Since the introduction of national guidelines in 2009 encouraging the use of total hip arthroplasty (THA) to treat intracapsular neck of femur fractures there has been no population-based studies into the surgical outcomes for this indication. This study aims to calculate the complication rates for THA when performed for a fractured neck of femur and compare them to THA performed for primary osteoarthritis in the same population.

The Scottish Arthroplasty Project was used to identify all THAs performed in Scotland for neck of femur fracture and osteoarthritis between 1st of January 2009 and 31st December 2014. Dislocation, infection and revision rates at 1 year were calculated.

The rate of dislocation, infection and revision at 1 year were all significantly increased among the fracture neck of femur cohort. In total 44046 THAs were performed, 38316 for OA and 2715 for a neck of femur fracture. 2.1% of patients (n=57) who underwent a THA for a neck of femur fracture suffered a dislocation in the 1st year postoperatively, compared to 0.9% (n=337) when the THA was performed for osteoarthritis. Relative Risk of dislocation: 2.3870 (95% C.I. 1.8077–3.1252, p value <0.0001). Relative Risk of infection: 1.4561 (95% C.I. 1.0496–2.0200, p value 0.0245) Relative Risk of revision: 1.4807 (95% C.I. 1.0308–2.1268, p value 0.0336).

This is the first time a dislocation rate for THA performed for a neck of femur fracture has been calculated for an entire population. As the number of THAs for neck of femur fracture increases this dislocation rate will have clinical implications.

Fractured neck of femur is a significant health concern within the UK. NICE guidance on the management of displaced intracapsular fractures states that total hip arthroplasty should be offered when patients can; walk independently out of doors with no more than a stick, not cognitively impaired, medically fit for anaesthesia and the procedure. We previously managed this subgroup using THA with standard sockets. Following an audit of this practice a dislocation rate of 9% was identified and practice was changed to using dual mobility (THA-DM) with the theoretical advantage of reducing dislocation. We reviewed all patients who underwent THA for fracture using Bluespier from 2013–2017. Operative notes and radiographs were reviewed to ensure the patients had undergone THA for displaced intracapsular fracture. Basic patient demographics were collected. Our primary outcome was dislocation rates at one year. Our secondary outcomes were length of time to surgery, length of stay, operative time, mortality, return to theatre rates and one year Oxford hip scores. We found a control group of 45 THA procedures and a dual mobility group of 143 procedures. The one year dislocation rate from the THA-SS group was 9% and the THA-DM group was 1.4%(CI±1.9%)(p=<0.05%). There were also non-significant reductions in time to surgery, length of stay, operative time, mortality, return to theatre rates. The one year Oxford hip score was comparable at 42.2 to 41.8. This study demonstrates a significant reduction in one year dislocation rates with comparable oxford hip scores. Use of THA-DM should be considered in those patients who meet NICE criteria. Further research is needed into long term dislocation rates

Few independent studies have reported the outcome of resurfacing arthroplasty of the hip. The aim of this study was to report the five-year clinical outcome and seven-year survival of an independent series. A total of 610 Birmingham Hip Resurfacing arthroplasties were performed in 532 patients with a mean age of 51.8 years (16.5 to 81.6). They were followed for between two and eight years; 107 patients (120 hips) had been followed up for more than five years. Two patients were lost to follow-up. At a minimum of five years’ follow-up, 79 of 85 hips (93%) had an excellent or good outcome according to the Harris hip score. The mean Oxford hip score was 16.1 points (. sd. 7.7) and the mean University of California Los Angeles activity score was 6.6 points (. sd. 1.9). There were no patients with definite radiological evidence of loosening or of narrowing of the femoral neck exceeding 10% of its width. There were 23 revisions (3.8%), giving an overall survival of 95% (95% confidence interval 85.3 to 99.2) at seven years. Fractured neck of femur in 12 hips was the most common indication for revision, followed by aseptic loosening in four. In three hips (three patients) (0.5%), failure was possibly related to metal debris. Considering that these patients are young and active these results are good, and support the use of resurfacing. Further study is needed to address the early failures, particularly those related to fracture and metal debris

Aims

Iliopsoas pathology is a relatively uncommon cause of pain following total hip arthroplasty (THA), typically presenting with symptoms of groin pain on active flexion and/or extension of the hip. A variety of conservative and surgical treatment options have been reported. In this retrospective cohort study, we report the incidence of iliopsoas pathology and treatment outcomes.

Aims

Instability continues to be a troublesome complication after total hip arthroplasty (THA). Patient-related risk factors associated with a higher dislocation risk include the preoperative diagnosis, an age of 75 years or older, high body mass index (BMI), a history of alcohol abuse, and neurodegenerative diseases. The goal of this study was to assess the dislocation rate, radiographic outcomes, and complications of patients stratified as high-risk for dislocation who received a dual mobility (DM) bearing in a primary THA at a minimum follow-up of two years.

Between April 1992 and July 2005, 310 posterior lip augmentation devices were used for the treatment of recurrent dislocation of the hip in 307 patients who had received primary total hip replacements (THRs) using Charnley/Charnley Elite components with a cemented acetabulum. The mean number of dislocations before stabilisation with the device was five (1 to 16) with a mean time to this intervention from the first dislocation of 3.8 years (0 days to 22.5 years). The mean age of the patients at this reconstruction was 75.4 years (39 to 96).

A retrospective clinical and radiological review was carried out at a mean follow-up of six years and nine months (4.4 months to 13 years and 7 months). Of the 307 patients, 53 had died at the time of the latest review, with a functioning THR and with the posterior lip augmentation device in situ. There were four revisions (1.3%), one for pain, two for deep infection and one for loosening of the acetabular component. Radiolucent lines around the acetabular component increased in only six cases after insertion of the device which was successful in eliminating instability in 302 patients, with only five further dislocations (1.6%) occurring after its insertion.

Metal-on-metal hip resurfacing was performed for developmental dysplasia in 96 hips in 85 patients, 78 in women and 18 in men, with a mean age at the time of surgery of 43 years (14 to 65). These cases were matched for age, gender, operating surgeon and date of operation with a group of patients with primary osteoarthritis who had been treated by resurfacing, to provide a control group of 96 hips (93 patients). A clinical and radiological follow-up study was performed. The dysplasia group were followed for a mean of 4.4 years (2.0 to 8.5) and the osteoarthritis group for a mean of 4.5 years (2.2 to 9.4). Of the dysplasia cases, 17 (18%) were classified as Crowe grade III or IV.

There were five (5.2%) revisions in the dysplasia group and none in the osteoarthritic patients. Four of the failures were due to acetabular loosening and the other sustained a fracture of the neck of femur. There was a significant difference in survival between the two groups (p = 0.02). The five-year survival was 96.7% (95% confidence interval 90.0 to 100) for the dysplasia group and 100% (95% confidence interval 100 to 100) for the osteoarthritic group. There was no significant difference in the median Oxford hip score between the two groups at any time during the study.

The medium-term results of metal-on-metal hip resurfacing in all grades of developmental dysplasia are encouraging, although they are significantly worse than in a group of matched patients with osteoarthritis treated in the same manner.