Objective: Revision total hip arthroplasty in cases of proximal femoral bone loss due to osteolysis and loosening is challenging for surgeon and implants. The use of tapered fluted modular titanium femoral stem in these situations may offer the advantage of better biomechanical reconstruction with a design that ensure primary stability and promotes bone integration.

Method: We studied retrospectively 83 cases of femoral reconstruction with the PFM-R stem. Paprosky classification was used to qualify bone defects on preoperative radiological evaluation. Demographic, clinical and intraoperative data were collected, along with any complications. Clinical (W.O.M.A.C. function score) and radiological follow-up was performed at a minimum of 12 months.

Results: The mean follow-up was 44 months (23 to 66 months). Five patients were lost to follow-up. 48% of patients had at least one previous revision. The mean post operative WOMAC score was 83. 91% of patients had no significant limb length discrepancy. Stabilization or regression of osteolytic lesions was observed in 75% of revised femur. Complications were 8 dislocations, 7 fractures and 3 infections. A correlation was found between the risk of dislocation and the number of previous revision surgery. Out of 14 cases revised for infection, one had a recurrence.

Discussion: This study confirmed the benefits of the PFM-R stem in difficult femoral revision in term of limb length equalization, stability of fixation, regression of osteolytic lesions and improved clinical function.

Purpose The dramatic improvement in clinical function after total hip arthroplasty (THA) has been well documented. However gait studies demonstrate abnormal gait pattern after THA, and patients may complain of thigh pain, leg length inequality, instability and reduced range of motion. Surface replacement arthroplasty (SRA) has the benefit of restoring a more normal hip anatomy and biomechanics, which could improve clinical function and patient satisfaction after surgery.

Method All patients eligible for the study were randomised to receive uncemented metal-metal THA or a hybrid metal-metal SRA. Clinical data were prospectively collected preoperatively and at 3, 6 and 12 months postoperatively. The WOMAC score, SF-36, Merle D’Aubigné, and other clinical data, along with patient satisfaction, were compared.

Summary of Results One hundred and fifty patients were randomized. Patients in both groups demonstrate very high satisfaction rate. Although there was a tendency for the SRA group to participate in more demanding activities at 6 months post operatively, no difference was found in clinical function scores. Two isolated dislocations occurred in the THA group and none in the SRA group. No other significant complication occurred in either group.

Discussion. The few short-term clinical data reported in the literature for new generation SRA implants demonstrates excellent outcome comparable to THA. Despite enthusiasm about total hip resurfacing, there is no direct prospective comparative study with THA published in the literature. This study confirms the safety and benefits of metal-metal surface arthroplasty of the hip in the early post op period.

Purpose: Kinematic studies have shown that patients with a total hip arthroplasty (THA) walk with different gait characteristics compared to normal subjects. This abnormal gait might result from difficulties restoring the normal hip anatomy and biomechanics with THA. Surface replacement arthroplasty (SRA) facilitates leg length management and reconstruction of the normal anatomy of the proximal femur, allowing potential improvements in muscle power, proprioception and hip stability compared to THA.

Method: Patients suffering from advanced hip joint disease were randomised to receive an uncemented metal-metal THA or metal-metal SRA. A group of patients from this study were evaluated pre operatively, at 6 months and one year post operatively at a gait laboratory. A VICON system with 8 cameras, platform (AMTI) and surface electromyograph (Motion Lab) were used. Articular and muscle power and work characteristics of the hip, knee and ankle were analysed with different tasks. Postural stability (e.g. distance between the mass centre and pressure centre) in the standing position will serve to differentiate the 2 groups. Other specific tests, such as the hop test, the step test and the TUG test, were performed.

Summary of Results: Thirty randomised patients were evaluated. The results will be presented and discussed.

Discussion: Considering the strong interest of patients and surgeons for the potential functional benefits of surface replacement arthroplasty, it is necessary to determine scientifically how it compares with the standard of care (THA). Patient age, weight, sex and pre operative function have a strong influence on the post operative function. Thus, a prospective randomised study is mandatory to obtain valid results.

Significance: We strongly believe that this subject warrants special attention considering the possible benefits associated with this technique in the young adult with hip osteoarthitis.

Purpose: In 1988, metal-on-metal bearing surfaces were reintroduced in hip replacement surgery with a 28 mm diameter femoral head. These bearings have potential advantages such as improved durability, absence of polyethylene particles and no secondary periprosthetic osteolysis. Tribological studies suggest that larger metal-on-metal articulations would produce less wear than smaller diameter components. But recent clinical studies revealed increased release of circulating ions in metal-metal hip resurfacing compared to 28 mm metal-metal articulation. The aim of the present study is to describe whole blood Chrome and Cobalt ions concentration after non-cemented metal-metal total hip arthroplasty (THA) and hybrid metal-metal surface replacement arthroplasty (SRA).

Method: All patients eligible for the study were randomised to receive uncemented THA or a hybrid SRA. Whole blood samples were collected pre-operatively, at three, six months and one year post operatively. Chrome and Cobalt concentration were measured using a spectrophotometer.

Summary of Results: Blood samples have been taken from 78 patients and are pending analysis.

Discussion: Considering the influence of activity level, weight, time after surgery, the renal function, etc. on the wear behaviour of bearing surfaces, a prospective randomised study is important to obtain a valid comparison. To our knowledge, this is the only randomised study comparing whole blood ions concentration in metal-metal THA and SRA.

Significance: We strongly believe that this subject warrants special attention considering the possible toxicity associated with high levels of circulating metal ions.

Introduction and Aims: Vertical acetabular cup positioning is an important technical aspect in total hip arthroplasty. It has been reported that acetabular component malpositioning is associated with an increased risk of dislocation, limited range of motion and impingement. A high vertical acetabular angle is correlated positively with premature polyethylene wear, osteolysis and early aseptic loosening in metal-polyethylene and ceramic-ceramic interface.

Method: To evaluate the potential benefit of using an inclinometer in vertical acetabular cup positioning, 96 patients were randomised to have their acetabular cup insertions done with an inclinometer or by visuo-spatial perception alone. The surgeries were performed by five hip surgeons.

Results: The precision of the acetabular vertical angles averaged 43 degrees +/-6.7 by visuo-spatial perception alone and 44 degrees +/-6.8 with the inclinometer. With the inclinometer and by visuo-spatial perception respectively, 12.8% and 9.3% of the cups were outside a safe angle range of 35–54 degrees. The standard deviation was +/-4.9 degrees for the inclinometer and +/-4.7 degrees for the visuo spatial perception method.

Conclusion: The use of an inclinometer is as precise as the visuo spatial perception of a hip surgeon. Positioning the cup with the inclinometer did not reduce the variability or improve the precision of the vertical acetabular position during total hip arthroplasty, suggesting it is not an essential adjunct in the clinical practice of hip surgeons. However, the inclinometer might be a valuable tool for surgeons performing a low volume of hip surgery.

We conducted a prospective randomised trial to compare the results of anatomical reduction and medial displacement osteotomy in 127 consecutive patients with unstable intertrochanteric fractures, of whom 109 completed the study. After an average follow-up of 11 months, we found no significant differences in walking ability, social status or failure of fixation in the two groups. Postoperative complication rates and the early mortality rate were not significantly different, but operating time and blood loss were significantly higher in the osteotomy group. With the use of modern sliding hip screws, medial displacement osteotomy is rarely indicated for unstable intertrochanteric fractures.