Aims. The benefit of a dual-mobility
Background. The current orthopaedic literature demonstrates a clear relationship between
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
Aims. Isolated acetabular liner exchange with a highly crosslinked polyethylene (HXLPE) component is an option to address polyethylene wear and osteolysis following total hip arthroplasty (THA) in the presence of a well-fixed acetabular shell. The liner can be fixed either with the original locking mechanism or by being cemented within the
We analysed the results of different strategies in the revision of primary uncemented
Aims. Dislocation remains a leading cause of failure following revision total hip arthroplasty (THA). While dual-mobility (DM) bearings have been shown to mitigate this risk, options are limited when retaining or implanting an uncemented shell without modular DM options. In these circumstances, a monoblock DM cup, designed for cementing, can be cemented into an uncemented acetabular shell. The goal of this study was to describe the implant survival, complications, and radiological outcomes of this construct. Methods. We identified 64 patients (65 hips) who had a single-design cemented DM cup cemented into an uncemented acetabular shell during revision THA between 2018 and 2020 at our institution. Cups were cemented into either uncemented cups designed for liner cementing (n = 48; 74%) or retained (n = 17; 26%)
Aims. To determine if primary cemented
In metal-on-metal (MoM) hip replacements or resurfacings, mechanical induced corrosion can lead to a local inflammatory response, pseudo tumours and elevated serum metal ions, requiring revision surgery. The size and diametral clearance of Anatomic (ADM) and Modular (MDM) Dual Mobility bearings matches that of certain MOM components. Presenting the opportunity for revision with exchange of the metal head for ADM/MDM bearings without removal of the
Aims. Various surgical techniques have been described for total hip arthroplasty (THA) in patients with Crowe type III dislocated hips, who have a large acetabular bone defect. The aim of this study was to evaluate the long-term clinical results of patients in whom anatomical reconstruction of the acetabulum was performed using a cemented
Aims. Uncemented metal
Aims. Appropriate
Aims. Mechanical impingement of the iliopsoas (IP) tendon accounts for 2% to 6% of persistent postoperative pain after total hip arthroplasty (THA). The most common initiator is anterior
Aims. Modular dual mobility (MDM)
Aims. Periprosthetic fracture and implant loosening are two of the major reasons for revision surgery of cementless implants. Optimal implant fixation with minimal bone damage is challenging in this procedure. This pilot study investigates whether vibratory implant insertion is gentler compared to consecutive single blows for
Abstract. Optimal
Aims. The aim of this study was to determine whether there is a difference
in the rate of wear between
Introduction. Re-revision due to instability and dislocation can occur in up to 1 in 4 cases following revision total hip arthroplasty (THA). Optimal placement of components during revision surgery is thus critical in avoiding re-revision. Computer-assisted navigation has been shown to improve the accuracy and precision of component placement in primary THA; however, its role in revision surgery is less well documented. The purpose of our study was to evaluate the effect of computer-assisted navigation on component placement in revision total hip arthroplasty, as compared with conventional surgery. Methods. To examine the effect of navigation on
Aims. To investigate the extent of bone development around the scaffold of custom triflange
Aims. The main aims were to identify risk factors predictive of a radiolucent line (RLL) around the
The Norwegian Arthroplasty Register has shown that several designs of uncemented femoral stems give good or excellent survivorship. The overall findings for uncemented total hip replacement however, have been disappointing because of poor results with the use of metal-backed
We compared the orientation of the
Aims. Custom triflange
Aims. Registry studies on modified acetabular polyethylene (PE) liner designs are limited. We investigated the influence of standard and modified PE acetabular liner designs on the revision rate for mechanical complications in primary cementless total hip arthroplasty (THA). Methods. We analyzed 151,096 primary cementless THAs from the German Arthroplasty Registry (EPRD) between November 2012 and November 2020. Cumulative incidence of revision for mechanical complications for standard and four modified PE liners (lipped, offset, angulated/offset, and angulated) was determined using competing risk analysis at one and seven years. Confounders were investigated with a Cox proportional-hazards model. Results. Median follow-up was 868 days (interquartile range 418 to 1,364). The offset liner design reduced the risk of revision (hazard ratio (HR) 0.68 (95% confidence interval (CI) 0.50 to 0.92)), while the angulated/offset liner increased the risk of revision for mechanical failure (HR 1.81 (95% CI 1.38 to 2.36)). The cumulative incidence of revision was lowest for the offset liner at one and seven years (1.0% (95% CI 0.7 to 1.3) and 1.8% (95% CI 1.0 to 3.0)). No difference was found between standard, lipped, and angulated liner designs. Higher age at index primary THA and an Elixhauser Comorbidity Index greater than 0 increased the revision risk in the first year after surgery. Implantation of a higher proportion of a single design of liner in a hospital reduced revision risk slightly but significantly (p = 0.001). Conclusion. The use of standard
Objectives. In order to address acetabular defects, porous metal revision
Introduction. Cup malpositioning remains a common cause of dislocation, wear, osteolysis, and revision. The concept of a “Safe Zone” for
Abstract. Background. Optimal
Aims. Accurate placement of the
Introduction. Cup malpositioning remains a common cause of dislocation, wear, osteolysis, and revision. The concept of a “Safe Zone” for
Orientation of the
We report the outcome of the flangeless, cemented all-polyethylene Exeter
Aims. We analyzed the acetabular morphology of Crowe type IV hips using CT data to identify a landmark for the ideal placement of the centre of the
Orientation of the native acetabular plane as defined by the transverse acetabular ligament (TAL) and the posterior labrum was measured intra-operatively using computer-assisted navigation in 39 hips. In order to assess the influence of alignment on impingement, the range of movement was calculated for that defined by the TAL and the posterior labrum and compared with a standard
In a prospective randomised clinical study
INTRODUCTION. Cup malpositioning remains a common cause of dislocation, wear, osteolysis, and revision. The concept of a “Safe Zone” for
A variety of radiological methods of measuring
version of the
Background. Ultraporous metals have now been used in acetabular reconstruction for two decades with excellent survival. The purpose of this study is to evaluate a newer porous metal made from Ti6Al4V titanium alloy in complex primary and revision hip arthroplasty. Methods. A retrospective review as performed on all total hip arthroplasty (THA) procedures in which a G7 Osseo-Ti (Zimmer Biomet, Warsaw, IN)
A modular layered
A well-fixed uncemented
Aims. This study aims to: determine the difference in pelvic position that occurs between surgery and radiographic, supine, postoperative assessment; examine how the difference in pelvic position influences subsequent component orientation; and establish whether differences in pelvic position, and thereafter component orientation, exist between total hip arthroplasties (THAs) performed in the supine versus the lateral decubitus positions. Patients and Methods. The intra- and postoperative anteroposterior pelvic radiographs of 321 THAs were included; 167 were performed with the patient supine using the anterior approach and 154 were performed with the patient in the lateral decubitus using the posterior approach. The inclination and anteversion of the
Aims. The stability of cementless
Aims. Accurate positioning of the
We treated 34 patients with recurrent dislocation of the hip with a constrained
Introduction:. Wear, wear-associated osteolysis, and instability are the most common reasons for revision total hip arthroplasty. These failures have been shown to be associated with
Abstract. Objectives. Accurate orientation of the
Aims. To compare the in vivo long-term fixation achieved by two
Aims. Dual-mobility
Aims. The aim of this study was to compare the incidence of aseptic
loosening after the use of a cemented
Introduction. The optimal
Recently, new metallurgical techniques allowed the creation of 3D metal matrices for cementless
Introduction. Proper
The practice of removing a well-fixed cementless
femoral component is associated with high morbidity. Ceramic bearing
couples are low wearing and their use minimises the risk of subsequent
further revision due to the production of wear debris. A total of
165 revision hip replacements were performed, in which a polyethylene-lined acetabular
component was revised to a new
Ideal placement of the
Cemented
We investigated the rate of polyethylene wear of a cementless
We present an update of the clinical and radiological results of 62 consecutive acetabular revisions using impacted morsellised cancellous bone grafts and a cemented
In a prospective study, 93 unselected consecutive uncemented hip arthroplasties were performed in 80 patients using the titanium-coated RM
Introduction. In total hip arthroplasty (THA), a high radiographic inclination angle (RI) of the
Introduction.
We reviewed the results at nine to 13 years of 125 total hip replacements in 113 patients using the monoblock uncemented Morscher press-fit
Cementless acetabular fixation has demonstrated superior long-term durability in total hip replacement, but most series have studied implants with porous metal surfaces. We retrospectively evaluated the results of 100 consecutive patients undergoing total hip replacement where a non-porous Allofit component was used for primary press-fit fixation. This implant is titanium alloy, grit-blasted, with a macrostructure of forged teeth and has a biradial shape. A total of 81 patients (82 hips) were evaluated at final follow-up at a mean of 10.1 years (8.9 to 11.9). The Harris Hip Score improved from a mean 53 points (23 to 73) pre-operatively to a mean of 96 points (78 to 100) at final review. The osseointegration of all
Aims. The hypothesis of this study was that thigh circumference, distinct from body mass index (BMI), may be associated with the positioning of components when undertaking total hip arthroplasty (THA) using the direct anterior approach (DAA), and that an increased circumference might increase the technical difficulty. Patients and Methods. We performed a retrospective review of prospectively collected data involving 155 consecutive THAs among 148 patients undertaken using the DAA at an academic medical centre by a single fellowship-trained surgeon. Preoperatively, thigh circumference was measured at 10 cm, 20 cm, and 30 cm distal to the anterior superior iliac spine, in quartiles. Two blinded reviewers assessed the inclination and anteversion of the
Polyethylene wear of
Aims. Several radiological methods of measuring anteversion of the
Cemented
Between November 1997 and December 2000 we performed 27 total hip replacements in 22 patients with high congenital dislocation of the hip using porous tantalum monoblock
Four hundred and fifteen patients with cementless
The ‘jumbo’
Aims. It is important to consider sagittal pelvic rotation when introducing
the
Introduction. Long-term success of the cementless
The treatment of extensive bone loss and massive acetabular defects is a challenging procedure, especially the concomitant pelvic discontinuity (PD) can be compounded by several challenges and pitfalls. The appropriate treatment strategy is to restore a stable continuity between the ischium and the ilium and to reconstruct the anatomical hip center. Antiprotrusio cages, metal augments, reconstruction cages with screw fixation, structural allograft with plating, jumbo cups, oblong cups and custom-made triflange
We performed 114 consecutive primary total hip arthroplasties with a cementless expansion
Implantation of a large-diameter femoral head prosthesis with a metal-on-metal bearing surface reduces the risk of dislocation, increases the range of movement, minimises the risk of impingement and, in theory, results in little wear. Between February 2004 and March 2007 we implanted 100 consecutive total hip replacements with a metal-on-metal bearing and a large femoral head into 92 patients. There were 51 men and 41 women with a mean age of 50 years (18 to 70) at the time of surgery. Outcome was assessed using the Western Ontario McMaster University osteoarthritis index and the Harris hip score as well as the Devane activity score. These all improved significantly (p <
0.0001). At the last follow-up there were no cases of dislocation, no impingement, a good range of movement and no osteolysis, but seven revisions, two for infection and five for aseptic loosening. The probability of groin pain increased if the other
Introduction.
Aims. The aim of this systematic review was to report the rate of dislocation
following the use of dual mobility (DM)
Aims . The highly cross-linked polyethylene Exeter RimFit flanged cemented
acetabular component was introduced in the United Kingdom in 2010.
This study aimed to examine the rates of emergence of radiolucent
lines observed when the Rimfit
Between January 1998 and December 1998, 82 consecutive patients (86 hips) underwent total hip arthroplasty using a trabecular metal monoblock
We have reviewed 70 Harris-Galante uncemented
We examined the relationships between the serum levels of chromium and cobalt ions and the inclination angle of the
The angle of inclination of the
Introduction: The development of Inflammatory Pseudotumour (IP) is a recognised complication following Metal on Metal Hip Resurfacing Arthroplasty (MoMHRA), thought to occur secondary to wear and elevated ion levels. Studies have shown that
Ensuring the accuracy of the intra-operative orientation of the
Objectives: We present the level of biological fixation and the medium-term results of the hemispherical porous coated
Revision of total hip arthroplasty (THA) is being performed with increasing frequency. However, outcomes of repeated revisions have been rarely reported in the literature, especially for severe defects. Cup revision can be a highly complex operation depending on the bone defect. In acetabular defects like Paprosky types 1 and 2 porous cementless cups maybe fixed with screws give good results. Modern trabecular metal designs improve these good results. Allografts are useful for filling cavitary defects. In acetabular defects Paprosky types 3A and 3B, impacted morselised allografts with a cemented cup technique produce good results. Difficult cases with pelvic discontinuity require reconstruction of the acetabulum with acetabular plates or large cup-cages to solve these difficult problems. However, there is still no consensus regarding the best option for reconstructing hips with bone loss. Although the introduction of ultraporous metals has significantly increased the surgeon's ability to reconstruct severely compromised hips, there remain some that cannot be managed readily using cups, augments, or cages. In such situations custom
Background. The cementless
Revision of total hip arthroplasty (THA) is being performed with increasing frequency. However, outcomes of repeated revisions have been rarely reported in the literature, especially for severe defects. Cup revision can be a highly complex operation depending on the bone defect. In acetabular defects like Paprosky types 1 and 2 porous cementless cups fixed with screws give good results. Modern trabecular metal designs improve these good results. Allografts are useful for filling cavitary defects. In acetabular defects Paprosky types 3A and 3B, especially the use of trabecular metal cups, wedges, buttresses and cup-cage systems can produce good results. Difficult cases in combination with pelvic discontinuity require reconstruction of the acetabulum with acetabular plates or large cup-cages to solve these difficult problems. However, there is still no consensus regarding the best option for reconstructing hips with bone loss. Although the introduction of ultraporous metals has significantly increased the surgeon's ability to reconstruct severely compromised hips, there remain some that cannot be managed readily using cups, augments, or cages. In such situations custom
Purpose. To review prospectively collected data on patients undergoing primary total hip arthroplasty utilizing two different cementless
Background. Radiostereometric Analysis (RSA) is an accurate measure of implant migration following total joint replacement surgery. Early implant migration predicts later loosening and implant failure, with RSA a proven short-term predictor of long-term survivorship. The proximal migration of an acetabular cup has been demonstrated to be a surrogate measure of component loosening and the associated risk of revision. RSA was used to assess migration of the R3
Aims. Custom flange
Aims. The aim of this study was to assess the reproducibility and validity
of cross table radiographs for measuring the anteversion of the
acetabular component after total hip arthroplasty (THA) and to compare
it with measurements using CT scans. Patients and Methods. A total of 29 patients who underwent THA between June 2010 and
January 2016 were included. There were 17 men and 12 women. Their
mean age was 43 years (26 to 65). Seven patients underwent a bilateral
procedure. Thus, 36 THAs were included in the study. Lateral radiographs
and CT scans were obtained post-operatively and radiographs repeated
three weeks later. The anteversion of the
We reviewed the clinical and radiological results of 131 patients who underwent acetabular revision for aseptic loosening with impacted bone allograft and a cemented
Porous tantalum is a highly osteoinductive biomaterial, initially introduced in orthopedics in 1997, with a subsequent rapid evolution of orthopedic applications. The use of porous tantalum for the
Aims. Accurate placement of the
The Morscher Cup is an
Introduction: Pelvic and acetabular reconstruction following tumor resections are often difficult and fraught with complications. This is the first report of a reconstruction utilizing sacral implantation of an
Acetabular cup positioning remains a real challenge and component malpositioning after total hip arthroplasty (THA) can lead to increased rates of dislocation and wear. It is a common cause for revision THA. A novel 3D imageless mini-optical navigation system was used during THA to provide accurate, intraoperative, real-time, and non-fluoroscopic data including component positioning to the surgeon. This retrospective comparative single surgeon and single approach study examined
Aims. The aim of the study was to investigate whether the primary stability of press-fit
Aims. We previously reported the long-term results of the cementless Duraloc-Profile total hip arthroplasty (THA) system in a 12- to 15-year follow-up study. In this paper, we provide an update on the clinical and radiological results of a previously reported cohort of patients at 23 to 26 years´ follow-up. Patients and Methods. Of the 99 original patients (111 hips), 73 patients (82 hips) with a mean age of 56.8 years (21 to 70) were available for clinical and radiological study at a minimum follow-up of 23 years. There were 40 female patients (44 hips) and 33 male patients (38 hips). Results. All acetabular and femoral components were well fixed and showed signs of bone ingrowth. Nine
Aims. This study aimed to determine the diagnostic performance of radiographic
criteria to detect aseptic acetabular loosening after revision total
hip arthroplasty (THA). Secondary aims were to determine the predictive
values of different thresholds of migration and to determine the
predictive values of radiolucency criteria. Patients and Methods. Acetabular component migration to re-revision was measured retrospectively
using Ein-Bild-Rontgen-Analyse (EBRA-Cup) and manual measurements
(Sutherland method) in two groups: Group A, 52 components (48 patients) found
not loose at re-revision and Group B, 42 components (36 patients)
found loose at re-revision between 1980 and 2015. The presence and
extent of radiolucent lines was also assessed. Results. Using EBRA, both proximal translation and sagittal rotation were
excellent diagnostic tests for detecting aseptic loosening. The
area under the receiver operating characteristic (ROC) curves was
0.94 and 0.93, respectively. The thresholds of 2.5 mm proximal translation
or 2° sagittal rotation (EBRA) in combination with radiolucency
criteria had a sensitivity of 93% and specificity of 88% to detect
aseptic loosening. The sensitivity, specificity, positive predictive
value and negative predictive value (NPV) of radiolucency criteria
were 41%, 100%, 100% and 68% respectively. Manual measurements of
both proximal translation and sagittal rotation were very good diagnostic tests.
The area under the ROC curve was 0.86 and 0.92 respectively. However,
manual measurements had a decreased specificity compared with EBRA.
Radiolucency criteria had a poor sensitivity and NPV of 41% and
68% respectively. Conclusion. This study shows that EBRA and manual migration measurements
can be used as accurate diagnostic tools to detect aseptic loosening
of cementless
Aims: Dislocation is one of the commonest complications following total hip arthroplasty. A significant proportion of these patients go on to have recurrent dislocations. Many factors have been identified as contributing to the risk of dislocation but treatment of recurrent dislocation is challenging. The use of semicaptive
The ideal