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 acetabular component liners remains a good choice in primary uncemented THA, as most modified liner designs were not associated with a reduced risk of revision for mechanical failure. Offset liner designs were found to be beneficial and angulated/offset liner designs were associated with higher risks of revision. Cite this article: Bone Joint J 2022;104-B(7):801–810

Special acetabular polyethylene (PE) liners are intended to increase the stability of the artificial hip joint, yet registry studies on them are limited. The pupose of this study was to investigate differences in revision rates for mechanical complications in primary cementless total hip arthroplasty (THA) with standard and special PE acetabular liners in patients with ostheoarthritis. Data from the German Arthroplasty Registry (EPRD) between 2012 until 2020 were analysed. Patients with diagnosed ostheoarthritis of the hip without relevant prior surgeries, who received a primary cementless THA with a ceramic/PE bearing articulation were included. Cumulative incidences of revision for mechanical complications for Standard and 4 special PE liners (Lipped, Increased Offset, Angulated, Angulated|Increased Offset) were determined using the Kaplan-Meier Estimator. Confounding factors were investigated with a Cox proportional-hazards model. In total 151.104 cases were included. 7-year unadjusted revision-free survival for mechanical complications compared to Standard liners (97.7%) was lower for Angulated (97.4%), Lipped (97.2%) and Angulated|Increased Offset liners (94.7%), but higher for Increased Offset liners (98.1%). Risk of revision for mechanical complications was not significantly different between Standard, Lipped and Angulated liners. Increased Offset liners (HR=0.68; 95% CI=0.5–0.92) reduced, while Angulated|Increased Offset liners (HR= 1.81; 95% CI=1.38–2.36) increased the risk. Higher age at admission and an Elixhauser comorbidity index greater zero increased the risk, whereas a larger liner share slightly reduced the risk. Only the use of Increased Offset liners reduced the risk of revision for mechanical complications compared to Standard liners — other special liners did not

Although the technique of autogenous acetabular bone grafting has been widely used to augment containment of the acetabulum in total hip arthroplasty (THA) for developmental dysplasia, the role of this technique in improving long-term results remains controversial. We present the long-term results of cemented THA with acetabular bone grafting in 112 patients (133 hips) in order to clarify the factors which affect the outcome. The mean follow-up was for 12.3 years (8 to 24). Kaplan-Meier survivorship analysis predicted a rate of survival of the acetabular component at 15 years of 96% (95% confidence interval (CI) 92 to 99) with revision for aseptic loosening as the endpoint, and of 75% (95% CI 65 to 85) when radiological loosening was used. Parametric survivorship analysis using the Cox proportional-hazards model indicated that trochanteric nonunion, lateral placement of the socket, and delayed trabecular reorientation of the bone graft were risk factors for loosening of the acetabular component. Our findings have shown that autologous acetabular bone grafting is of value for long-term success provided that the risk factors are reduced

With the increasing demand for hip and knee replacement and move towards seven-day services, we examined whether this planned, elective surgery performed at the weekend is associated with a different 30-day mortality versus that performed between Monday and Friday. The study dataset comprised 118,096 joint replacement episodes performed at the weekend and 1,233,882 episodes done on a weekday. We used a Kaplan-Meier framework to examine the 30-day cumulative mortality rate for all elective hip and knee replacements performed in England and Wales and recorded in the NJR between 1st April 2003 and 31st December 2014, with Cox proportional-hazards regression models to assess for time-dependent variation and adjust for identified risk factors for mortality. For hip replacement the cumulative 30-day mortality was 0.15% (95%CI: 0.12–0.19) for patients operated on at the weekend versus 0.20% (0.19–0.21) for patients undergoing surgery during the normal working week. For knee replacement the cumulative 30-day mortality was 0.14% (0.11–0.17) for patients operated on at the weekend versus 0.18% (0.17–0.19) for patients undergoing surgery during the normal working week. The lower mortality associated with weekend operating was most apparent in the later years of the audit (2009 to 2014) and remained after adjustment for any differences in patient age, gender, American Society of Anaesthesiologist grade, surgeon seniority, surgical and anaesthetic practices, and thrombo-prophylaxis choice in weekend versus weekday operated patients. Routine hip and knee replacements performed at the weekend in England and Wales and are not associated with an increased risk of post-operative mortality

With the increasing demand for hip and knee replacement, and the increasing pressure to move towards routine seven-day services within the National Health Service, the trend towards weekend operating is set to increase. We aimed to determine whether planned, elective total hip and total knee replacement performed at the weekend is associated with a different 30-day mortality versus those performed between Monday and Friday. We used National Joint Registry of England, Wales, Northern Ireland and Isle of Man (NJR) linked to Office for National Statistics (ONS) data. The study dataset comprised 118,096 joint replacement episodes performed at the weekend and 1,233,882 episodes done on a weekday. The main outcome measure was 30-day all-causes mortality. We applied a survivorship analysis using a Kaplan-Meier framework to examine the 30-day cumulative mortality rate for all elective hip and knee replacements performed in England and Wales between 1st April 2003 and 31st December 2014, with Cox proportional-hazards regression models to assess for time-dependent variation and adjust for identified risk factors for mortality. For hip replacement the cumulative 30-day mortality was 0.15% (95%CI: 0.12–0.19) for patients operated on at the weekend versus 0.20% (0.19–0.21) for patients undergoing surgery during the normal working week. For knee replacement the cumulative 30-day mortality was 0.14% (0.11–0.17) for patients operated on at the weekend versus 0.18% (0.17–0.19) for patients undergoing surgery during the normal working week. The lower mortality associated with weekend operating was most apparent in the later years of the audit (2009 to 2014) and remained after adjustment for any differences in patient age, gender, American Society of Anaesthesiologist grade, surgeon seniority, surgical and anaesthetic practices, and thrombo-prophylaxis choice in weekend versus weekday operated patients. Hip and knee replacements are routinely performed on Saturdays, and to a lesser extent on Sundays, in England and Wales and are not associated with an increased risk of post-operative mortality

We surveyed 343 young women with 420 total hip arthroplasties (THAs) regarding pregnancy and childbirth after THA. The mean age at surgery was 35 years (18 to 45). The mean length of follow-up after the initial arthroplasty was 16 years (6 to 27).

Of these 343 women, 47 (13.7%) had a successful pregnancy after their primary THA. The first baby after a THA was delivered vaginally in 30 patients and by Caesarean section in 17. Of the 343 patients, 138 underwent a revision. For the entire series, the risk of revision at five years was 5%, at ten years 24%, and at 20 years 50%. After adjusting for age at surgical intervention, the risk of revision was not significantly associated with childbirth. Of the 47 patients who had a successful pregnancy, 28 (60%) noted an increase in pain in the hip during pregnancy and ten of these patients had persistent pain after their pregnancy. Seven patients complained of pain in the groin in the replaced hip after childbirth. At the time of this survey, five of these patients (70%) had had revision THA.

Childbirth is not affected by the presence of a THA. Pregnancy after THA is not associated with decreased survival of the prosthesis. Pain in the hip is common during pregnancy in these patients. Pain in the groin which persists after delivery commonly leads to revision of the THA.