We report a case of local compression-induced transient femoral nerve palsy in a 46-year-old man. He had previously undergone surgical release of the soft tissues anterior to both hip joints because of contractures following spinal injury. An MRI scan confirmed a synovial cyst originating from the left hip joint, lying adjacent to the femoral nerve. The cyst expanded on standing, causing a transient femoral nerve palsy. The symptoms resolved after excision of the cyst

Aims. This study aimed to use intraoperative free electromyography to examine how the placement of a retractor at different positions along the anterior acetabular wall may affect the femoral nerve during total hip arthroplasty (THA) when undertaken using the direct anterior approach (THA-DAA). Methods. Intraoperative free electromyography was performed during primary THA-DAA in 82 patients (94 hips). The highest position of the anterior acetabular wall was defined as the “12 o’clock” position (middle position) when the patient was in supine position. After exposure of the acetabulum, a retractor was sequentially placed at the ten, 11, 12, one, and two o’clock positions (right hip; from superior to inferior positions). Action potentials in the femoral nerve were monitored with each placement, and the incidence of positive reactions (defined as explosive, frequent, or continuous action potentials, indicating that the nerve was being compressed) were recorded as the primary outcome. Secondary outcomes included the incidence of positive reactions caused by removing the femoral head, and by placing a retractor during femoral exposure; and the incidence of femoral nerve palsy, as detected using manual testing of the strength of the quadriceps muscle. Results. Positive reactions were significantly less frequent when the retractor was placed at the ten (15/94; 16.0%), 11 (12/94; 12.8%), or 12 o’clock positions (19/94; 20.2%), than at the one (37/94; 39.4%) or two o’clock positions (39/94; 41.5%) (p < 0.050). Positive reactions also occurred when the femoral head was removed (28/94; 29.8%), and when a retractor was placed around the proximal femur (34/94; 36.2%) or medial femur (27/94; 28.7%) during femoral exposure. After surgery, no patient had reduced strength in the quadriceps muscle. Conclusion. Placing the anterior acetabular retractor at the one or two o’clock positions (right hip; inferior positions) during THA-DAA can increase the rate of electromyographic signal changes in the femoral nerve. Thus, placing a retractor in these positions may increased the risk of the development of a femoral nerve palsy. Cite this article: Bone Joint J 2022;104-B(2):193–199

Aims. Brace treatment is the cornerstone of managing developmental dysplasia of the hip (DDH), yet there is a lack of evidence-based treatment protocols, which results in wide variations in practice. To resolve this, we have developed a comprehensive nonoperative treatment protocol conforming to published consensus principles, with well-defined a priori criteria for inclusion and successful treatment. Methods. This was a single-centre, prospective, longitudinal cohort study of a consecutive series of infants with ultrasound-confirmed DDH who underwent a comprehensive nonoperative brace management protocol in a unified multidisciplinary clinic between January 2012 and December 2016 with five-year follow-up radiographs. The radiological outcomes were acetabular index-lateral edge (AI-L), acetabular index-sourcil (AI-S), centre-edge angle (CEA), acetabular depth ratio (ADR), International Hip Dysplasia Institute (IHDI) grade, and evidence of avascular necrosis (AVN). At five years, each hip was classified as normal (< 1 SD), borderline dysplastic (1 to 2 SDs), or dysplastic (> 2 SDs) based on validated radiological norm-referenced values. Results. Of 993 infants assessed clinically and sonographically, 21% (212 infants, 354 abnormal hips) had DDH and were included. Of these, 95% (202 infants, 335 hips) successfully completed bracing, and 5% (ten infants, 19 hips) failed bracing due to irreducible hip(s). The success rate of bracing for unilateral dislocations was 88% (45/51 infants) and for bilateral dislocations 83% (20/24 infants). The femoral nerve palsy rate was 1% (2/212 infants). At five-year follow-up (mean 63 months (SD 5.9; 49 to 83)) the prevalence of residual dysplasia after successful brace treatment was 1.6% (5/312 hips). All hips were IHDI grade I and none had AVN. Four children (4/186; 2%) subsequently underwent surgery for residual dysplasia. Conclusion. Our comprehensive protocol for nonoperative treatment of infant DDH has shown high rates of success and extremely low rates of residual dysplasia at a mean age of five years. Cite this article: Bone Joint J 2023;105-B(8):935–942

There is no consensus regarding the optimum frequency of ultrasound for monitoring the response to Pavlik harness (PH) treatment in developmental dysplasia of hip (DDH). The purpose of our study was to determine if a limited-frequency hip ultrasound (USS) assessment in children undergoing PH treatment for DDH had an adverse effect on treatment outcomes when compared to traditional comprehensive ultrasound monitoring. This study was a single-center non-inferiority randomized controlled trial. Children aged less than six months of age with dislocated, dislocatable and stable dysplastic hips undergoing a standardized treatment program with a PH were randomized, once stability had been achieved, to our current standard USS monitoring protocol (every clinic visit) or to a limited-frequency ultrasound protocol (USS only until hip stability and then end of treatment). Groups were compared based on alpha angle at the end of treatment, acetabular indices (AI) and IHDI grade on follow up radiographs at one-year post harness and complication rates. The premise was that if there were no differences in these outcomes, either protocol could be deemed safe and effective. One hundred patients were recruited to the study; after exclusions, 42 patients completed the standard protocol (SP) and 36 completed the limited protocol (LP). There was no significant difference between the mean age between both groups at follow up x-ray (SP: 17.8 months; LP: 16.6 months; p=0.26). There was no difference between the groups in mean alpha angle at the end of treatment (SP: 69°; LP: 68.1°: p=0.25). There was no significant difference in the mean right AI at follow up (SP: 23.1°; LP: 22.0°; p=0.26), nor on the left (SP:23.3°; LP 22.8°; p=0.59). All hips in both groups were IHDI grade 1 at follow up. The only complication was one femoral nerve palsy in the SP group. In addition, the LP group underwent a 60% reduction in USS use once stable. We found that once dysplastic or dislocated hips were reduced and stable on USS, a limited- frequency ultrasound protocol was not associated with an inferior complication or radiographic outcome profile compared to a standardized PH treatment pathway. Our study supports reducing the frequency of ultrasound assessment during PH treatment of hip dysplasia. Minimizing the need for expensive, time-consuming and in-person health care interventions is critical to reducing health care costs, improving patient experience and assists the move to remote care. Removing the need for USS assessment at every PH check will expand care to centers where USS is not routinely available and will facilitate the establishment of virtual care clinics where clinical examination may be performed remotely

Introduction: Total hip replacement (THR) in young patients is a controversial subject due to high failure rates reported in the literature. The purpose of this study was to show our short term results of primary total hip replacement in patients younger than 30 years of age. Methods: Patients who underwent THR prior to the age of 30 years between 1998 and 2007 were identified and records of all patients were reviewed together with the radiographs till the last follow up. Results: Forty three THRs were performed on 36 patients with an average age of 24.4 years (range, 17–30) and an average follow up period of 47 months (range, 7–109 months). There were 5 cases of Juvenile chronic arthritis, 2 Rheumatoid arthritis, 11 DDH, 2 septic arthritis, 1 pseudoachondroplasia, 4 Perthes disease, 2 seronegative arthitides, 2 SUFE and 7 AVN [alcohol, leukaemia, fracture, SLE (2), mannosidosis, idiopathic]. Thirty cemented THRs and 13 hybrid THRs were performed through trochanteric osteotomy approach (23), posterior approach (17), Hardinge approach (2) and anterior approach (1). In the cemented group there were 3 cases of superficial wound discharges, 1 recurrent dislocation, 1 complete femoral nerve palsy, 2 cases of neuropraxia and 1 case with persistent hip pain but no cases of infection. In the hybrid group there was one case of partial femoral nerve palsy. None of the patients has undergone any revision surgery till the latest follow up. Radiologically only one case showed aseptic loosening in both femoral and acetabular components, which is not revised as the patient is asymptomatic. Discussion: THR is an elegant procedure and should be certainly considered in young patients suffering with disabling arthritic conditions affecting the hip joint. Our results show that THR - both cemented and hybrid types - is a successful and durable treatment

Purpose: Multi-modal therapy remains the cornerstone of post-operative pain management following knee replacement surgery. Femoral nerve catheters and blocks have been used with success in the management of post-operative pain yet most practicing arthroplasty surgeons and anaesthesiologists are unaware of the potential complications and risks of the procedure. The purpose of this study is to report on the complications associated with these techniques following knee replacement surgery. Method: One thousand one hundred and ninety patients underwent knee replacement surgery between January 2004 and July 1, 2007 and received an indwelling continuous infusion femoral catheter for post-operative marcaine pump infusion. For the initial 469 patients (Group 1), the continuous infusion ran for 2 to 3 days. In 721 patients, the continuous infusion was discontinued 12 hours following surgery (Group 2). Results: There were 15 major complications observed in 1190 patients: 7 femoral nerve palsies (2 in Group 1, 5 in Group 2) and 8 falls (4 in each group). For the patients who had fallen in hospital, the injuries sustained were: traumatic hemarthrosis, hemarthrosis requiring arthrotomy, major wound dehiscence with exposed implants, complete medial collateral ligament rupture requiring repair, quadriceps tendon rupture requiring delayed repair, minor wound dehiscence with suture, and displaced ankle fracture. Conclusion: Femoral nerve catheters and blocks are effective tools for post-operative pain relief following knee arthroplasty surgery. However, it is important for the surgeon and anaesthesiologist to provide information regarding the potential complications of the treatment as part of an informed consent. Although the complication rate is relatively low at 1.3%, the occurrence of femoral nerve palsies as well as re-operations significantly delayed patient recovery. We did not observe a benefit in terms relative risk reduction with discontinuation of the continuous infusion 12 hours following surgery. The femoral palsies reported in our series have led our institution to adopt ultrasound guidance for catheter placement rather than tradition nerve stimulation technique, although the safety of this newer technique is currently under evaluation

When performing total hip replacement (THR) in high dislocated hips, the presence of soft-tissue contractures means that most surgeons prefer to use a femoral shortening osteotomy in order to avoid the risk of neurovascular damage. However, this technique will sacrifice femoral length and reduce the extent of any leg-length equalisation. We report our experience of 74 THRs performed between 2000 and 2008 in 65 patients with a high dislocated hip without a femoral shortening osteotomy. The mean age of the patients was 55 years (46 to 72) and the mean follow-up was 42 months (12 to 78). All implants were cementless except for one resurfacing hip implant. We attempted to place the acetabular component in the anatomical position in each hip. The mean Harris hip score improved from 53 points (34 to 74) pre-operatively to 86 points (78 to 95) at final follow-up. The mean radiologically determined leg lengthening was 42 mm (30 to 66), and the mean leg-length discrepancy decreased from 36 mm (5 to 56) pre-operatively to 8.5 mm (0 to 18) postoperatively. Although there were four (5%) post-operative femoral nerve palsies, three had fully resolved by six months after the operation. No loosening of the implant was observed, and no dislocations or infections were encountered. Total hip replacement without a femoral shortening osteotomy proved to be a safe and effective surgical treatment for high dislocated hips

Several design principles were considered paramount when the surgical technique of performing total hip arthroplasty through an incision in the superior capsule without dislocation of the hip joint was developed. These design principles include: Preservation of the abductors; Preservation of the posterior capsule and short external rotators; Preparation of the femur in situ without dislocation of the hip; In-line access to the femoral shaft axis; Ability to perform a trial reduction; Independence from intraoperative imaging; Independence from a traction table; Applicable to at least 99% of THA procedures. Personal experience with more than 1950 THA using the superior capsulotomy technique over a 12-year period has demonstrated several observations: Dislocation rate of 0.15% (3 in 1950); Acute deep infection rate of 0% (0 in 1950); Universal applicability: used in 99.7% of primary THA; Lateral femoral cutaneous nerve palsy incidence: 0/1950; Femoral nerve palsy incidence: 0/1950; Transient peroneal palsy incidence: 2/1950; Length of stay (since 2010): 1.55 days; Discharge to home: 98%; 90-day cost (2/13 to 2/14) compared to other exposures in CMS patients in the same institution: $24,200 vs $30,100; Readmission costs (CMS 2/13 to 2/14) at 90 days: $0. Conclusion: Performing total hip arthroplasty without dislocation and with preservation of the abductors, posterior capsule and short external rotations has proven to have a low dislocation rate, a low infection rate, and wide applicability. CMS 12-month expenditure data documenting ZERO dollars spent on readmission for any reason within 90 days of surgery demonstrates the potential for simultaneously improving incomes and reducing cost, with particular benefit within the CMS BPCI and private bundled payment programs

In recent years, the direct anterior approach (DAA) has become a standard approach for primary total hip arthroplasty (THA). With the increasing use of the DAA in primary cases also more and more revision surgeries are performed through the same interval. With ability to extend the DAA interval proximally and distally, loose cups, loose stems, and even periprosthetic femoral fractures (PPF) can be treated. Especially, PPF are devastating complications causing functional limitations and increased mortality. Therefore, we conducted a study to report the outcome of surgical treatment of PPF with the DAA interval. We report on the one year complications and mortality in 40 cases with a mean clinical follow-up of 1.5 years. Mean age of patients was 74.3 years. Fractures were classified as Vancouver B2 (36), and B3 (N=4). In 14 cases, a standard stem was used, and in 26 cases a modular revision stem. In 30 cases, a distal extension +/- tensor release was used, in 4 cases a proximal tensor release was done, and in the remaining 6 cases revision could be performed without extension of the approach. Median cut/suture time was 152 minutes (IQR 80 – 279). The overall complication rate in our patient group was 12.5%. 2 patients died in the first three months after operation. One patient had a transient femoral nerve palsy, which completely recovered. The DAA interval to the hip for the treatment of PFF showed similar results compared with other approaches regarding mortality, complications, fracture healing, dislocation rate and clinical results. We conclude that femoral revision in case of PPF in the DAA interval is a safe and reliable procedure. Each Vancouver type of periprosthetic fracture can be treated by use of this approach

Traditional risk factors for post-operative neuropathy include learning curve of surgical approach, DDH, and significant leg lengthening (>1 inch). Despite these risk factors, the most common scenario of a neuropathy is in a routine THA, by an experienced surgeon, for osteoarthritis, with no leg lengthening. Post-operative hematoma can lead to nerve compression, albeit rarely. The usual clinical presentation is of an acute event, with a previously intact nerve, sometime within the first days of surgery. Once diagnosed, immediate surgical decompression should be performed. Sciatic neuropathy is the most common, regardless of surgical approach, but the posterior approach poses the highest risk. Routine gluteus maximus tendon release may help to reduce the risk. When seen in the PACU, our approach is to immediately perform CT imaging to evaluate nerve integrity or to check on acetabular screw position. If no underlying cause is identified, the patient will be managed conservatively with foot orthotics and monitored for recovery. Femoral nerve palsy (FNP) can result in significant initial disability. Fortunately most patients recover function (although it can take over 18 months). In the early post-operative period it is often diagnosed after a patient complains of the leg giving away while attempting to walk. A knee brace will assist the patient with mobilization while the nerve recovers. The highest incidence of FNP is described for the direct lateral approach. Superior gluteal nerve (SGN) palsy is related to the direct lateral approach and may be avoided if the gluteus medius split is made within the safe zone (<5 centimeters from the tip of the greater trochanter). While early post-operative limp is common after the direct lateral approach, the true reported incidence of SGN palsy is low. Few studies showed that the persistent positive Trendelenburg test and limp is not exclusively related to the SGN damage and therefore the clinical effect of the SGN damage remains controversial. Lateral femoral cutaneous nerve can be affected during the direct anterior hip approach. One study suggests the presence of peri-incisional numbness in over 80% of patients. This is akin to numbness seen lateral to the incision after TKA. The incidence of meralgia paresthetica is extremely low (<1%)

Introduction. The removal of a well fixed cement mantle for revision of a total hip replacement (THR) can be technically challenging and carries significant risks. Therefore, a cement-in-cement revision of the femoral component is an attractive option. The Exeter Short Revision Stem (SRS) is a 125 mm polished taper stem with 44 mm offset specifically designed for cement-in-cement revisions. Only small series using this implant have been reported. Patients/Materials & Methods. Records for all patients who had undergone a cement-in-cement revision with the SRS were assessed for 1) radiological femoral component loosening 2) clinical femoral component loosening 3) further revision of the femoral component 4) complications. We assessed serial radiographs for changes within the cement mantle and for implant subsidence. Results. 50 implants in 46 patients were reviewed. Mean age at surgery was 67.7 (range 39–88) years. 7 patient (8 implant) deaths at mean 128 (range 17 – 267) weeks following surgery were identified. Complications included one intra-operative greater trochanter fracture, one femoral nerve palsy, and one early infection following surgery. Three implants required revision. One at 11 weeks following surgery for recurrent dislocation, one at 138 weeks for infection and one at 290 weeks for breakage of the femoral implant. The mean time from surgery to both radiographic and clinical follow-up was 3.4 years. Radiographs available for 48 implants showed no radiographic evidence of loosening. Clinical follow-up information was available for 45 patients. Only one patient reported thigh pain but a bone scan showed no evidence of loosening. Discussion. This is the largest reported series with SRS we are aware of outside the design centre. Conclusions. The Exeter Short Revision Stem provides a viable option for cement-in-cement revision surgery. Further evaluation of the use of this implant in patients with a high BMI is required given the implant failure in this series and the reported literature

Background:. The direct anterior approach (DAA) is one of the muscle sparing approaches in total hip arthroplasty (THA). The advantages of the DAA-THA include low dislocation rate, quick recovery with less pain, and accurate implantation. However, complications related to the learning curve have been reported. The aim of this study was to analyze the first 100 cases of DAA-THA performed by 2 surgeons. Methods:. The records of first 100 consecutive primary DAA-THAs performed by 2 orthopedic surgeons who have np experience of DAA-THA previously were retrospectively reviewed. All operations were performed using DAA in the supine position without the special traction table. The surgical result, the early clinical results, complications, and accuracy of prosthesis placement were investigated. Results:. The mean intraoperative blood loss was 424 ± 216 m. The mean operative time was 55.4 ± 17.5 minutes. One-hundred and ninety-one cups (96%) were placed within the Lewinnek's safe zone. The overall complication rate was 6% (12 hips), including 5 proximal femoral fracture, 3 stem subsidence, 2 temporal femoral nerve palsy, and 2 cup migration. No revision surgery was required, No postoperative dislocation occurred. Conclusion:. We analyzed the first 100 cases of DAA-THA performed by 2 orthopedic surgeons. We concluded that with appropriate training this procedure can be performed safely and effectively without increasing the risk of complications

The transiliac method of leg lengthening uses a modification of Salter's innominate osteotomy. The bone graft increases the length of the hemipelvis distal to the sacro-iliac joint. Leg-length inequality in 23 patients was treated by this method with an average gain in length of 2.8 cm (2.0 to 3.5). Apart from one residual femoral nerve palsy there were no notable complications. The facility to redirect the acetabulum allowed by the technique, may be useful in cases of potential hip instability or acetabular dysplasia

We report the results of 62 hips in 62 patients (17 males, 45 females) with mean age of 62.4 years (37 to 81), who underwent revision of the acetabular component of a total hip replacement due to aseptic loosening between May 2003 and November 2007. All hips had a Paprosky type IIIa acetabular defect. Acetabular revision was undertaken using a Procotyl E cementless oblong implant with modular side plates and a hook combined with impaction allografting. . At a mean follow-up of 60.5 months (36 to 94) with no patients lost to follow-up and one died due to unrelated illness, the complication rate was 38.7%. Complications included aseptic loosening (19 hips), deep infection (3 hips), broken hook and side plate (one hip) and a femoral nerve palsy (one hip). Further revision of the acetabular component was required in 18 hips (29.0%) and a further four hips (6.4%) are currently loose and awaiting revision. . We observed unacceptably high rates of complication and failure in our group of patients and cannot recommend this implant or technique

Pelvic reconstruction after tumour resection is challenging. Pelvic replacements are usually custom made at considerable expense and then need very careful positioning at the time of surgery. They have a very high rate of complications with up to 30% risk of infection and 10% dislocation. In 2003 we developed a new type of pelvic replacement which would be simple to make, simple to use and which would hopefully avoid the major complications of previous pelvic replacements whist being versatile to use even when there was very little pelvis remaining. The concept is based on the old design of Ring stemmed hip replacement and has become known as the ice-cream cone prosthesis. It is inserted into the remnant of pelvis or sacrum and is surrounded by bone cement containing antibiotics. One of the main advantages is it’s flexibility, allowing insertion after resection at a variety of levels. It is also suitable for patients with metastatic disease. We have inserted 12 of these implants in the past 4 years, resolving very difficult reconstruction problems. There was one case that became infected but was cured with washout and antibiotics. In one patient there was excessive leg lengthening resulting in a sciatic and femoral nerve palsy and the prosthesis had to be revised. All patients can walk with one stick or less. These results are encouraging and suggest that this versatile implant may be the way forward for pelvic reconstruction because of it’s flexibility of use and low complication rate

Reasons for bone loss in septic hip prosthesis include osteolysis caused by the infection in itself and by the mechanical loosening, while implant removal and the necessary bone debridment usually ends in a even more severe bone loss. In two stage revision surgery the use of a long stem antibiotic-loaded pre-formed cement spacer (Spacer G – Tecres s.r.l., Italy) appears particularly useful to allow mechanical stability and antibiotic local elution even in the presence of wide proximal femoral bone loss. After two months the revision is performed with non-cemented long stem modular implants (Profemur – Wright-Cremascoli) without the need for massive bone grafts. Recently we have also started using growth factors to stimulate bone stock reconstitution. In all the patients a double antibiotic therapy is administered after the first and second stage procedures for 6–8 weeks. The results obtained (54 patients, follow-up 2 – 5 years) according to this protocol show the absence of infection recurrence, 10 cranial spacer dislocation, not treated, 2 revision prosthesis dislocations, that required open reduction, 1 transient femoral nerve palsy. The described technique, used according to a proper protocol, allows to obtain good results, in the medium term follow-up

Background. Minimally invasive surgery is being widely used in the field of total hip arthroplasty (THA). The advantages of the direct anterior approach (DAA), which is used in minimally invasive surgery, include low dislocation rate, quick recovery with less pain, and accuracy of prosthesis placement. However, minimally invasive surgery can result in more complications related to the learning curve. The aim of this study was to evaluate the learning curve of DAA-THA performed by a senior resident. Methods. Thirty-three consecutive patients (33 hips) who underwent primary THA were enrolled in this study. All operations were performed by a senior resident using DAA in the supine position without the traction table. The surgeon started using DAA exclusively for all cases of primary THA after being trained in this approach for 6 months. Operative time, intraoperative blood loss, complications, and accuracy of prosthesis placement were investigated. Results. The mean intraoperative blood loss was 524 mL (range, 130–1650 m L). The mean operative time was 60 min (range, 41–80 min). Radiographic analysis showed an average acetabular anteversion angle of 17.0±3.3°, abduction angle of 37.8±4.3°, and stem alignment of 0±0.8°. Thirty-two (97%) of 33 cups were placed within the Lewinnek's safe zone. The overall complication rate was 12% (4 of 33 hips), including 1 proximal femoral fracture (salvaged with circumferential wiring), 1 temporary femoral nerve palsy (completely recovered in 2 weeks), 1 stem subsidence (5 mm), and 1 cup migration. Three of these complications were occurred in the first 10 cases. No revision surgery was required, No postoperative dislocation occurred. Conclusion. We investigated the learning curve of DAA-THA performed by a senior resident. We considered the first 10 cases as the learning curve, but concluded that with adequate training this procedure can be performed safely and effectively without increasing the risk of complications

Introduction: Metal on metal Hip Resurfacing Arthroplasty (MoMHRA) has gained popularity due to its perceived advantages of bone conservation and relative ease of revision to a conventional THR if it fails. This retrospective study is aimed at assessing the functional outcome of failed MoMHRA revised to THR and comparing it with a matched cohort of primary THRs. Method: Since 1999 we have revised 53 MoMHRA to THR. The reasons for revision were femoral neck fracture (Group A, n=21), pseudotumour (Group B, n=16) and other causes (Group C, n=16: loosening, avascular necrosis and infection). Average follow-up was 3 years months (1.2–7.3). These revisions were compared with 106 primary THRs which were age, gender and follow-up matched with the revision group in a ratio of 2:1. Results: The mean Oxford Hip Score (OHS) was 20.1 (12–51) for group A, 39.1 (14– 56) for group B, 22.8 (12–39) for group C and 17.8 (12–45) for primary THR group. In group A, there were three infections requiring further revisions. In group B, there were three recurrent dislocations, three patients with femoral nerve palsy and one femoral artery stenosis. In group C, there were no complications. The differences in clinical and functional outcome between group B and the remaining groups as well as the difference in the outcome between group B and control group were statistically significant (p < 0.05). Conclusions: THR for failed MoMHRA was associated with significantly more complications, operation time and need for blood transfusion for the pseudotumour group. In addition, the revisions secondary to pseudotumour also had significantly worse functional outcome when compared to other MoMHRA revisions or primary THR

Introduction: Hip resurfacing is a method of treating the degenerative hip joint in higher demand patients. In this study we present the results of the first four years of using this technique in a typical District General Hospital. Materials and Methods: This is a review of the outcome of 303 consecutive hip resurfacing procedures performed at Ashford and St. Peter’s Hospitals NHS Trust. All patients had a posterior approach to the hip joint, followed by standard resurfacing using metal on metal components. The patients were evaluated radiographically and clinically pre-operatively and post-operatively. All patients had regular follow up. Results: The mean age was 56 with a range from 24 to 75 years old. There was a statistically significant improvement between the pre-operative Harris Hip Score and those at the latest follow up. All patients achieved a full range movement in the hip within twelve weeks following surgery. There were four fractures of the femoral neck, one was intra-operative and was converted to total joint arthroplasty. Three further fractures occurred, two were revised and one was treated conservatively. Two patients had transient femoral nerve palsies. There were no cases of dislocation or deep infection. All the prostheses remain well fixed with no signs of osteolysis. There were three cases of avascular necrosis, all of which show no signs of further collapse. Conclusions: The short and medium term results that have been achieved in a District General Hospital are comparable to those that have been achieved in the originator’s institution

Purpose. This study was undertaken to assess the result of total hip arthroplasty (THA) performed for fused hips. Patients and Methods. Twenty nine patients (31 hips), aged 21 to 70 years (average 46 years), underwent THA conversion surgery and were followed for an average of 4.6 years (2.4-12.0 years). There were 23 cases of spontaneous fusion and 8 case of surgical fusion. The causes of joint fusion were tuberculosis in 6 hips, childhood coxitis in 13, ankylosing spondylitis in 6 and childhood trauma in 4. Modified two incision technique was used in 9 hips and in 22 hips, the surgery was performed through a posterolateral approach combined with anterior capsulotomy through gluteus medius and tensor fasica lata interval. In 1 case, greater trochanter osteotomy was done. All acetabular components were inserted at the true acetabulum and the articulations were metal on metal in 7 cases and ceramic on ceramic in 24 cases. Postoperatively, range of motion exercises were encouraged after 2 to 3 weeks of bed rest and subsequent weight bearing crutch ambulation. Then active exercises were strongly encouraged to stretch abductors. We evaluated the clinical and radiological results. Results. Mean duration of surgery was 178.6 minutes, and mean perioperative blood loss was 1420.1 ml. Post-operative dislocation occurred in 1 case and partial femoral nerve palsy developed in 1 case. Mean Harris Hip Score improved from 42.4 to 84.2 and mean leg lengthening of 36.6 mm was achieved. Sitting cross legged was possible in 15 patients and except 2 patients, all patients were satisfied with the surgery. On the radiologic evaluation, there was no changes in cup position and there was one case with acetabular focal osteolysis. Postoperative dislocation occurred in one case and there was no revision surgery or infection. Conclusion. Our study suggest that THA performed for fused hips with hard bearing articulation can provide good clinical and radiological results in mid-term follow up