Introduction

Osteoarthritis (OA) of the hip is an important cause of pain and morbidity. The mechanisms and pathogenesis of OA'sdevelopment remain unknown. Minor acetabular dysplasia and subtle variations in proximal femoral morphology are increasingly being recognized as factors that potentially compromise the joint biomechanically and lead to OA. Previous studies have shown that risk of hip OA increased as the femoral head to femoral neck ratio (HNR) decreased. Previous work has described the evolutionary change in inferior femoral neck trabecular density and geometry associated with upright stance, but no study has highlighted the evolutionary change in HNR. The aim of this study was to examine evolutionary evidence that the hominin bipedal stance has lead to alterations in HNR that would predispose humans to hip OA.

Total Hip Arthroplasty (THA) is one of the most successful and cost-effective treatments available for painful hip arthritis. Unfortunately, dislocation following primary THA is one of the most common complications, occurring in approximately 0.50–10percnt; cases. However, there is little literature that investigates the effects that dislocation has on the patient's overall function and satisfaction. We reviewed 229 THA patients that had sustained dislocation from a prospective database, consisting 156 single dislocations and 73 with two or more. Patient outcomes were compared with a matched control group of 196 patients without dislocation in the same follow-up period. Harris Hip Score (HHS) and patient satisfaction were recorded pre-operatively and at one, five and ten years post-operatively. Mann-Whitney test compared HHS between control and dislocation groups, Chi-Square test compared patient satisfaction and implant survival. Total HHS and functional component were significantly lower in the dislocation group at one, five and ten years (p<0.05). HHS Pain component revealed a significant difference but only at one and three years (p<0.05). Patient satisfaction only showed a significant difference at one-year review. Dislocation rates were significantly higher in females. Implant survivorship was significantly lower in the dislocation group at 15-years. Hip-function and implant survival is significantly reduced following prosthesis dislocation, however patient satisfaction and pain levels appear unaffected at long-term follow-up

BACKGROUND. Many patients who underwent a THA, report a feeling of more “physiological” hip and of faster recovery when bigger heads are used. The aim of this study is to evaluate the walking recovery of patients after THA with different head diameters by the means of gait analysis. MATERIALS AND METHODS. A prospective, randomized, blind study was conducted on 60 patients operated by THA at our Institution. Inclusion criteria were: primary hip arthritis, women, age between 55 and 70 years. Exclusion criteria were: other problems influencing walking ability (previous operations of the lower limbs, spine disorders, knee or controlateral hip arthritis). The same uncemented stem, same uncemented press-fit cup, same surgical technique and approach (posterolateral), same surgeons, same postoperative protocol and rehabilitation were employed. The only difference was the head diameter. The patients were randomized into three groups, of twenty patients each one (28mm Cer-on-XPE, 36mm Cer-on-XPE, >42mm Met-on-Met). The gait evaluation have been performed at three temporal steps: preoperatively, two months postoperatively and four months postoperatively. Kinematic parameters were acquired with Elite opto-electronic system (BTS, Milan, Italy) equipped with 6 cameras at 100 Hz frame rate. The system is integrated with a force platform (Kistler, CH) and a synchronic video system using two cameras (BTS, Milan, Italy). Data acquisition and processing were carried out using passive markers positioned according to Davis protocol. At least ten trials for each session were collected in order to assess the repeatability of the results. Gait analysis included kinematic parameters (temporal-spatial parameters and joint angular values) and kinetic parameters (ground interaction forces during walking). Articular moments and powers were computed on the basis of data obtained from dynamometric platform along with those given by kinematic analysis. All patients were compared to a control group. Wilcoxon signed rank test was employed for statistical evaluation. RESULTS. At a preliminary evaluation (still in progress) and statistical analysis, temporal-spatial parameters show no significant differences among the three groups. All the variables of step length, stride length, cadence and velocity show statistical significant improvements towards the standard values, in the four months follow-up in all the groups, and the improvement does not depend on the side operated. CONCLUSIONS. The preliminary evaluation of this study shows that there is no statistical significant difference in standard gait analysis parameters in patients with different head diameters (28mm, 36mm, >42mm) after THA

Aims

This study aimed to compare the change in health-related quality of life of patients receiving a traditional cemented monoblock Thompson hemiarthroplasty compared with a modern cemented modular polished-taper stemmed hemiarthroplasty for displaced intracapsular hip fractures.

Background

Approximately half of all hip fractures are displaced intracapsular fractures. The standard treatment for these fractures is either hemiarthroplasty or total hip arthroplasty. The recent National Institute for Health and Care Excellence (NICE) guidance on hip fracture management recommends the use of ‘proven’ cemented stem arthroplasty with an Orthopaedic Device Evaluation Panel (ODEP) rating of at least 3B (97% survival at three years). The Thompsons prosthesis is currently lacking an ODEP rating despite over 50 years of clinical use, likely due to the paucity of implant survival data. Nationally, adherence to these guidelines is varied as there is debate as to which prosthesis optimises patient outcomes.