Recurrent posterior dislocation is a recognised complication following primary total hip arthroplasty. Incidences of between 0.11% and 4.5% have been reported in the literature.

Component revision is regarded as standard management of recurrent posterior dislocation. However, revision surgery is a major surgical procedure and is often unsuitable for elderly, frail patients.

A congruent, ultra-high molecular weight polyethylene acetabular augment with a stainless steel backing plate has been developed. This can be inserted providing there is no malalignment, wear or loosening of the primary components.

In this study we compared twenty patients who underwent conventional revision surgery to twenty patients who had a PLAD inserted for recurrent posterior dislocation following primary Charnley total hip arthroplasty. Both groups were age and sex-matched and the average number of dislocations prior to surgery was three for each group.

For the PLAD group, the mean operative time, the mean intraoperative blood loss, the time spent in HDU, the transfusion requirements and the duration of hospital stay was significantly less than that for the revision group. Furthermore, there was no significant difference in the Oxford Hip Score recorded preoperatively and at 6 weeks, 6 months, one year and two years following surgery. None of the patients had sustained a further dislocation at latest review.

We conclude that the Posterior Lip Augmentation Device is a safe and effective option in the management of patients with recurrent posterior hip dislocation when there is no evidence of component failure or gross malposition.

We performed arthrodesis with a cobra head compression plate in 18 young adults with severely degenerative arthritis of the hip. The aetiology was trauma in 4 patients, sepsis in 3, slipped upper femoral epiphysis in 3, Perthes disease in one, acute lymphblastic lymphoma in one, alcohol related avascular necrosis in 2, epiphyseal dysplasia in one, multiple osteochondromatosis in one, (bilateral) idiopathic chondrolysis in one and in the remaining case there was no apparent cause. At a mean follow up of 4 years 14 patients were complaining of back pain compared to 4 patients preoperatively. Preoperatively 4 patients had ipsilateral knee pain compared to 5 patients postoperatively. Four patients complained of pain at rest or night. Eleven of the 18 patients have returned to work. The average score of satisfaction on a scale of zero to ten was 7.2, with only 3 patients giving a mark of 4 and below.

The management of osteoarthritis of the hip in the young adult is challenging and arthrodesis of the hip is a reasonable option for the very painful arthritic hip.