed to a collagen abnormality associated with excessive joint flexibility. Approximately 90% of females with hip dysplasia have hypermobility. Manifestations of hypermobility in various body systems are unique to every patient, affecting different tissues of the body with varying degrees of severity. Our purposes were to identify the manifestations of hypermobility across multiple body systems and to study the recognition of hypermobility in the medical literature of multiple specialties over multiple decades. A literature search of the major medical disciplines for key words associated with HSD was performed. These specialties included gastroenterology, gynecology, neurology, psychiatry, oral-maxillofacial surgery, cardiology, and orthopaedic surgery. A specialty-specific impact factor (IF) score was calculated as the percentage of research articles that referenced hypermobility as a comorbidity over all articles within that specialty. Statistical differences were identified using single factor ANOVA with significance determined at p<0.05. We reviewed many published, specialty-specific manifestations of hypermobility, and describe them. All six non-orthopaedic specialties demonstrated a continually increasing relative IF ratio throughout the study period with a peak impact average of 0.22 (p<0.05 compared with other time ranges). There was a 93.3% overall increase in IF scores from the 1992–1998 period to the most recent period examined (p<0.05). Hypermobility is increasingly recognized as a significant health issue in multiple disciplines. Since dysplasia is associated with approximately 40% of all primary total hip arthroplasty cases, understanding the multi-system manifestations, and broad impact of hypermobility on patients, is relevant for every hip surgeon. We are expanding our research into other medical disciplines, including urology, ophthalmology, dermatology, clinical psychology, and others

The variables involved in a robotic THA can exceed 52: many parameters as pelvic orientation with CT scan, templating, offset, and leg-length, acetabular reaming, femoral osteotomy, mapping the anatomy; predefining safe zones, robotic execution, femoral head size, thickness of PE etc. with several variables for each parameter, with a total number of variables exceeding 52. This familiar number is the number of cards in a standard deck. The number of possible combinations (factorial 52! = 10^67) to shuffle the cards (and may be to perform a THA) is greater than the number of atoms on earth! Thinking that artificial intelligence and robotics can solve these problems, some surgeons and implant manufacturers have turned to artificial intelligence and robotics. We asked two questions:1) can robot with artificial intelligence really process 52 variables that represent 10^67 combinations? 2) the safety of the technology was ascertained by interrogating Food and Drug Administration (FDA) database about software-related recalls in computer-assisted and robotic arthroplasty [1], between 2017 and 2022. 1). The best computers can only calculate around 100 thousand billion combinations (10^14), and with difficulty: it takes more than 100 days to arrive at this number of digits (10^14) after the decimal point for the number π (pi). We can, therefore, expect the robot to be imperfect. 2). For the FDA software-related recalls, 4634 units were involved. The FDA determined root causes were: software design (66.6%), design change (22.2%), manufacturing deployment (5.6%), design manufacturing process (5.6%). Among the manufacturers’ reasons for recalls, a specific error was declared in 88.9%. a coding error in 43.8%. 94.4% software-related recalls were classified as class 2. Return of the device was the main action taken by firms (44.4%), followed by software update (38.9%). 3). In the same period, no robot complained about its surgeon!. Hip surgeon is as intelligent as a robot and almost twice as safe

Aim. A septic revision of an artificial joint is routinely split up in a so-called dirty phase and a clean phase. The measures taken to initiate the start of the clean phase vary significantly between musculoskeletal infection centers. We performed simulations of one-step exchanges of infected THAs and sought to 1) determine the effect of different clean phase protocols on the sterile field, and 2) determine whether or not it is possible to re-implant the new prosthesis completely clean. Method. Nine fresh frozen cadaveric hips were used and primary THA was undertaken via a direct anterior approach. Before implantation of the components varying amounts of fluorescent powder (GloGerm) were deposited, simulating bacterial infection. Second, a one-step exchange was performed via a posterolateral approach. After implant removal, debridement, and lavage, randomization determined which clean phase protocol was followed, i.e. no, some or full additional measures. Finally, the new prosthesis was re-implanted (fig. 1). In order to determine the effect of different clean phase protocols on contamination of the sterile field standardized UV light-enhanced photographs were obtained of 1) the gloves, 2) the instrument table, 3) the drapes, and 4) the wound and these were ranked on cleanliness by a blind panel of hip surgeons. In order to determine whether or not it is possible to re-implant the prosthesis completely clean, the implant was taken out again at the end of the one-step exchange and inspected for contamination under UV light. Results. The gloves, the instrument table, the drapes (fig. 2) and the wound were significantly cleaner after a clean phase using full additional measures compared to partial or no additional measures (p < 0.000). Partial measures were able to reduce some of the contamination of the gloves and the wound, but had no effect on the drapes and the instrument table. All re-implanted implants were contaminated with some amount of fluorescent powder at the end of the one-step exchange. Conclusions. We advise to incorporate a clean phase with full additional measures into the surgical treatment of prosthetic joint infections, as the effect of partial measures seems to be a poor compromise. The results of this study have now been published: Vles G, Bossen J, Kloos J, Debeer P, Ghijselings S. On the value and limitations of incorporating a “clean phase” into the surgical treatment of prosthetic joint infections - an illustrative cadaveric study using fluorescent powder. J Exp Orthop. 2022 Mar 21;9(1):28. doi: 10.1186/s40634-022-00467-x

Purpose. Patients may present with concurrent symptomatic hip and spine problems, with surgical treatment indicated for both. Controversy exists over which procedure, total hip arthroplasty (THA) or lumbar spine procedure, should be performed first, and does the surgeon's area of expertise influence the choice. Materials & Methods. Clinical scenarios were devised for 5 fictional patients with both symptomatic hip and lumbar spine disorders for which surgical treatment was indicated. An email with survey link was sent to 110 clinical members of the Hip Society and 101 experienced spine surgeons in the USA requesting responses to: which procedure should be performed first, and the rationale for the decision with comments. The clinical scenarios were painful hip osteoarthritis and (1) lumbar spinal stenosis with neurologic claudication; (2) lumbar degenerative spondylolisthesis with leg pain; (3) lumbar disc herniation with leg weakness; (4) lumbar scoliosis with back pain; and (5) thoracolumbar disc herniation with myelopathy. Surgeon choices were compared among scenarios and between surgical specialties using chi-square analysis and comments analyzed using text mining. Results. Complete responses were received from 51 hip surgeons (46%), with a mean of 30.8 (+ 10.4) years of practice experience, and 37 spine surgeons (37%), with a mean of 23.4 (+ 6.5) years of experience. The percentages of hip surgeons recommending “THA first” differ significantly among scenarios: 59% for scenario 1; 73% for scenario 2; 47% for scenario 3; 47% for scenario 4; and 10% for scenario 5 (χ. 2. =44.5, p<0.001). The percentages of spine surgeons recommending “THA first” were 49% for scenario 1; 70% for scenario 2; 19% for scenario 3; 78% for scenario 4; and 0% for scenario 5. There were significant differences between the surgeon groups only for scenarios 3 and 4 (Fishers exact test, p=0.003 and p=0.006 respectively). Hip surgeons were significantly more likely to choose “THA first” despite radicular leg pain (scenario 2), and less likely to choose “THA first” with the presence of myelopathy (scenario 5). The choice of “THA first” in scenarios 1, 3, and 4 were more equivocal, dependent on surgeon impression of clinical severity. Spine surgeons were more likely to recommend THA first with back pain caused by spinal deformity, and spine surgery first with lumbar disc herniation with leg weakness. Surgeon comments suggested the utility of injection of the joint for decision making, the merit of predictable outcome with THA first, leg weakness as an indication for spine surgery, the concern of THA position with spinal deformity, and the urgency of myelopathy. Conclusion. With the presence of concurrent hip and spine problems, the question of “THA or lumbar surgery first” remains controversial in certain clinical scenarios, even for experienced hip and spine surgeons. Additional outcome studies of these patients are necessary for appropriate decision making

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

Background. Accurate implant orientation is associated with improved outcomes after artificial joint replacement. We investigated if a novel augmented-reality (AR) platform (with live feedback) could train novice surgeons to orientate an acetabular implant as effectively as conventional training (CT). Methods. Twenty-four novice surgeons (pre-registration level medical students) voluntarily participated in this trial. Baseline demographics, data on exposure to hip arthroplasty, and baseline performance in orientating an acetabular implant to six patient-specific values on a phantom pelvis, were collected prior to training. Participants were randomised to a training session either using a novel AR headset platform or receiving one-on-one tuition from a hip surgeon (CT). After training, they were asked to perform the six orientation tasks again. The solid-angle error in degrees between the planned and achieved orientations was measured using a head-mounted navigation system. Results. Novice surgeons in both groups performed with a similar degree of error prior to training (AR: 14.2°±7.0°, CT: 15.7°±6.9° (p>0.05)). After training, average error was 10.7°±5.8° for AR participant and 7.2°±4.4° for CT participants. The average improvement per student was 3.5°±7.2° and 8.5°±8.0° respectively (p>0.05). Conclusions. A novel AR platform delivered training for acquiring skills to orientate an acetabular cup implant. After one session, novices trained by a hip surgeon outperformed those trained using AR. In both groups, accuracy remained below “expert” level proficiency (<5 degrees error). Further investigation is required to evaluate if novices retain skills, continue to improve with further training, and can transfer this to clinical practice

Aims

Our primary aim was to establish the proportion of female orthopaedic consultants who perform arthroplasty via cases submitted to the National Joint Registry (NJR), which covers England, Wales, Northern Ireland, the Isle of Man, and Guernsey. Secondary aims included comparing time since specialist registration, private practice participation, and number of hospitals worked in between male and female surgeons.

The ideal operative treatment of displaced sub capital femoral fractures in the elderly is controversial. Recently, randomised controlled trials have suggested a better outcome with the use of total hip arthroplasty (THA) to treat displaced intra capsular fractures of the femur for elderly patients in good health. More recently the concept of dual mobility cups is being promoted to avoid dislocations in this cohort of patients. However, overall there is limited evidence to support the choice between different types of arthroplasty. Dislocation remains a main concern with THA, especially when a posterior approach is used. We analysed the outcome of 115 primary THR (112 cements and 3 uncemented) THR using a posterior approach with soft tissue repair in active elderly patients presenting with displaced intra capsular femoral neck fractures. Size 28 mm head was used in 108 and a size 32 mm head in the rest. All surgery was performed by specialist hip surgeons. Satisfactory results were noted in terms of pain control, return to pre-morbid activity and radiological evidence of bone implant osteo-integration. The 30-day mortality was nil. There were two dislocations and only one needed revision surgery due to recurrent dislocation. In conclusion, with optimal patient selection, THA seems to provide a good functional outcome and pain relief in the management of displaced intracapsular femoral neck fractures. Excellent outcome can be achieved when done well using the standard cemented THR and with 28mm head. A good soft tissue repair and a specialist hip surgeon is preferable

Aims

Pelvic discontinuity is a rare but increasingly common complication of total hip arthroplasty (THA). This single-centre study evaluated the performance of custom-made triflange acetabular components in acetabular reconstruction with pelvic discontinuity by determining: 1) revision and overall implant survival rates; 2) discontinuity healing rate; and 3) Harris Hip Score (HHS).

Aims

The Exeter short stem was designed for patients with Dorr type A femora and short-term results are promising. The aim of this study was to evaluate the minimum five-year stem migration pattern of Exeter short stems in comparison with Exeter standard stems.

Aims

The preventive effects of bisphosphonates on articular cartilage in non-arthritic joints are unclear. This study aimed to investigate the effects of oral bisphosphonates on the rate of joint space narrowing in the non-arthritic hip.

The challenges faced by hip surgeons have changed over the last decade. Historically, fixation, polyethylene wear, osteolysis, loosening and failure to osseointegrate dominated the discussions at hip surgery meetings. With the introduction of highly crosslinked polyethylene, wear and osteolysis are currently not significant issues. Improved surgical technique has resulted in a high rate of osseointegration and once fixed, loosening of cementless components is rare. In this session, we will focus on issues that orthopaedic surgeons performing hip surgery routinely face including bearing couples in the young active patient, implant choices in the dysplastic hip and osteoporotic femur, evaluation and management of the unstable hip and differential diagnosis of the painful THR