In this review, we discuss the evidence for patients returning to sport after hip arthroplasty. This includes the choices regarding level of sporting activity and revision or complications, the type of implant, fixation and techniques of implantation, and how these choices relate to health economics. It is apparent that despite its success over six decades, hip arthroplasty has now evolved to accommodate and support ever-increasing patient demands and may therefore face new challenges.

Cite this article: Bone Joint J 2020;102-B(6):661–663.

Introduction

We investigated whether blood metal ions could effectively identify bilateral metal-on-metal hip patients at risk of adverse reactions to metal debris (ARMD).

We report the survival at ten years of 173 consecutive Birmingham Hip Resurfacing’s implanted between August 1997 and August 1998 at a single institution. Failure was defined as revision of either the acetabular or femoral component for any reason during the study period.

The survival at the end of ten years was 96.5% (95%c. i. 89.1 – 99.5%) The mean age of the patients at implantation was 50 years (range 15 – 75). There were 124 (72%) male cases and 49 (28%) female cases. 123 (71%) cases had the diagnosis of osteoarthritis, 9 osteonecrosis, 5 rheumatoid and 3 DDH. The posterior approach was used in 154 (89%) cases and anterolateral in 19 (11%). Cases were performed by 5 different surgeons.

There were 5 revisions, 9 unrelated deaths and 18 were lost to follow-up beyond 5 years. Two revisions occurred for infection (6 months and 2 years). A revision at 3.5 years for acetabular loosening and two further at 6.4 and 7.9 years due to avascular necrosis of the femoral head and collapse were performed. No other revisions are impending. The median pre-operative oxford hip score was 61% (IQR 48–73) and the median 10 year score was 7% (IQR 0–31) for 110 completed forms.

Further analysis of the total resurfacing database at this institution of 2775 cases was performed. Cox-proportional hazard analysis identified that component size and pre-operative diagnosis were significantly associated with failure. Although females may initially appear to have a greater risk of revision this is related to differences in the size and pre-operative diagnosis between the genders. This study confirms that hip resurfacing using a metal-on-metal bearing of known provenance can provide a solution in the medium term for the younger more active adult who requires surgical intervention for hip disease.

Introduction: Hip resurfacing has gained popularity for treating young and active patients with arthritis. Recent literature has reported increase revision rate amongst females as compared to males undergoing resurfacing. The aim of this study is to identify any differences in survival or functional outcome between male and female patients treated with metal-on-metal hip resurfacing.

Methods: All procedures performed between July 1997 to July 2003 were extracted from the database and grouped based on gender. 1266 patients (1441 hips, 582 female and 859 male patients) were identified. The preoperative diagnosis, Oxford hip score, component size, post operative complications and revisions were recorded. Failures included revision of either the femoral or acetabular components.

Results: The mean follow up was 5.5 years. There were 52 revisions in total (30 in female and 22 in male group). The 8 year survival in the male and female groups were 96.1% and 91.5% respectively which is significantly different (p=0.0006). The size of the femoral component was significantly associated with revision (p=0.0008). Cox proportional hazard modelling including gender, aetiology and femoral component size identified a diagnosis of osteoarthritis reduced the risk of revision of 0.2 times (p=0.0004). However, SUFE was significantly associated 5.57 times increased risk of revision (p=0.0019). With every millimetre increase in head size there was a reduction in risk of revision of 0.89 (p=0.0098). By inclusion of all variables in this model gender was found not to be significantly associated with failure.

Conclusion: This study demonstrates that although females may initially appear to have a greater risk of revision this is related to differences in the femoral size and pre-operative diagnosis between the genders. Patient selection for resurfacing is best made on size and diagnosis rather than gender.

Metal-on-metal hip resurfacing is increasingly common. Patients suitable for hip resurfacing are often young, more active, may be in employment and may have bilateral disease. One-stage bilateral total hip replacement has been demonstrated to be as safe as a two-stage procedure and more cost effective. The aim of this study was to compare the in-patient events, outcome and survival in patients undergoing one-stage resurfacing with a two-stage procedure less than one-year apart.

Methods. Between July 1994 and August 2006 a consecutive series of 93 patients underwent bilateral hip resurfacing within a year. 34 patients in the one-stage group. 44 patients in the two-stage group. The age, gender, diagnosis, ASA grade, total operative time, blood transfusion requirements, medical complication, surgical complications, length of stay, duration of treatment, revision and Oxford hip scores were recorded.

Results. There were no significant differences in age, gender, ASA grade between the one-stage and the two-stage. There were 4 minor complications in the one stage group and 5 in the two-stage group. All patients that suffered a complication made a full recovery. There was no significant difference in the blood transfusion requirements. The mean anaesthetic time was 136 minutes in the one stage group and 92 minutes in the two-stage group with a significant mean difference of 44 minutes(95% c.i. 31–52). The mean total length of hospital stay was 11 days in the one-stage group and 16 days in the two-stage group with a significant mean difference of 5 days(95\% c.i. 4.0–6.9). The mean difference in length of treatment time of 6.5 months was significant(95\% c.i. 4.0–9.0).

No patients have undergone a revision procedure during the study period and no patient is awaiting revision surgery.

Conclusions. This study demonstrates no detrimental effects when performing a one-stage bilateral metal-on-metal hip resurfacing in comparison to a two-stage procedure. There are advantages of a one-stage procedure over a two-stage procedure for bilateral disease. Total hospital stay is reduced by 31.3% and the mean length of treatment is reduced by 50.0%. These benefits do not appear to come at the cost of increase complications. The complication rate in both groups was very low and all of the complications were short-term and are unlikely to have any bearing on the longevity of the prosthesis.

Weight gain is often reported by patients who succumb to impaired activity as a result of progressive osteoarthritis of the hip or knee. Optimistic views of weight loss after joint replacement are often held by patients. We studied the affect of lower limb arthroplasty on body weight.

We reviewed 144 patients having undergone hip and knee arthroplasty and were functionally well. Infected cases were excluded. Average age was 65 years and average follow up was 27 months. The Body Mass Index (BMI) was prospectively measured at follow up and compared to immediate pre-operative BMI.

Our findings demonstrated an average rise in BMI post-operatively which was statistically significant. A rise in post operative BMI was seen in patients who were obese to start with or those who had undergone a total hip replacement (statistically significant). Moderate rises were seen in patients who had underwent hip resurfacing procedures or those who were overweight preoperatively (p=0.06).

These findings are useful in informing patients of achievable expectations following joint replacement surgery and preoperative overweightness should be treated as a separate entity unrelated to co-existing joint degeneration.

Introduction: We have investigated the accuracy of a serological marker to distinguish between septic and aseptic loosening of Total Hip Replacements (THR). We present the preliminary results of our on-going prospective study.

Methods: After obtaining Ethical Committee approval, 46 patients were collected in 3 groups; “control” primary THR, revision THR for aseptic loosening, and revision THR for infection. Serum IgG responses to an exocellular bacterial antigen (Lipid S) were determined by enzyme-linked immunosorbent assay (ELISA).

Results: Our results show that the test can accurately differentiate between the patients with infected joint replacements and the control group. The test, to date, has a specificity of 93% and a sensitivity of 100%.

Discussion and Conclusion: This simple and cheap test can reliably assist in the accurate evaluation of a painful hip arthroplasty, and planning for revision surgery. It will also be useful in the management of patients in whom the microbiology results are either negative or based on a single isolate of an organism, which may be either a contaminant or a possible pathogen. This, in turn, would have implications on financial costs and the optimum use of available resources.

Introduction and Aims: We have investigated the accuracy of a serological marker to distinguish between septic and aseptic loosening of Total Hip Replacements (THR). We present the preliminary results of our ongoing prospective study.

Method: After obtaining Ethical Committee approval, 46 patients were collected in three groups: ‘control’ primary THR, revision THR for aseptic loosening and revision THR for infection. Serum IgG responses to an exocellular bacterial antigen (LipidS) were determined by enzyme-linked immunosorbent assay (ELISA).

Results: Our results show that the test can accurately differentiate between the patients with infected joint replacements and the control group. The test, to date, has a specificity of 93% and a sensitivity of 100%.

Conclusions: This simple and cheap test can reliably assist in the accurate evaluation of a painful hip arthroplasty, and planning for revision surgery. It will also be useful in the management of patients in whom the microbiology results are either negative or based on a single isolate of an organism, which may be either a contaminant or a possible pathogen. This, in turn, would have implications on financial costs and the optimum use of available resources.