Aims

The aim of this study was to evaluate the suitability of the tapered cone stem in total hip arthroplasty (THA) in patients with excessive femoral anteversion and after femoral osteotomy.

Satisfactory intermediate and long-term results of rotational acetabular osteotomy (RAO) for the treatment of early osteoarthritis secondary to developmental dysplasia of the hip have been reported. The purpose of this study is to examine the 30-year results of RAO.

Between 1987 and 1994, we treated 49 patients (55 hips) with RAO for diagnosis of pre- OA or early-stage OA. Of those patients, 35 patients (43 hips) were available at a minimum of 28 years. The follow-up rate was 78.2% and the mean follow-up was 30.5 years. The mean age at the time of surgery was 34 years. Clinical evaluation was performed with the Merle d'Aubigne and Postel rating scale, and radiographic analyses included measurements of the center-edge angle, acetabular roof angle, and head lateralization index on preoperative, postoperative AP radiographs of the pelvis. Postoperative joint congruency was classified into four grades. The radiographic evidence of progression of OA was defined as the minimum joint space less than 2.5mm.

The mean preoperative clinical score was 14.0, which improved to a mean of 15.3 at the time of the latest follow-up. The mean center-edge angle improved from 0.6° preoperatively to 34° postoperatively, the mean acetabular roof angle improved from 28.4°preoperatively to 1.0°postoperatively, the mean head lateralization index improved from 0.642 preoperatively to 0.59 postoperatively. Postoperative joint congruency was excellent in 11 hips, good in 29 hips, and fair in 3 hips. Nineteen patients (20 hips) had radiographic OA progression, and 10 patients (11 hips) were converted to THA. Kaplan-Meier survivorship analysis, with radiographic OA progression as the end point, predicted survival of 75.6% at 20 years and 48.8% at 30 years, and with THA conversion as the end point, 90.2% at 20 years and 71.2% at 30 years.

The RAO is an effective surgical procedure for symptomatic dysplastic hips of pre- and early-stage OA and could change the natural history of the dysplastic hip.

Injury of the lateral femoral cutaneous nerve (LFCN) is one of the known complications after periacetabular osteotomy (PAO) using anterior approach. We previously reported that the incidence of LFCN injury was 48% at 1 year after PAO. However, there was no study examining the sequential changes of LFCN injury status. In this study, we performed a prospective over 3-year follow-up study as to the incidence of LFCN injury as well as its clinical outcomes. This study included 40 consecutive hips in 40 patients (3 males and 37 females) who underwent PAO from May 2016 to July 2018. The mean age at surgery was 36.7 years (17 to 60). The mean observation period was 47.3 months (36 to 69). The incidence and severity of LFCN injury was evaluated, while clinical scores, including the Harris Hip Score (HHS), Short-Form 36 Health Survey (SF-36), and Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ), were also investigated. At 3 years after PAO, LFCN injury was observed in 13 of 40 (33%) patients, in which 7 patients who had a symptom at 1 year have completely recovered. There was no significant difference in the HHS and SF-36 between patients with and without LFCN injury at 3 years. Regarding the JHEQ, a significant difference was recognized in the patient satisfaction and mental score between patients with and without LFCN injury, but there were no significant differences in the other clinical scores. The incidence of LFCN injury gradually decreased to 33% at 3 years after CPO. LFCN injury did not influence the clinician-reported outcome, while it had a negative impact on patient satisfaction and mental score based on the patient-reported outcome

The Paprosky acetabular bone defect classification system and related algorithms for acetabular reconstruction cannot properly guide cementless acetabular reconstruction in the presence of porous metal augments.

We aimed to introduce a rim, points, and column (RPC)-oriented cementless acetabular reconstruction algorithm and its clinical and radiographic outcomes.

A total of 123 patients (128 hips) were enrolled. A minimum 5-year radiographic follow-up was available for 96 (75.8%) hips. The mean clinical and radiographic follow-up durations were 6.8±0.9 (range: 5.2–9.2) and 6.3±1.9 (range: 5.0–9.2) years, respectively.

Harris hip score (HHS) improved significantly from 35.39±9.91 preoperatively to 85.98±12.81 postoperatively (P<0.001). Among the fixation modes, 42 (32.8%) hips were reconstructed with rim fixation, 42 (32.8%) with three-point fixation without point reconstruction, 40 (31.3%) with three-point fixation combined with point reconstruction, and 4 (3.1%) with three-point fixation combined with pelvic distraction. Complementary medial wall reconstruction was performed in 20 (15.6%) patients. All acetabular components were radiographically stable. Nine-year cumulative Kaplan–Meier survival rates for 123 patients with the endpoint defined as periprosthetic joint infection, any reoperation, and dissatisfaction were 96.91% (confidence interval [CI]: 86.26%, 99.34%), 97.66% (CI: 92.91%, 99.24%), and 96.06% (CI: 86.4%, 98.89%), respectively.

Cup stability in cementless acetabular reconstruction depends on rim or three-point fixation. The continuity of the anterior and posterior columns determines whether the points provide adequate stability to the cup. Medial wall reconstruction is an important complementary fixation method for rim or three-point fixation. The patients who underwent cementless acetabular reconstruction guided by the RPC decision-making algorithm demonstrated satisfactory mid-term clinical function, satisfaction levels, radiographic results, and complication rates.

In total hip arthroplasty (THA), cementless cup without screw holes has the putative benefits of maximizing host bone contact and reducing osteolysis by eliminating channels to backside wear particles. However, supplemental trans-acetabular screws cannot be used.

74 hips in 60 patients receiving same model of cementless cup without screw holes (Depuy Duraloc 100 HA cup) from 6/1999 to 3/2003 were prospectively followed up. All patients were allowed to have immediate full weight bearing. Age at THA was 53 ± 13 (range 24–74) years. Osteonecrosis was the leading hip disease (45% of hips). Survivorship was assessed using revision of the cup as the end point. Radiological parameters, including lateral opening angle, vertical and horizontal migration distances of the cups were measured. Paired t-test was used to compare between the measurements in early postoperative period and at final follow up.

51 hips were assessed at minimum 20 years follow-up. The mean follow-up was 22.6 (range 21 – 25) years. All the cups were well fixed. There were two cup revisions. Conventional polyethylene (PE) was used in both hips; osteolysis occurred 17 and 18 years later. Both cups were well fixed but were revised, one due to cup mal-positioning, one due to need in upsizing the articulation. 14 other hips were revised but these cups were well fixed and not revised; 9 loosened stems (most were cemented Elite plus stems), 5 PE wear and osteolysis (all were conventional PE). At 20 years, the survivorship of cups was 96.1%. Changes in lateral opening angle, vertical and horizontal migration distances were 0.44±1.59°, 0.01±1.52mm and -0.32±1.47mm respectively, without statistical significance.

This study provided evidence of excellent long-term survivorship of cementless cup without screw holes. Immediate postoperative weight-bearing also did not lead to cup migration in the long-term.

Highly cross-linked polyethylene (HXLPE) has decreased wear and revision rates in total hip replacement (THR) at a long-term. However, the effect of HXLPE manufacturing characteristics on femoral head penetration has not been clearly defined yet. We report this single-institution study to investigate the clinical and radiological results of different HXLPE liners in THR.

In this retrospective cohort analysis of our prospective database, we identified 904 THRs performed between 2000 and 2013. Seven different HXLPE liner types were assessed: remelted (3), annealed (2), sequentially annealed (1) and vitamin E-infused (1). The linear femoral head penetration rate was measured at six weeks, one year, and annually thereafter, using the Roman Software v1.70 package.

Thirty hips were revised for the following reasons: aseptic loosening (11), dislocation (12), periprosthetic femoral fracture (6), and infection (1). No hip was revised for wear or osteolysis. 741 THRs were evaluated for a mean follow-up of 15 years (range, 10 to 20). The mean total penetration 15 years after THR was 0.17 mm in the sequentially annealed, and 0.16 mm in the vitamin E-infused groups, whereas it was 0.26 mm in the melted 95 kGy, 0.27 mm in the melted 5 Mrad and 0.25 mm in the melted 100 kGy groups (p=0.001). From one to 15 years after surgery, the mean wear was 0.206 mm in cups with an acetabular inclination greater than 50º and 0.105 mm in those placed between 35º and 50º (p<0.001).

Although HXLPE characteristics can result in a different wear performance in patients undergoing THR at a mean follow-up of 15 years, the clinical results are excellent. The position of the acetabular component can influence on the femoral head penetration of modern HXLPEs. Nevertheless, these patients should continue to be monitored to detect future problems.

We assessed the clinical and radiological outcome of a single uncemented total hip replacement (THR) after twenty years, analysing polyethylene wear and osteolysis.

82 hips implanted between 1992 and 1995 were prospectively evaluated. Mean follow-up was 20.6 years (18–23). A hemispherical porous-coated cup matched to a proximally hydroxyapatite-coated anatomic stem. A 28mm PE liner, sterilised by gamma irradiation in air, was used in all hips. Radiological position, eventual loosening and osteolysis were recorded over time. Penetration of the head into the liner was measured by the Roentgen Monographic Analysis (ROMAN) Tool at 6 weeks, 6 months, one year and yearly thereafter.

Six cups were revised due to wear and four cups because of late dislocation. All stems showed osseointegration and all cups appeared radiographically well-fixed. Six unrevised hips showed osteolysis on the acetabular side and two hips on the proximal femur. Creep at one year was 0.30±0.23 mm. Mean total femoral head penetration was 1.23mm at ten years, 1.52mm at 15 years and 1.92mm at 23 years. Overall mean wear was 0.12±0.1 mm/year and 0.09±0.06 mm/year after the creep period. Mean wear was 0.08±0.06 mm/year in hips without osteolysis and 0.14±0.03 mm/year in hips revised or hips with osteolysis (p<0.001).

Although continued durable fixation can be observed with porous-coated cups and proximally hydroxyapatite-coated anatomic stems, true wear continues to increase at a constant level over time. PE wear remains as the main reason for osteolysis and revision surgery in uncemented THR after twenty years.

Aims

We present the ten-year data of a cohort of patients, aged between 18 and 65 years (mean age 52.7 years; 19 to 64), who underwent total hip arthroplasty. Patients were randomised to be treated with a cobalt-chrome (CoCr) femoral head with an ultra-high molecular weight polyethylene (UHMWPE), highly cross-linked polyethylene (XLPE) or ceramic-on-ceramic (CoC) bearing surface.

Introduction

The Opera acetabular component (Smith & Nephew Ltd) shares many same design features with the Ogee (Depuy Int.). Differences are a malleable flange, instrumentation designed to improve cement pressurisation and the specifics of the UHMW-poly used.

Introduction: Revision hip arthroplasty for aseptic loosening of femoral component is successfully treated with impaction bone grafting technique. Owing to easier technique and shorter operative time, distally fixed non-cemented long stems have gained popularity in the present era. However, use of long stems could make subsequent re-revision difficult due to further bone loss. The standard length stem has been often critiqued due to apprehension of peri-prosthetic fracture.

This study aims to determine the long-term outcomes of the impaction bone grafting of the femur for aseptic loosening in revision hip arthroplasty using standard length C-stems. 168 total hip revisions of 162 patients with impaction bone grafting and cemented standard C-stem (done with standardized technique) between 1995 and 2008 at a tertiary referral centre were included. Revisions for infection and segmental bone defects were excluded.

Mean follow-up of the 168 revision hips was 10.5 years (range 5 – 19.1 years). 14 patients (8.3%) were re-revised, reasons being, persistent deep infection (1.8%), repeated dislocations (1.2%), cup loosening (4.8%) and stem loosening (1.2%). Only 1 patient (0.6%) was re-revised due to stem loosening alone. No peri-prosthetic fractures (intra-operative or post-operative) or stem breakage were identified.

Use of standard stem length in hip revisions with impaction bone grafting does not increase the risk of peri-prosthetic fractures, instead, reconstitutes the bone stock. This questions the conventional principle of bypassing the distal cavitation of femur by 2 cortical diameters with the use of long stem. In our experience, a good proximal femur support is key to performance of standard length cemented stems in revision for aseptic loosening irrespective of grade of distal cavitation for cavitatory defects of femur when treated with impaction bone grafting.

Objectives

There are several reports clarifying successful results following open reduction using Ludloff’s medial approach for congenital (CDH) or developmental dislocation of the hip (DDH). This study aimed to reveal the long-term post-operative course until the period of hip-joint maturity after the conventional surgical treatments.

In metal-on-polyethylene (MoP) THA large femoral metal heads are designed to increase stability and to reduce dislocation risk. The increased head size could lead to increased taper corrosion with the release of metal ions and adverse reactions. Using blood ion measurements, we aimed to investigate the association between femoral head size and metal-ion release after MoP THA. 96 patients were enrolled at two centers and randomized to receive either a 32-mm metal head or a 36–44 mm metal head (the largest possible fitting the thinnest available polyethylene insert). Blood metal ions and PROMs (OHS, UCLA) were measured at two- and five-year follow-ups. Both 2- and 5-year median chrome, cobalt, and titanium levels were below taper corrosion indicative ion levels. At 5 years, median chrome, cobalt, and titanium levels were 0.5 μg/L (0.50–0.62), 0.24 μg/L (0.18–0.30), and 1.16 μg/L (1.0–1.68) for the 32-mm group, and 0.5 μg/L (0.5–0.54), 0.23 μg/L (0.17–0.39), and 1.30 μg/L (1–2.05) for the 36–44 mm group, with no difference between groups (p=0.825, p=1.000, p=0.558). At 2 years, 7 (32-mm) versus 4 (36–44-mm) patients had elevated ions. At 5 years, 6 (32-mm) versus 7 (36–44-mm) patients had elevated ions. There was no difference in either OHS (p=0.665) or UCLA (p=0.831) between patients with or without elevated blood metal ions. 5 years after the insertion of MoP THAs, we found no differences in the blood metal ion levels between 32 mm heads and 36–44 mm heads and no corrosion-related revisions. As taper corrosion can debut after 5 years, there is still a need for long-term follow-up studies on the association between head size and corrosion in MoP THA

Aims

The primary outcome was investigating differences in wear, as measured by femoral head penetration, between cross-linked vitamin E-diffused polyethylene (vE-PE) and cross-linked polyethylene (XLPE) acetabular component liners and between 32 and 36 mm head sizes at the ten-year follow-up. Secondary outcomes included acetabular component migration and patient-reported outcome measures (PROMs) such as the EuroQol five-dimension questionnaire, 36-Item Short-Form Health Survey, Harris Hip Score, and University of California, Los Angeles Activity Scale (UCLA).

Aims

The objectives of this study were to investigate the patient characteristics and mortality of Vancouver type B periprosthetic femoral fractures (PFF) subgroups divided into two groups according to femoral component stability and to compare postoperative clinical outcomes according to treatment in Vancouver type B2 and B3 fractures.

Aims

Perthes’ disease (PD) is a childhood hip disorder that can affect the quality of life in adulthood due to femoral head deformity and osteoarthritis. There is very little data on how PD patients function as adults, especially from the patients’ perspective. The purpose of this study was to collect treatment history, demographic details, the University of California, Los Angeles activity score (UCLA), the 36-Item Short Form survey (SF-36) score, and the Hip disability and Osteoarthritis Outcome score (HOOS) of adults who had PD using a web-based survey method and to compare their outcomes to the outcomes from an age- and sex-matched normative population.

Aims

To clarify the mid-term results of transposition osteotomy of the acetabulum (TOA), a type of spherical periacetabular osteotomy, combined with structural allograft bone grafting for severe hip dysplasia.

Aims

Custom triflange acetabular components (CTACs) play an important role in reconstructive orthopaedic surgery, particularly in revision total hip arthroplasty (rTHA) and pelvic tumour resection procedures. Accurate CTAC positioning is essential to successful surgical outcomes. While prior studies have explored CTAC positioning in rTHA, research focusing on tumour cases and implant flange positioning precision remains limited. Additionally, the impact of intraoperative navigation on positioning accuracy warrants further investigation. This study assesses CTAC positioning accuracy in tumour resection and rTHA cases, focusing on the differences between preoperative planning and postoperative implant positions.

Aims

The aims of this study were to determine if an increasing serum cobalt (Co) and/or chromium (Cr) concentration is correlated with a decreasing Harris Hip Score (HHS) and Hip disability and Osteoarthritis Outcome Score (HOOS) in patients who received the Articular Surface Replacement (ASR) hip resurfacing arthroplasty (HRA), and to evaluate the ten-year revision rate and show if sex, inclination angle, and Co level influenced the revision rate.

Aims

The aim of this study is to report the long-term outcomes of instrumented femoral revisions with impaction allograft bone grafting (IBG) using the X-change femoral revision system at 30 years after introduction of the technique.

Aims

The aim of this study was to explore the relationship between reason for revision total hip arthroplasty (rTHA) and outcomes in terms of patient-reported outcome measures (PROMs).