Aims. The purpose of this study was to assess the reliability and responsiveness to
Aims. In UK there are around 76,000 hip fractures occur each year 10% to 15% of which are undisplaced intracapsular. There is considerable debate whether internal fixation is the most appropriate treatment for undisplaced fractures in older patients. This study describes cannulated hip screws survivorship analysis for patients aged ≥ 60 years with undisplaced intra-capsular fractures. Methods. This was a retrospective cohort study of consecutive patients aged ≥ 60 years who had cannulated screws fixation for Garden I and II fractures in a teaching hospital between March 2013 and March 2016. The primary outcome was further same-side
Aims. This study aimed to develop and validate a fully automated system that quantifies proximal femoral bone mineral density (BMD) from CT images. Methods. The study analyzed 978 pairs of hip CT and dual-energy X-ray absorptiometry (DXA) measurements of the proximal femur (DXA-BMD) collected from three institutions. From the CT images, the femur and a calibration phantom were automatically segmented using previously trained deep-learning models. The Hounsfield units of each voxel were converted into density (mg/cm. 3. ). Then, a deep-learning model trained by manual landmark selection of 315 cases was developed to select the landmarks at the proximal femur to rotate the CT volume to the neutral position. Finally, the CT volume of the femur was projected onto the coronal plane, and the areal BMD of the proximal femur (CT-aBMD) was quantified. CT-aBMD correlated to DXA-BMD, and a receiver operating characteristic (ROC) analysis quantified the accuracy in diagnosing osteoporosis. Results. CT-aBMD was successfully measured in 976/978 hips (99.8%). A significant correlation was found between CT-aBMD and DXA-BMD (r = 0.941; p < 0.001). In the ROC analysis, the area under the curve to diagnose osteoporosis was 0.976. The diagnostic sensitivity and specificity were 88.9% and 96%, respectively, with the cutoff set at 0.625 g/cm. 2. . Conclusion. Accurate DXA-BMD measurements and diagnosis of osteoporosis were performed from CT images using the system developed herein. As the models are open-source, clinicians can use the proposed system to screen osteoporosis and determine the surgical strategy for
The primary treatment goal for patients with femoroacetabular impingement syndrome, a common hip condition in athletes, is to improve pain and function. In selected patients, in the short term following intervention, arthroscopic
Young patients undergoing THA or hip used. HOS and iHOT33 have demonstrated to be useful in
Aims. In the native hip, the hip capsular ligaments tighten at the limits of range of hip motion and may provide a passive stabilizing force to protect the hip against edge loading. In this study we quantified the stabilizing force vectors generated by capsular ligaments at extreme range of motion (ROM), and examined their ability to prevent edge loading. Methods. Torque-rotation curves were obtained from nine cadaveric hips to define the rotational restraint contributions of the capsular ligaments in 36 positions. A ligament model was developed to determine the line-of-action and effective moment arms of the medial/lateral iliofemoral, ischiofemoral, and pubofemoral ligaments in all positions. The functioning ligament forces and stiffness were determined at 5 Nm rotational restraint. In each position, the contribution of engaged capsular ligaments to the joint reaction force was used to evaluate the net force vector generated by the capsule. Results. The medial and lateral arms of the iliofemoral ligament generated the highest inbound force vector in positions combining extension and adduction providing anterior stability. The ischiofemoral ligament generated the highest inbound force in flexion with adduction and internal rotation (FADIR), reducing the risk of posterior dislocation. In this position the hip joint reaction force moved 0.8° inbound per Nm of internal capsular restraint, preventing edge loading. Conclusion. The capsular ligaments contribute to keep the joint force vector inbound from the edge of the acetabulum at extreme ROM. Preservation and appropriate tensioning of these structures following any type of
The challenges faced by hip surgeons have changed over the last decade. Historically, fixation, polyethylene wear, osteolysis, loosening and failure to osseointegrate dominated the discussions at
When removing femoral cement in revision
An international faculty of orthopaedic surgeons
presented their work on the current challenges in
Genetic skeletal disorders constitute a rare and heterogeneous bone diseases often leading to poor quality of life. Several surgical options are available. The surgeon must deal with specific features (bone deformity, previous procedures, abnormal bone quality, stiffness or instability, muscle weakness). The questions concern the feasibility of the procedures and the surgical strategy. 55 patients (26 W, 29 M) were reviewed between 2016 and 2022. The mean age of the patients was 35 years (17–71). The diagnosis included 9 hereditary multiple exostoses, 8 osteogenesis imperfecta, 6 multiple epiphyseal dysplasia congenita, 6 achondroplasia, 4 osteopetrosis, 3 pycnodysostosis, 3 hypophosphatemic rickets, 3 fibrous dysplasia, 2 mucopolysaccharidosis, and 10 miscellaneous. 25 patients were referred for hip problems (40 hips). 4 patients (7 hips) requiring a THA have not been operated (4 planned). 4 patients (6 hips) had a proximal femoral fixation (2 osteotomies, 4 fracture fixations). 17 patients (27 hips) sustained a THA (25 primary, 2 revisions). All of them were operated by one operator, using a posterolateral approach and standard implants (including 7 dysplastic and 2 short stems). No customized implant has been used. As regard the 27 THAs, the mean follow up was 4.2 years (1–12). The early complications included 2 femoral cracks and 1 femur fracture. There were 2 revisions (1 cup loosening at 2 years, 1 stem loosening at 4 years). No infection nor dislocation occurred. All the patients were satisfied with their treatment and regain some autonomy. 3 THA were considered as unfeasible. Constitutional bone diseases need a multidisciplinary program of care. The indication for surgery is based on a mutual trust patient/surgeon, a careful evaluation of benefits/risks, and an accurate imaging to anticipate the difficulties. The expected results are a better function and quality of life, and a stability over time.
Fracture of contemporary femoral stems is a rare occurrence. Earlier THR stems failed due to design issues or post manufacturing heat treatments that weakened the core metal. Our group identified and analyzed 4 contemporary fractured femoral stems after revision surgery in which electrochemical welds contributed to the failure. All four stems were proximally porous coated titanium alloy components. All failures occurred in the neck region post revision surgery in an acetabular cup exchange. All were men and obese. The fractures occurred at an average of 3.6 years post THR redo (range, 1.0–6.5 years) and 8.3 years post index surgery (range, 5.5–12.0 years). To demonstrate the effect of electrocautery on retained femoral stems following revision surgery, we applied intermittent electrosurgical currents at three intensities (30, 60, 90 watts) to the polished neck surface of a titanium alloy stem under dry conditions. At all power settings, visible discoloration and damage to the polished neck surface was observed. The localized patterns and altered metal surface features exhibited were like the electrosurgically-induced damage priorly reported. The neck regions of all components studied displayed extensive mechanical and/or electrocautery damage in the area of fracture initiation. The use of mechanical instruments and electrocautery was documented to remove tissues in all 4 cases. The combination of mechanical and electrocautery damage to the femoral neck and stem served as an initiation point and stress riser for subsequent fractures. The electrocautery and mechanical damage across the fracture site observed occurred iatrogenically during revision surgery. The notch effect, particularly in titanium alloys, due to mechanical and/or electrocautery damage, further reduced the fatigue strength at the fractured femoral necks. While electrocautery and mechanical dissection is often required during revision THA, these failures highlight the need for caution during this step of the procedure in cases where the femoral stem is retained.
Hip fractures are a major cause of morbidity and mortality, and malnutrition is a crucial determinant of these outcomes. This meta-analysis aims to determine whether oral nutritional supplementation (ONS) improves postoperative outcomes in older patients with a hip fracture. A systematic literature search was conducted in August 2022. ONS was defined as high protein-based diet strategies containing (or not containing) carbohydrates, fat, vitamins, and minerals. Randomized trials documenting ONS in older patients with hip fracture (aged ≥ 50 years) were included. Two reviewers evaluated study eligibility, conducted data extraction, and assessed study quality.Aims
Methods
The challenges faced by hip surgeons have changed over the last decade. Historically, fixation, polyethylene wear, osteolysis, loosening and failure to osseointegrate dominated the discussions at
The disadvantages of hip spica casts following
Objective of the study is to determine to what extent patients experience more limitations 1–5 years after revision total hip arthroplasty (THA) compared to patients after primary THA, and if this is accompanied by a reduction in physical activity behavior. Five hundred and six patients were included: 372 primary and 134 revision THA. Questionnaires were used to measure limitations and physical activity. Linear regression analysis showed that patients after revision surgery report significantly more, clinically relevant limitations compared with primary THA patients, but did not show a significant difference in mean total minutes of physical activity per week. Physical activity behavior appeared to be similar for primary and revision THA patients. The results stress the importance of determining different aspects of recovery after THA.
The aim of this study is to evaluate which patients, if any, can be eligible for a rapid discharge from
Peripheral nerve injury is an uncommon but serious
complication of
We describe the clinical and radiological results of 120 consecutive revision hip replacements in 107 patients, using the JRI Furlong hydroxyapatite-ceramic-coated femoral component. The mean age of the patients at operation was 71 years (36 to 92) and the mean length of follow-up 8.0 years (5.0 to 12.4). We included patients on whom previous revision
Introduction: With an ever-increasing elderly population the rise in primary total hip replacement is inevitable. This translates into a comparative rise in revision
Introduction: Revision
The burden of revision total hip arthroplasty (rTHA) continues to grow. The surgery is complex and associated with significant costs. Regional rTHA networks have been proposed to improve outcomes and to reduce re-revisions, and therefore costs. The aim of this study was to accurately quantify the cost and reimbursement for a rTHA service, and to assess the financial impact of case complexity at a tertiary referral centre within the NHS. A retrospective analysis of all revision hip procedures was performed at this centre over two consecutive financial years (2018 to 2020). Cases were classified according to the Revision Hip Complexity Classification (RHCC) and whether they were infected or non-infected. Patients with an American Society of Anesthesiologists (ASA) grade ≥ III or BMI ≥ 40 kg/m2 are considered “high risk” by the RHCC. Costs were calculated using the Patient Level Information and Costing System (PLICS), and remuneration based on Healthcare Resource Groups (HRG) data. The primary outcome was the financial difference between tariff and cost per patient episode.Aims
Methods
Significant proximal femoral bone deficiency in revision
Litigation costs are significant and increasing annually within the National Health Service (NHS) in England. The aim of this work was to evaluate the burden of successful litigation relating to
Background. Revision total hip arthroplasty is a technically demanding procedure and especially removing a well fixed femoral stem is a challenge for revision surgeons. There are various types of trochanteric osteotomies used during revision surgery; extended trochanteric osteotomy (ETO) is being more popular. Aim. The aim of this study is to look at types of trochanteric osteotomy used during the revision surgery. We looked at the success and failure of these osteotomies. Failure of the osteotomy is defined by complete pull off by the hip abductors resulting in osteotomy fragment is no contact with the femur. We sought to assess the time to healing of osteotomy and number of cables used. Methods. We retrospectively reviewed the hospital theatre database and identified 97 patients who underwent revision
Introduction: Revision
The aim of this study is to evaluate techniques which may reduce intra and Post-Operative (PO) bleeding in
Postoperative dislocations are known to be a big problem in revision surgery. In literature dislocation rates vary from 4.8% to 33% after previous surgery. In revision surgery, impingement of the implant components, the capsular and soft tissue release, muscular weakness and greater trochanter problems can give additional instability. The reason for revision is important, where instability, infection and tumour cases will lead to a higher percentage of dislocations. The use of big metal heads on polyethylene should be avoided because of the higher volumetric wear. With the new developments of metal-on-metal hip resurfacing and the production of big modular metal heads, the metal-on-metal bearing should guarantee a low-wear result without osteolysis. Between November 2000 and December 2003 45 patients requiring a revision were treated with a Birmingham Hip Resurfacing cup (MMT, UK) and a big metal-on-metal modular head. All surgery was done with a posterolateral approach. Cup sizes range from 44 to 66 mm, head sizes range from 38 to 58 mm. The head sizes most often used were 58 mm, 54 mm and 50 mm. All patients were prospective followed using the Orthowave software (CRDA France). In this series of 45 revisions (mean age 56.17) with large modular heads we encountered 2 dislocations, which give us a dislocation rate of 4.4%. One of these dislocations became recurrent and was revised to a full-constrained acetabular component. Our own dislocation rate in revision
Allogenic blood is a finite resource, with associated risks. Previous studies have shown intra-operative cell salvage (ICS) can reduce allogenic transfusion rates in orthopaedic surgery. However, recent concerns regarding the efficacy and cost-effectiveness of ICS mean we must continually re-assess its usefulness in current practice. This study was carried out to review the use of ICS, to establish if its use has led to a reduction in patient exposure to post-op allogenic transfusion. All orthopaedic patients who underwent ICS and re-infusion between 2008–2010 in the Southern General Hospital (SGH) were audited. The Haemoglobin (Hb) drop, volume of blood re-infused and post-op allogenic transfusion rates were recorded. The revision hip group was compared to a similar SGH cohort, who underwent surgery by the same surgeons between 2006–2008, and a pre-2005 control group. The Cell Saver (Haemonetics) machine was used. The proportion of patients who received a post-op allogenic transfusion fell by 55% in the 2008–2010 ICS cohort compared with the control, and by 40% compared with the previous ICS study group. In both instances, this was accompanied by a statistically significant (p<0.001) reduction in mean number of units transfused per patient. ICS has been shown to be effective in reducing rates and volume of post-op allogenic transfusion in patients undergoing revision
Background: Perioperative red cell salvage may be of use in cases where significant blood loss is likely. The purpose of this investigation was to see if its use in revision
Background: Perioperative red cell salvage may be of use in cases where significant blood loss is likely. The purpose of this investigation was to see if its use in revision
Introduction. Revision hip arthroplasty with massive proximal femoral bone loss remains challenging. Whilst several surgical techniques have been described, few have reported long term supporting data. A proximal femoral allograft (PFA) may be used to reconstitute bone stock in the multiply revised femur with segmental bone loss of greater than 8 cm. This study reports the outcome of largest case series of PFA used in revision hip arthroplasty. Methods. Data was prospectively collected from a consecutive series of 69 revision hip cases incorporating PFA and retrospective analyzed. Allografts of greater than 8 cm in length (average 14cm) implanted to replace deficient bone stock during revision
Introduction: In a climate of tightening budgets and rising cost the pressure on those performing complex and expensive surgery is ever increasing. Patients requiring revision
Purpose. Tape blisters after
Introduction: Recurrent dislocation is a significant problem after total hip replacement. Aetiology is multifactorial and treatment should address the reason for dislocation. The use of a constrained tripolar liner is an option in the surgical treatment of dislocation. Methods: A retrospective review was carried out of patients who have undergone revision
Introduction: Recurrent dislocation can be a significant problem after total hip replacement. The use of a constrained tripolar liner is an option in the surgical treatment of dislocation or instability. Methods: A retrospective review was carried out of patients identified from a prospective database. All patients had a constrained liner cemented onto a satisfactory pre-existing cement mantle, cemented into a reconstruction ring, or cemented into a well fixed cementless shell. The Osteonics Tripolar Liner was used in all cases; the outer aspect of the liner was prepared with a burr to create grooves and thus improve cement interlock. Data collected included demographics, reason for revision, re-revision rate, outcome and survival. Results: There were 58 cases identified where a cemented constrained liner was inserted at revision
Introduction. Surgical simulation and ‘virtual’ surgical tools are becoming recognised as essential aids for speciality training in Trauma & Orthopaedics, as evidenced by the BOA T&O Simulation Curriculum 2013. 1,2. The current generation of hip arthroplasty simulators, including cadaveric workshops, offers the trainee limited exposure to reproducible real life bony pathology. We developed and implemented a novel training course using pathological dry bone models generated from real patient cases to support senior orthopaedic trainees and new consultants in developing knowledge and hands on skills in complex total hip arthroplasty. Patient/Materials & Methods. A two-day programme for 20 delegates was held at a specialist centre for hip arthroplasty. Three complex femoral and three complex acetabular cases were identified from patients seen at our centre. 3D models were printed from CT scans and dry bone models produced (using a mold-casting process), enabling each delegate to have a copy of each case at a cost of around £30 per case per delegate (Figure 1). The faculty was led by 4 senior Consultant revision hip surgeons. A computerised digitising arm was used to measure cup positioning and femoral stem version giving candidates immediate objective feedback (Figure 2). Candidate experience and satisfaction with the course and models was evaluated with a standardised post-course questionnaire. Results. 91% of respondents rated overall course satisfaction good or very good with 100% stating learning objectives were met or exceeded. 100% of delegates rated the bone model workshop cases as good or very good for the acetabular course, and 88% for the femoral course. Discussion. This course has been shown to enhance learning of surgical techniques and skills in complex
On the basis of observations made in recent years, it can be inferred that the incidence of venous thromboembolism (VTE) in Japan is as high as that in Western countries. Since 2007, the use of fondaparinux for the prophylaxis of VTE following lower-limb orthopedic surgery has been approved for Japanese patients. This study was performed with an aim to investigate the safety and efficacy of fondaparinux for the prevention of VTE following
Tantalum is a pure metallic element and is attractive for use in orthopaedic implants because it is one of the most biocompatible metals available for implant fabrication. The potential advantages for the use of porous tantalum in total hip arthroplasty include:. excellent bone and tissue ingrowth observed histologically;. direct polyethylene intrusion into the metal substrate. This allows the elimination of any potential backside wear in the monoblock cup;. The two-piece design consist of a tantalum shell with screw holes for fixation into the dome of the ilium and posterior column. A polyethylene liner is cemented into the tantalum shell to eliminates backside motion. In addition, acetabular augments of porous tantalum have been developed for use in restoration of major bone deficiencies. Prospective study on a case serie of 113 THA’s performed by two surgeons in a single institution. From 2000 to December 2003, 113 hips have undergone arthroplasty using porous tantalum implants consisting of 54 primary hip arthroplasties and 59 revision THA’s. The patients where evaluated clinical and radiographically every 3 month during the first year, and after yearly. Mean patient age was 64,2 years, (range 44–87); with 59% males and 41% females. No patients died or lost to follow-up. No further surgeries of the involved hip. No radiographic signs of loosening of the acetabular component according to the criteria of Hodgkinson et al. No problems specifically from the use of acetabular augments or extra screws has been noted. Of the revision series, a total of 16 cases have received acetabular augments. Complications included 1 superficial infection, 2 dislocations. No vasculonervous complication; and in 2 cases technical difficulties to achieve good fixation due to ethiology of the THA (desarthrodesis). The average Harris hip score improved from 48 to 89 following primary surgery. Tantalum acetabular components for primary and revision
Tantalum is a pure metallic element and is attractive for use in orthopaedic implants because it is one of the most biocompatible metals available for implant fabrication. The potential advantages for the use of porous tantalum in total hip arthroplasty include:. excellent bone and tissue in growth observed histologically;. direct polyethylene intrusion into the metal substrate. This allows the elimination of any potential backside wear in the monoblock cup;. The two-piece design consist of a tantalum shell with screw holes for fixation into the dome of the ilium and posterior column. A polyethylene liner is cemented into the tantalum shell to eliminates backside motion. In addition, acetabular augments of porous tantalum have been developed for use in restoration of major bone deficiencies. Prospective study on a case serie of 113 THA’s performed by two surgeons in a single institution. From 2000 to December 2003, 113 hips have undergone arthroplasty using porous tantalum implants consisting of 54 primary hip arthroplasties and 59 revision THA’s. The patients where evaluated clinical and radiographically every 3 month during the first year, and after yearly. Mean patient age was 64,2 years, (range 44–87); with 59% males and 41% females. No patients died or lost to follow-up. No further surgeries of the involved hip. No radiographic signs of loosening of the acetabular component according to the criteria of Hodgkinson et al. No problems specifically from the use of acetabular augments or extra screws has been noted. Of the revision series, a total of 16 cases have received acetabular augments. Complications included 1 superficial infection, 2 dislocations. No vasculo-nervous complication; and in 2 cases technical difficulties to achieve good fixation due to ethiology of the THA (desarthrodesis). The average Harris hip score improved from 48 to 89 following primary surgery. Tantalum acetabular components for primary and revision
We describe the clinical and radiological results of 120 consecutive revision hip replacements in 107 patients, using a titanium alloy femoral component fully coated with Hydroxyapatite ceramic (HAC). The mean age at operation was 71 years (range 36 to 92). The average length of follow up was 8.0 years (range 5.0 to 12.4). All patients receiving a JRI Furlong HAC coated femoral component (JRI Instrumentation Ltd, London, UK) with a minimum follow up of 5 years were included. These included patients on whom previous revision
Queen Elizabeth the Queen Mother Hospital, Margate, East Kent Hospitals NHS University Trust, UK. PURPOSE. Surfaces of supports used to position patients for hip replacement are usually are in direct contact with the patient skin around the groin/buttock areas & repeated use of same supports, in trauma & elective surgeries, can be a source of cross-infection & wound contamination. MATERIALS AND RESULTS. Swab samples from 12 supports, employed interchangeably for elective & trauma surgery. Cultured & incubated at 37 0 C in Columbia Blood Agar. 2 random supports cleaned using Sani Cloth Detergent non-alcoholic wipes & 2 samples were obtained from each support, 5 min later. 71% sampled supports were contaminated, with Coagulase-negative Staphylococcus, including Staph Epidermidis, being the most commonly grown organism with average of 5.3 colony forming units (CFU) (0-38) per swab. 5 min after cleaning 2 of above supports there was a 100% reduction in their contamination with no growth from the 4 swabs. CONCLUSION. Trauma patients are not necessarily subjected to groin MRSA swabs pre-operatively in contrast to patients undergoing elective
Introduction and objective: Infection is one of the greatest threats in
Purpose. The purpose of this paper is to describe the outcomes of major
Aim. Different perioperative strategies have been implemented to reduce the devastating burden of infection following arthroplasty. The use of iodophor-impregnated adhesive incise drapes is one such strategy. Despite its wide adoption, there is little proof that this practice leads to a reduction of bacterial colonization. The aim of this randomized, prospective study was to evaluate the efficacy of iodophor-impregnated adhesive drapes for reducing bacterial count at the incision site. Method. A total of 96 patients undergoing open joint preservation procedure of the hip were enrolled in this prospective, randomized clinical trial of iodophor-impregnated adhesive drapes. *. One half of patients (n=48) had iodophor-impregnated adhesive drapes. *. applied to the skin prior to incision and kept on throughout the procedure, while the other half (n=48) underwent the same surgery without the use of iodophor-impregnated adhesive drapes. *. Culture swabs were taken from the surgical site at five different time points during surgery (pre-skin preparation, after skin preparation, post-incision, before subcutaneous closure, and prior to dressing application) and sent for culture and colony counts. Mixed-effects and multiple logistic regression analyses were utilized. Results. Iodophor-impregnated adhesive drapes resulted in a significant reduction of bacterial colonization of the surgical incision. At the conclusion of surgery, 12.5% (6/48) of incisions with iodophor-impregnated adhesive drapes. *. and 27.0% (13/48) without adhesive drapes were positive for bacteria. When controlling for preoperative colonization and other factors, patients without adhesive drapes were significantly more likely to have bacteria present at the incision at the time of closure (odds ratio (OR) 11.88, 95% confidence interval (CI) 1.45–80.00), and at all time-points when swab cultures were taken (OR 2.48, 95% CI 1.00–6.15). Conclusions. Based on this skin sampling study, incise draping significantly reduces the rate of bacterial colonization/contamination during
Angiogenesis, the growth of new blood vessels from pre-existing vasculature has an obvious and essential role in soft and hard tissue repair. During the wound healing many potential angiogenic factors are released and may be found in circulating blood. The most important are basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF). Experimental data confirm the important role of VEGF and bFGF in wounds and bone healing. It was proved that heparin and its low-molecular derivatives may interfere with various steps of angiogenesis process. Enoxaparine (En) is frequently used as anticoagulant for prophylaxis of thromboembolic complications. The aim of this study was to evaluate in vivo angiogenic potency and VEGF and bFGF content of sera collected from 7 patients after
Open and arthroscopic hip debridement may be used for treatment of femoral acetabular impingement (FAI). There is a paucity of evidence regarding the efficacy of one over the other. To compare survivorship in terms of further surgical procedure at five years, in patients having undergone either arthroscopic or open hip debridement.Introduction
Aim
Introduction: Severe stress shielding and radiographic cortical changes in the proximal femur are frequent after extensively porous-coated stem in revision surgery. We have analyzed the evolution of the femoral cortex at different levels and related factors. Material and Methods: We assessed 95 extensively porous-coated stems in revision surgery with a minimum 5-year follow-up (Mean 10.2 years). 77 hips were revised due to aseptic loosening and 18 due to periprosthetic fractures. Extended osteotomy was used in 29 hips. No cortical struts were used. Preoperative and postoperative osteoporosis was graded according to Moreland and bone defect according to Paprosky. Femoral cortex width was measured at different levels in the immediate postoperative radiograph, at 3, 6 and 12 months and at the last follow-up. Results: There were 2 re-revisions for aseptic loosening. Radiographic ingrowth fixation was more frequent in minor intraoperative bone defects (p=0.011). Preoperative osteoporosis was related to the width of the medial and lateral cortex. Medial cortical thickness increased at different levels with a mean increase of 13.4% (p<
0.001) and the lateral cortical thickness showed a mean decrease of 2.7% at the proximal level. The femoral medial cortex tended to show a higher slope trend in periprosthetic fractures (p=0.015). The outside femoral diameter increased more rapidaly with an extended trochanteric osteotomy (p=0.007). The slope trend of the lateral and medial cortex was significantly higher at proximal levels in hips with a 10-inch stem (p=0.015). Conclusions: Although without clinical relevance at the end of follow-up, femoral medial cortical thickness increased while frequently lateral cortical thickness decreased over time after an extensively porous -coated stem in revision