Aims

In metal-on-metal (MoM) hip arthroplasties and resurfacings, mechanically induced corrosion can lead to elevated serum metal ions, a local inflammatory response, and formation of pseudotumours, ultimately requiring revision. The size and diametral clearance of anatomical (ADM) and modular (MDM) dual-mobility polyethylene bearings match those of Birmingham hip MoM components. If the acetabular component is satisfactorily positioned, well integrated into the bone, and has no surface damage, this presents the opportunity for revision with exchange of the metal head for ADM/MDM polyethylene bearings without removal of the acetabular component.

Aims

The aims of this study were to evaluate the incidence of reoperation (all cause and specifically for periprosthetic femoral fracture (PFF)) and mortality, and associated risk factors, following a hemiarthroplasty incorporating a cemented collarless polished taper slip stem (PTS) for management of an intracapsular hip fracture.

Aims

The objective of this study was to compare the two-year migration and clinical outcomes of a new cementless hydroxyapatite (HA)-coated titanium acetabular shell with its previous version, which shared the same geometrical design but a different manufacturing process for applying the titanium surface.

Aims. The primary aim of this study is to assess the survival of the uncemented hydroxyapatite (HA) coated Trident II acetabular component as part of a hybrid total hip arthroplasty (THA) using a cemented Exeter stem. The secondary aims are to assess the complications, joint-specific function, health-related quality of life, and radiological signs of loosening of the acetabular component. Methods. A single-centre, prospective cohort study of 125 implants will be undertaken. Patients undergoing hybrid THA at the study centre will be recruited. Inclusion criteria are patients suitable for the use of the uncemented acetabular component, aged 18 to 75 years, willing and able to comply with the study protocol, and provide informed consent. Exclusion criteria includes patients not meeting study inclusion criteria, inadequate bone stock to support fixation of the prosthesis, a BMI > 40 kg/m. 2. , or THA performed for pain relief in those with severely restricted mobility. Results. Implant survival, complications, functional outcomes and radiological assessment up to ten years following index THA (one, two, five, seven, and ten years) will be performed. Functional assessment will include the Oxford Hip Score, Forgotten Joint Score, 12-Item Short Form Health Survey, EuroQol five-dimension health questionnaire, and pain and patient satisfaction. Radiological assessment with assess for acetabula lucent lines, lysis, and loosening according to DeLee and Charnley zones. Conclusion. This study is part of a stepwise introduction of a new device to orthopaedic practice, and careful monitoring of implants should be carried out as part of the Beyond Compliance principles. The results of this study will provide functional, radiological, and survival data to either support the ongoing use of the HA acetabulum or highlight potential limitations of this new implant before wide adoption. Cite this article: Bone Jt Open 2023;4(10):782–790

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. Methods. In this case-control study, 25 patients (22 female) at mean age of 78 years (70 to 89) received cemented Exeter short stem (case group). Cases were selected based on Dorr type A femora and matched first by Dorr type A and then age to a control cohort of 21 patients (11 female) at mean age of 74 years (70 to 89) who received with cemented Exeter standard stems (control group). Preoperatively, all patients had primary hip osteoarthritis and no osteoporosis as confirmed by dual X-ray absorptiometry scanning. Patients were followed with radiostereometry for evaluation of stem migration (primary endpoint), evaluation of cement quality, and Oxford Hip Score. Measurements were taken preoperatively, and at three, 12, and 24 months and a minimum five-year follow-up. Results. At three months, subsidence of the short stem -0.87 mm (95% confidence interval (CI) -1.07 to -0.67) was lower compared to the standard stem -1.59 mm (95% CI -1.82 to -1.36; p < 0.001). Both stems continued a similar pattern of subsidence until five-year follow-up. At five-year follow-up, the short stem had subsided mean -1.67 mm (95% CI -1.98 to -1.36) compared to mean -2.67 mm (95% CI -3.03 to -2.32) for the standard stem (p < 0.001). Subsidence was not influenced by preoperative bone quality (osteopenia vs normal) or cement mantle thickness. Conclusion. The standard Exeter stem had more early subsidence compared with the short Exeter stem in patients with Dorr type A femora, but thereafter a similar migration pattern of subsidence until minimum five years follow-up. Both the standard and the short Exeter stems subside. The standard stem subsides more compared to the short stem in Dorr type A femurs. Subsidence of the Exeter stems was not affected by cement mantle thickness. Cite this article: Bone Jt Open 2023;4(7):507–515

The Norwegian Arthroplasty Register (NAR) started collecting data on total hip arthroplasty (THA) in 1987. Very long-term results of implants for THA are scarce. We aimed to show long-term results for the three most used femoral stems, operated from 1987. We included the uncemented Corail femoral stem (n=66,309) and the cemented Exeter stem (n=35,050) both of which are currently in frequent use. In addition, we included the Charnley stem (n=32,578, in use until 2014). To ensure comparable conditions, stems fixated with low viscosity cement and stems revised due to infections were excluded. Differences in risk of revision (all reasons and stem revisions) were assessed with Kaplan-Meier and Cox regression analyses with adjustment for possible confounding from age, sex and diagnosis (OA, other). Stem revision was defined as a revision caused by loosening of the stem, dislocation, osteolysis in the femur, or periprosthetic femur fracture, and in which the femoral component was removed or exchanged. The median and max follow-up for Corail, Exeter and Charnley were 6.3 (33.1), 8.0 (34.2) and 13.1 (34.3) respectively. Thirty years survival estimates for Corail, Exeter and Charnley stems were 88.6% (CI:85.8–90.9%), 86.7% (83.7–89.2%) and 87.1% (85.4–88.5%) respectively with stem revision as endpoint, and 56.1% (CI:53.1–59.1%), 73.3% (70.5–76.1%) and 80.2% (78.4–82.0%) with all THA revisions as endpoint. Compared to the Corail, the Exeter (HRR=1.3, CI:1.2–1.4) and the Charnley (HRR=1.9, CI:1.7–2.1) had a significant higher risk of stem revision. Women 75 years and older had better results with the cemented stems. Analyses accounting for competing risk from other causes of revision did not alter the findings. The uncemented Corail stem performed well in terms of stem revisions for stem-related revision causes compared to two frequently used cemented stems with very long follow-up. The differences between the three stems were small

Although data on uncemented short stems are available, studies on cemented short-stemmed THAs are limited. These cemented short stems may have inferior long-term outcomes and higher femoral component fracture rates. Hence, we examined the long-term follow-up of cemented short Exeter stems used in primary THA. Within the Exeter stem range, 7 stems have a stem length of 125 mm or less. These stems are often used in small patients, in young patients with a narrow femoral canal or patients with anatomical abnormalities. Based on our local database, we included 394 consecutive cemented stems used in primary THA (n=333 patients) with a stem length ≤125 mm implanted in our tertiary referral center between 1993 and December 2021. We used the Dutch Arthroplasty Registry (LROI) to complete and cross-check the data. Kaplan-Meier survival analyses were performed to determine 20-year survival rates with stem revision for any reason, for septic loosening, for aseptic loosening and for femoral component fracture as endpoints. The proportion of male patients was 21% (n=83). Median age at surgery was 42 years (interquartile range: 30–55). The main indication for primary THA was childhood hip diseases (51%). The 20-year stem survival rate of the short stem was 85.4% (95% CI: 73.9–92.0) for revision for any reason and 96.2% (95%CI: 90.5–98.5) for revision for septic loosening. No stems were revised for aseptic femoral loosening. However, there were 4 stem fractures at 6.6, 11.6, 16.5 and 18.2 years of follow-up. The stem survival with femoral component fracture as endpoint was 92.7% (CI: 78.5–97.6) at 20 years. Cemented short Exeter stems in primary THA show acceptable survival rates at long-term follow-up. Although femoral component fracture is a rare complication of a cemented short Exeter stem, orthopaedic surgeons should be aware of its incidence and possible risk factors

Aims

The primary aim of our study was to assess the influence of age on hip-specific outcome following total hip arthroplasty (THA). Secondary aims were to assess health-related quality of life (HRQoL) and level of activity according to age.

Aims

The aim of this study is to report the long-term outcomes of instrumented femoral revisions with impaction allograft bone grafting (IBG) using the X-change femoral revision system at 30 years after introduction of the technique.

The MAKO Robotic arm is a haptic robotic system that can be used to optimise performance during total hip arthroplasty (THA). We present the outcome of the first 40 robotic cases performed in an NHS foundation trust along with the technique of performing robotic THA in our unit. Forty consecutive patients undergoing robotic THA (rTHA) were compared to a case matched group of patients undergoing manual THA (m-THA). 2:1 blinded case matching was performed for age, sex, implants used (Trident uncemented socket and cemented Exeter stem, Stryker Mahwah, NJ, US) and surgeon grade. Comparisons were made for radiological positioning of implants, including leg length assessment, and patient reported functional outcome (PROMS). Pre- and post-operative radiographs were independently analysed by 2 authors. All patients underwent THA for a primary diagnosis of osteoarthritis. No significant difference between groups was identified for post-operative leg length discrepancy (LLD) although pre-operatively a significantly higher LLD was highlighted on the MAKO group, likely due to patient selection. Significantly lower post-operative socket version was identified in the MAKO cohort although no difference in post-operative cup inclination was noted. However, there was significantly larger variance in post-op LLD (p=0.024), cup version (p=0.004) and inclination (p=0.05) between groups indicating r-THA was significantly less variable (Levene's test for homogeneity of variance). There was no significant difference in the number of cases outside of Lewinnek's ‘safe’ zone for inclination (p=0.469), however, there were significantly more cases outside Lewinnek's ‘safe’ zone for version (12.5% vs 40.3%, p=0.002) in the m-THA group. We report the commencement of performance of MAKO robotic THA in an NHS institution. No problems with surgery were reported during our learning curve. Robotic THA cases had less variability in terms of implant positioning suggesting that the MAKO robot allows more accurate, less variable implant positioning with fewer outliers. Longer term follow-up of more cases is needed to identify whether this improved implant positioning has an effect on outcomes, but the initial results seem promising

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The aim of this study was to assess the clinical and radiological outcomes of an antiprotrusio acetabular cage (APC) when used in the surgical treatment of periacetabular bone metastases.

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The aim of this study was to assess medium-term improvements following total hip arthroplasty (THA), and to evaluate what effect different preoperative Oxford Hip Score (OHS) thresholds for treatment may have on patients’ access to THA and outcomes.

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Femoral cement-in-cement revision is a well described technique to reduce morbidity and complications in hip revision surgery. Traditional techniques for septic revision of hip arthroplasty necessitate removal of all bone cement from the femur. In our two centres, we have been using a cement-in-cement technique, leaving the distal femoral bone cement in selected patients for septic hip revision surgery, both for single and the first of two-stage revision procedures. A prerequisite for adoption of this technique is that the surgeon considers the cement mantle to be intimately fixed to bone without an intervening membrane between cement and host bone. We aim to report our experience for this technique.

Femoral cement-in-cement revision is a well described technique to reduce morbidity and complications in hip revision surgery. Traditional techniques for septic revision necessitate removal of all bone cement from the femur. In our two institutions, we have been using a cement-in-cement technique, leaving the distal femoral cement in selected cases for septic hip revision surgery. Between February 2010 and September 2019, 89 patients with prosthetic hip infection underwent first or single stage procedures leaving the distal femoral cement in situ and performing a cement-in-cement revision. The mean patient age was 72.0 years (24–92). The median time from the last arthroplasty procedure was 29.0 months (1–294). 81 patients underwent revision using a cemented Exeter stem, 7 patients received an articulating spacer, and one patient underwent excision arthroplasty with the distal cement left in situ. Patients received clinical and radiographic follow-up with a mean of 42.8 months (range 11.0–120.1 months). Oxford hip scores were collected from each institution's existing databases. 9 patients (10.1%) died within one year of surgery. No deaths were directly related to joint infection or the surgery. One patient was lost to follow up before one year. Of the remainder, 7 patients (8.9%) required further procedures for infection and were therefore considered to be treatment failures. 6 patients (7.6%) underwent planned second stage procedures with no recurrence of infection. 7 patients (8.9%) had further surgery for non-infective reasons. The Kaplan-Meier estimate of infection free survival at one year was 93.7% (95% CI 88.4 to 99.0%). No patients underwent revision for stem loosening. Oxford hip scores were available at over one year postoperatively for 51 patients with a mean score of 30.6, and a mean gain of 11.9. In our combined cohort of patients, cement-in-cement revision had an infection eradication rate of 91.1%. Patient selection is crucial, and the procedure can only be performed when there is a well-fixed cement mantle. However, when strict criteria are followed, this technique offers potential significant benefits to surgeons performing this challenging surgery, and more importantly the patients undergoing them

Aims

The aim of this study was to determine whether fixation, as opposed to revision arthroplasty, can be safely used to treat reducible Vancouver B type fractures in association with a cemented collarless polished tapered femoral stem (the Exeter).

Aims

The primary aim of this study was to compare the hip-specific functional outcome of robotic assisted total hip arthroplasty (rTHA) with manual total hip arthroplasty (mTHA) in patients with osteoarthritis (OA). Secondary aims were to compare general health improvement, patient satisfaction, and radiological component position and restoration of leg length between rTHA and mTHA.

Objectives

Our primary aim was to describe migration of the Exeter stem with a 32 mm head on highly crosslinked polyethylene and whether this is influenced by age. Our secondary aims were to assess functional outcome, satisfaction, activity, and bone mineral density (BMD) according to age.

The number of cemented femoral stems implanted in the United States continues to slowly decrease over time. Approximately 10% of all femoral components implanted today are cemented, and the majority are in patients undergoing hip arthroplasty for femoral neck fractures. The European experience is quite different. In the UK, cemented femoral stems account for approximately 50% of all implants, while in the Swedish registry, cemented stems still account for the majority of implanted femoral components. Recent data demonstrating some limitations of uncemented fixation in the elderly for primary THA, may suggest that a cemented femoral component may be an attractive alternative in such a group. Two general philosophies exist with regards to the cemented femoral stem: Taper slip and Composite Beam. There are flagship implants representing both philosophies and select designs have shown excellent results past 30 years. A good femoral component design and cementing technique, however, is crucial for long-term clinical success. The author's personal preference is that of a “taper slip” design. The cemented Exeter stem has shown excellent results past 30 years with rare cases of loosening. The characteristic behavior of such a stem is to allow slight subsidence of the stem within the cement mantle through the process of cement creep. One or two millimeters of subsidence in the long-term have been observed with no detrimental clinical consequences. There have been ample results in the literature showing the excellent results at mid- and long-term in all patient groups. The author's current indication for a cemented stem include the elderly with no clear and definitive cutoff for age, most likely in females, THA for femoral neck fracture, small femoral canals such as those patients with DDH, and occasionally in patients with history of previous hip infection. Modern and impeccable cement technique is paramount for durable cemented fixation. It is important to remember that the goal is interdigitation of the cement with cancellous bone, so preparing the femur should not remove cancellous bone. Modern technique includes distal plugging of the femoral canal, pulsatile lavage, drying of the femoral canal with epinephrine or hydrogen peroxide, retrograde fill of the femoral canal with cement with appropriate suction and pressurization of the femoral cement into the canal prior to implantation of the femoral component. The dreaded “cement implantation syndrome” leading to sudden death can be avoided by appropriate fluid resuscitation prior to implanting the femoral component. This is an extremely rare occurrence today with reported mortality for the Exeter stem of 1 in 10,000. A cemented femoral component has been shown to be clinically successful at long term. Unfortunately, the art of cementing a femoral component has been lost and is rarely performed in the US. The number of cemented stems, unfortunately, may continue to go down as it is uncommonly taught in residency and fellowship, however, it might find a resurgence as the limits of uncemented fixation in the elderly are encountered. National joint registers support the use of cemented femoral components, and actually demonstrate higher survivorship at short term when compared to all other uncemented femoral components. A cemented femoral component should be in the hip surgeons armamentarium when treating patients undergoing primary and revision THA

Aims

To evaluate the outcomes of cemented total hip arthroplasty (THA) following a fracture of the acetabulum, with evaluation of risk factors and comparison with a patient group with no history of fracture.