Total hip replacement causes a short-term increase in the risk of mortality. It is important to quantify this and to identify modifiable risk factors so that the risk of post-operative mortality can be minimised. We performed a systematic review and critical evaluation of the current literature on the topic. We identified 32 studies published over the last 10 years which provide either 30-day or 90-day mortality data. We estimate the pooled incidence of mortality during the first 30 and 90 days following hip replacement to be 0.30% (95% CI 0.22 to 0.38) and 0.65% (95% CI 0.50 to 0.81), respectively. We found strong evidence of a temporal trend towards reducing mortality rates despite increasingly co-morbid patients. The risk factors for early mortality most commonly identified are increasing age, male gender and co-morbid conditions, particularly cardiovascular disease. Cardiovascular complications appear to have overtaken fatal pulmonary emboli as the leading cause of death after hip replacement.

Cite this article: Bone Joint Res 2014;3:175–82

Intra-operative Tip-Apex Distance (TAD) estimation optimises dynamic hip screw (DHS) placement during hip fracture fixation, reducing risk of cut-out. Thread-width of a standard DHS screw measures approximately 12.5 millimetres. We assessed the effect of introducing screw thread-width as an intra-operative distance reference to surgeons. The null hypothesis was that there were no differences between hip fracture fixation before and after this intervention. Primary outcome measure was TAD. Secondary outcome measures included position of the screw in the femoral head, quality of reduction, cut-out and surgeon accuracy of estimating TAD.

150 intra-operative DHS radiographs were assessed before and after introducing screw thread-width distance reference to surgeons.

Mean TAD reduced from 19.37mm in the control group to 16.49mm in the prospective group (p=<0.001). The number of DHS with a TAD > 25mm reduced from 14% to 6%. Screw position on lateral radiographs was significantly improved (p=0.004). There were no significant differences in screw position on antero-posterior radiographs, quality of reduction, or rate of cut-out. Significant improvement in accuracy (p=0.05) and precision (p=0.005) of TAD estimation was demonstrated.

Awareness and use of screw-thread width improves estimation and positioning of a DHS screw in the femoral head during fixation of hip fractures.

Pre-existing hip pathology such as femoroacetabular impingement is believed by some, to have a direct causal relationship with osteoarthritis of the hip. The strength of this relationship remains unknown.

We investigate the prevalence of abnormal bone morphology in the symptomatic hip on the pre-operative anteroposterior pelvic radiograph of consecutive patients undergoing hip resurfacing. Rotated radiographs were excluded. One hundred patients, of mean age 53.5 years were included (range 33.4–71.4 years, 32% female). We examined the films for evidence of a cam-type impingement lesion (alpha angle >50.5°, a pistol grip, Pitt's pits, a medial hook, an os acetabuli and rim ossification), signs of acetabular retroversion or a pincer-type impingement lesion (crossover sign, posterior wall sign, ischial sign, coxa profunda, protrusio, coxa vara, Tonnis angle < 5°), and hip dysplasia (a Tonnis acetabular angle >14° and a lateral centre-edge angle of Wiberg <20°).

Pre-existing radiographic signs of pathology were present in a large proportion of hips with low grade (Tonnis grade 1–2) arthritis. There is a group of patients who presented with more advanced osteoarthritis in which we suspect abnormal bone morphology to be a causative factor but, for example, neck osteophytes obscure the diagnosis of a primary cam lesion.

Our findings corroborate those of Harris and Ganz. Impingement is radiographically detectable in a large proportion of patients who present with early arthritis of the hip, and therefore we agree that it is a likely pre-cursor for osteoarthritis. Treatments directed at reducing hip impingement may stifle the progression of osteoarthritis.

Manual templating using transparencies allows preoperative visualisation of anatomy and prosthesis size, as well as ease of exchange from prosthesis type to another. Most UK hospitals have converted X-ray provision to Picture Archiving and Communication Systems (PACS), necessitating the use of digital templating.

We assessed the accuracy and speed of templating for hip replacement on 36 occasions in 12 patients listed for hip replacement, using final component choice as an indicator of accuracy. Each hip was templated using, “Orthoview,” templating programme

without initial scaling and

A two pence coin taped to the lateral aspect of the thigh at the level of the greater trochanter was used for scaling purposes.

Our results showed acetate templating to be most accurate, correlating identically with the prosthesis stem size in 9/12 cases, and with the acetabulum reamed size on 10/12 occasions. Acetate templating was also the most accurate method when allowing for +/− one size difference, being within +/− one size in all 12/12 cases for both stem size and acetabulum size. In comparison, both scaled and non scaled Orthoview templating correlated with the correct femoral prosthesis size in 5/12 patients. The acetabulum ream size was correctly templated in 10/12 patients using unscaled Orthoview, and 8/12 patients using scaled Orthoview. Additionally, Orthoview templating took a mean of 6 minutes, whereas manual templating can be achieved in under 30 seconds.

Manual templating of scaled PACS images using transparencies conferred considerable advantages in terms of accuracy and speed. Moreover, this method allows a hands-on assessment of the forthcoming surgical procedure immediately prior to the operation, as well as late changes in implant choice. We recommend the continuation of manual templating using modern scaled digital images.