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

Aims. Our aim was to analyse the long-term functional outcome of two forms of surgical treatment for active patients aged > 70 years with a displaced intracapsular fracture of the femoral neck. Patients were randomised to be treated with either a hemiarthroplasty or a total hip arthroplasty (THA). The outcome five years post-operatively for this cohort has previously been reported. We present the outcome at 12 years post-operatively. Patients and Methods. Initially 252 patients with a mean age of 81.1 years (70.2 to 95.6) were included, of whom 205 (81%) were women. A total of 137 were treated with a cemented hemiarthroplasty and 115 with a cemented THA. At long-term follow-up we analysed the modified Harris Hip Score (HHS), post-operative complications and intra-operative data of the patients who were still alive. Results . At a mean follow-up of 12 years (8.23 to 16.17, standard deviation 2.24), 50 patients (20%), 32 in the hemiarthroplasty group and 18 in the THA group, were still alive, of which 47 (94%) were women. There were no significant differences in the mean modified HHS (p = 0.85), mortality (p = 0.13), complications (p = 0.93) or rate of revision surgery (p = 1.0) between the two groups. Conclusion. In the treatment of active elderly patients with an intracapsular fracture of the hip there is no difference in the functional outcome between hemiarthroplasty and THA treatments at 12 years post-operatively. Cite this article: Bone Joint J 2017;99-B:250–4

A multicentre retrospective study of 879 total hip replacements (THR) was undertaken to investigate any differences in outcome between trainee surgeons and consultants. The effect of trainee supervision was also assessed. The primary outcome measures were survivorship and the Harris Hip Score (HHS). Length of stay was a secondary outcome. Patients were evaluated pre-operatively and at 1, 3, 5, 7 and 10 years post-operatively. Surgical outcome was compared between junior trainees, senior trainees and consultants. The effect of supervision was determined by comparing supervised and unsupervised trainees. There was no significant difference in post-operative HHS among consultants, senior and junior trainees at 1 year (p=0.122), at 3 years (p=0.282), at 5 years (p=0.063), at 7 years (p=0.875), or at 10 years (p=0.924) follow up. Additionally there was no significant difference in HHS between supervised and unsupervised trainees at 1 year (p=0.220), 3 years (p=0.0.542), 5 years (p=0.880), 7 years (p=0.953) and 10-year (p=0.787) follow-up. Comparison of surgical outcome between the supervised and unsupervised trainees also shows no significant difference in hospital stay (p=0.989), or implant survival years (p=0.257). This study provides evidence that when trainees are appropriately supervised, they can obtain equally good results compared with consultants when performing THR

We present the results of Chiari pelvic osteotomy in the treatment of adolescent hip incongruence, with special interest in identifying possibilities, limitations and complications. In a series of 86 patients treated by Chiari pelvic osteotomy (13 operated bilateraly) at the Institute for Orthopaedic Surgery “Banjica” with a follow-up period more than 48 months, we analyzed the relation of Chiari-specific parameters collected from postoperative radiograms (osteotomy angle and heigth, and displacement index) to various preoperative and postoperative parameters (Sharp acetabular angle, Wiberg CE angle, Heyman and Herndon femoral head extrusion index (FHEI), Acetabular depth ratio (ADR), Shenton-Menard arch integrity, limb length discrepancy, gait quality) and functional result according to HHS and McKay scoring systems. We found highly significant improvements of Sharp angle (from 47.2±6.1° preoperatively to 38.6±7.8° finally, p<0.01), Wiberg CE angle (from 10.2±16.8° to 38.9±14.6°, p<0.01) and FHEI (from from 53.4±21% to 1.9±70.7%, p<0.01). In adition, HHS was also improved from 76±15.1 to final 87.9±9.4, p<0.01). We also assessed the satisfaction of both patients (index 4.2 out of 5) and surgeons (index 3.7 out of 5). Chiari pelvic osteotomy is useful surgical procedure in the selected cases of adolescent hip incongruence with disturbance of hip centering and coverage

Cemented total hip arthroplasty yields reliable results in short to medium term studies, but aseptic loosening remains a problem in long-term follow up, especially in young and active patients. Aseptic loosening has been related to wear, and in order to minimize wear various alternatives to the traditional metal on polyethylene have been proposed. Both ceramic on polyethylene (COP) and metal on metal (MOM) have been shown to produce less wear than metal on polyethylene (MOP). In order to study the effect of the bearing, we have utilized identical stems and cups while comparing the different bearings. Methods and material. 396 hips were randomized to MOP, COP or MOM using a cemented triple tapered polished stem (MS-30; Sulzer Orthopedics) with a cemented polyethylene cup (Weber; Sulzer, Orthopedics) and a 28 millimeter head. For the MOP and COP articulations, a all-polyethylene cup was used with a Protasul™ metal head or a Sulox™ alumina head, whereas a polyethylene cup with metal insert was used for the MOM articulations (Weber Polyethylene Cup with Metasul™ Insert) with a Metasul™ metal head. Harris Hip Score (HHS) and radiological evaluation was performed after two, five and seven years. Ethical approval was obtained. Results. HHS was available for 338 hips after seven years. The HHS in the MOP group (116 hips) was 93.7 (SD 9.0), 93.5 in the COP group (112 hips) (SD 8.8), and 91.0 (SD 13.4) in the MOM group (110 hips). Radiographic evaluation was available for 335 hips. Radiolucencies around the stem larger than one millimeter were found in five of 115 MOP hips, seven of 111 COP hips and in seven of 110 MOM hips. Periacetabular radiolucencies identified as larger than one millimeter were found in none of the 116 MOP hips, five of the 112 COP hips and in 19 of the 110 MOM hips. Ten revisions were performed. In the MOP group there were three revisions (infection, dislocation, pain); one in the COM group (infection), and six in the MOM group (three infections, two aseptic loosening and one septic loosening). Discussion. Clinically, the three bearing types perform equally well at seven years, and there are few signs of impending failure for the stem. However, there are an alarmingly high proportion of cups showing signs of loosening. Two hips have been revised in the MOM group for aseptic loosening as opposed to none in the two other groups, which adds to the concern. The MOM articulation used in this study should be monitored closely for signs of aseptic loosening

Introduction. Large diameter metal on metal cups have been used in total hip arthroplasty advocating superior results with respect to dislocation rates, range of motion and long term survival. The Durom cup used as part of the Durom hip resurfacing system has been incriminated with poor short term results sometimes correlated to incorrect positioning of either the femoral or acetabular component. Our objective was to evaluate short term results of the Durom cup used in conjunction with standard stems. Methods. We prospectively followed all patients with a large diameter metal-on-metal articulation (Durom) and a standard stem operated upon between 9/2004 and 9/2008. Patients were seen at follow-up for a clinical (Harris hip score=HHS, UCLA scale and patient satisfaction), radiographic and questionnaire assessment. Results. 89 primary THAs in 80 patients (74% men) with a mean age of 52 (±12) years were included. Main diagnoses were primary osteoarthritis in 47% and aseptic necrosis in 35%. An uncemented stem was used in 79%. Overall, 80 THAs were controlled at a mean follow-up of 39 months (range 16–67 months), 4 patients were lost to follow-up and 5 patients refused or were unable to attend the visit. However, none of the 5 underwent revision. Overall, 8 THAs (8/85, 9.4%) were revised in mean 28 months (range 8–60) after the operation. One additional patient was awaiting revision for aseptic loosening of both cup and stem. The reasons for revision were aseptic loosening in three cases, presence of a granuloma (histological diagnosis of ALVAL) in three, deep infection in one and impingement in one case. Radiographic analysis revealed linear (n=2) and focal (n=3) osteolysis as well as early cup migration (n=2). In 5 revised patients no radiographic changes were found. 56 (70%) of the 80 patients with follow-up had a HHS between 80 and 100. Among those who were not revised, the mean HHS improved from 55.2 to 88.4 (mean increase 33.2, 95% CI 27.7; 38.7). The mean activity level (UCLA scale) at follow-up was 6.4 (±1.8). Overall, mild to severe pain was reported in 14 cases and occasional pain in 22. Groin pain was present in 18 patients (22.5%), 7 of them belonged to the revised group. 61 (76.3%) of the 80 patients with follow-up were satisfied. Mean patient satisfaction on the VAS scale among those who were not revised was 9.0 (±1.3). Conclusion. This study confirms the increased short-term revision rate of the large diameter metal-on-metal couple (Durom) reported by others. In all revision cases the retrieved cups showed no osteo-integration and were removed easily. The operative indication for revision was based upon groin pain and patient dissatisfaction. Radiographic signs of implant loosening were not always present even though in all revised cases except for one the cup was found loose

The use of Birmingham hip resurfacing (BHR) remains controversial due to the increased revision rate in female patients. We compared the outcomes of BHR in female patients to an age matched total hip arthroplasty(THA) cohort. We reviewed the pain, function and total Harris Hip Scores(HHS), and Kaplan-Meir survivorship for BHR and THA cohorts from a prospective regional arthroplasty database. There were 234 patients in each cohort, with mean age of 51 years. The BHR cohort had significantly better function and total HHS at all points of the 5-year study, but not for the post-operative pain score. The 5-year revision rate for the BHR cohort was significantly higher than the THA cohort (6.8% vs 3.4%, p=0.001). The main reason for revision in the BHR cohort was aseptic loosening (n=8), followed by metallosis (n=3). The 5-year Kaplan-Meier survivorship was 92.6% (95% CI±1.7%) and 96.4% (95% CI±1.3%) for the BHR and THA cohort (p=0.001). BHR can give significantly better functional outcomes than THA. The vast majority of female patients were happy with BHR and did not need further surgery at the 5-year stage. This is somewhat at odds with the recent reputation of the procedure. The 10-year result of the same cohort is warranted to provide further data. Our study is not a recommendation to still offer BHR to female patients, but rather to inject a note of realism into the debate. There are implications for future implant development in that these results do validate resurfacing as a functionally valuable option for active patients

Two stage revision for infection is considered the gold standard with a success rate of 80–90%. Overall functional outcomes of these patients are commonly overlooked. There is a trend towards single stage revision to improve functional outcomes. We examined the functional scores of 2 stage revision for total hip arthroplasty (THR) and total knee arthroplasty (TKR). 72 revisions were identified over 9 years: 30 THR and 42 TKR. Two year survivorship was 96% in THR revision and 88% TKR revision. Five year survival was 83% and 84% respectively. 50 patients (without recurrence of infection) had recorded functional scores at a minimum of 1 year. The mean Harris-hip score (HHS) of THR was 75 (21 patients) prior to developing symptoms of infection. Once infected, the mean score fell to 46. At 1 year post revision it returned to 77. At 3 years HHS of 78 (12 patients) and at 5 yrs 62 (3 patients). The mean knee society score (KSS) of TKR was 66 (29 patients) prior to developing symptoms of infection. Once infected, the mean score fell to 34. At 1 year post revision it returned to 73. At 3 years KSS of 76 (16 patients) and at 5 years 62 (10 patients). We conclude that functional scores of staged revisions of infected THR and TKR return to pre-morbid levels within a year of completing the second stage. Although single stage revision may have a quicker return to function, by 1 year, staged revision has comparable results

Between July 2000 and December 2002, 263 consecutive patients across 5 surgical centers underwent to a revision surgery of a failed acetabular component in which TM acetabular components were used. There were 150 women and 113 men with a mean age of 69.5 years. The indication for acetabular revision was aseptic loosening in 186 cases (70.7%). Clinical evaluations were performed using the Harris hip score, the WOMAC and UCLA activity scale. Implant and screw position, polyethylene wear, radiolucent lines, gaps, and osteolysis were assessed. Preoperatively, acetabular bone deficiency was categorized using the classification of Paprosky et al. Statistical analysis was performed using nonparametric correlations. Standard life table was constructed, and the survival rate was calculated by means of Kaplan-Meier method. The overall mean follow-up was 73.6 months (range, 60–84 months), and no patient was lost to follow-up. The preoperative HHS rating improved from a mean of 43.6 ± 11.4 before revision, to a mean of 82.1 ± 10.7. None of the patients was re-revised for loosening. The cumulative prosthesis survival was 99.2% at 5 years. There was no correlation found between the various degrees of acetabular bony defect and the magnitude of clinical results (independent of pre-revision Paprosky grade). The use of component augments allowed us to minimize the volume of morsellized allograft used for defect repair. TM acetabular component demonstrates promising midterm results similar to those reported by other authors

Aims

Acetabular fractures in older adults lead to a high risk of mortality and morbidity. However, only limited data have been published documenting functional outcomes in such patients. The aims of this study were to describe outcomes in patients aged 60 years and older with operatively managed acetabular fractures, and to establish predictors of conversion to total hip arthroplasty (THA).

Introduction. The usefulness of minimal invasive hip replacement is frequently discussed but there is a lack of data on the effect of the surgical approach on early results. We wanted to study the effect of the surgical approach on the peri- and early postoperative outcome. Material/Methods. In a prospective case control study 315 elective hip replacements were performed between January 2008 and March 2010. Until March 2009 a lateral transgluteal approach (STD) was used, then the approach was changed to a minimal invasive anterior approach (MIS). All operations were performed in the same routine setting not affected by the approach. Duration of operation, complications and bloodloss were assessed. 1 week postoperatively, independent mobility, stairs, central analgetics were analysed and length of stay was recorded. At 6 and 12 weeks, pain and patients satisfaction (VAS) and the Harris Hip Score were assessed. Pre- and postoperative radiographs were compared for component position and orientation (EBRA). Results. 6 patients (hips) refused participation, 4 were excluded for other reasons. 174 (57%) hips belonged to STD and 131 (43%) to MIS. There were no demographic differences between both groups. Operation time was longer for MIS (109 vs. 123 min, p=.001). At 1 week, MIS patients were more mobile (rising up from bed, p=.009; stairs, p=.015) and time of hospitalisation became shorter (p=.001). At 6 weeks, MIS patients had less pain at motion (p=.013), less limb (p=.001), a higher HHS (p=.007) and were more satisfied (p=.046). The differences remained unchanged after 12 weeks. There was no difference in implant positioning between the groups. Inclination was higher in group MIS [39° (SD 6°) vs. 38° (SD 7°), p=.030], anteversion was lower [21° (SD 8°) vs. 24° (SD 8°), p=.010]. Conclusion. The introduction of the MIS anterior approach was safe. Early rehabilitation was facilitated and clinical results were better. Radiographical results were not impaired by the new approach. We see no disadvantage of the MIS anterior approach. Adaptions in the clinical setup might further facilitate rehabilitation

Aim. to compare the medium term clinical and functional results of total hip arthroplasty after intertrochanteric osteotomy and primary total hip replacement. Material and methods. We compared 2 groups of patients: Group I-93 patients with total hip arthroplasty after intertrochanteric osteotomy and Group II-93 patients with primary total hip arthroplasty. The patients in the control group (Group II) were randomly chosen from the cases operated by the same surgical team using the same kind of implant like those in Group I. The osteotomies were of different types: medial displacement (27), varisation(19), valgisation (18), flexion(25), rotational (4). The demographic parameters were similar in the 2 groups. Technical intraoperative challenges were noted. The Harris Score was determined at 12 months and 3 years after surgery. Clinical and radiological check-ups were performed each year. The duration of each surgical procedure was recorded. Complications were noted during the entire follow-up. The mean follow-up was 77 months. Results. The average time interval between osteotomy and total hip replacement was 76 months. The average Harris Score (HHS) at 1 year after surgery was 88 in Group I and 93 in Group II. At 3 years, the average values of HHS were 85 in the first group and 92 in the second. After an average follow-up of 6 years, 6 patients in group I (6,45%) required revision arthroplasty, while in the second group this procedure was not necessary. The indication of revision was loosening of the femoral component in 4 cases and of both components in 2 cases. The duration of a total hip arthroplasty after an ostheotomy was almost two times longer than a primary total hip replacement. In most cases, the surgical procedure implicated removal of a blade plate or others fixation devices, reaming of the femur, osteotomies of the greater trochanter, reverse osteotomies of the intertrochanteric region and the use of special design (thin or curved) femoral stems. In group I, intraoperative complications included fractures of the femoral diaphysis, fractures of the greater trochanter, false passage for the femoral component and malposition of the femoral stem. Postoperative complications consist in dislocations, early loosening, heterotopical ossifications, wound sepsis, etc. Conclusions. Total hip arthroplasties after intertrochanteric osteotomies have clinical results a little bit inferior of those of primary total hip replacements, but the difference is not significative. The survival rate of prosthesis implanted after intertrochanteric osteotomies at 6 years is significantly inferior. Both the intraoperative and postoperative complications rates are far superior of those of the primary arthroplasties

Introduction. treatment of femoral neck fractures in the physically active elderly, is still an open question. The comparison of total replacement and partial hip replacement showed substantial superiority of the first approach than the latter. We can not disregard the problems that THR can lead in the elderly: more surgical time, greater blood loss, major sacrifice of bone in osteoporotic subjects. The Tribofit® acetabular system, has the objective to overcome these problems with the implantation of a single 3mm soft, pliable buffer made of polycarbonate-urethane between the large diameter metal femoral head and the subchondral bone, thus replacing the articular cartilage. The surgical technique includes the reaming of the cartilage layer, the creation of a circumferential groove and the snap-fit insertion of the buffer. The purpose of the prospective study was to evaluate the effectiveness of this approach in the treatment of femoral neck fractures in the elderly. Materials and Methods. from September 2008 to July 2010 we performed 45 implants with the Tribofit® Acetabular Buffer (Active Implants®, Memphis TN, USA). The inclusion criteria for the study were: femoral neck fracture patients over 75 years of age, physically independent before the injury, with good life expectancy, mild or absent arthritis, absence of morphological alterations of the acetabulum. The average age of these patients was 81,2 (75–89), the sex distribution was 36 females and 9 males, with 22 fractures of the left hip and 23 of the right. In all cases an uncemented straight femoral stem was implanted. We recorded per-operative blood loss and intra-per-operative problems encountered. Follow-up were performed at 1, 3, 6 and 12 months post-op with radiographic control and clinical examination. The clinical outcome was objectively measured by the Harris Hip Score, pain Visual Analogue Scale and SF-36 questionnaire. Results. Of the 45 patients, 4 died of unrelated causes and 3 were lost to follow-up (2 due to cognitive impairment and 1 due to peri-prosthetic fracture of the femur). Of the 38 available for follow-up, all were followed at the staged time. No intra-operative problems were registered. The mean HHS for these fractures patients was 74,2 at 6 months and 86 at 12 months (90–80 good; 80–70 fair). The mean pain VAS was 4,3 at 6 months and 2 at 12 months. The mean SF-36 Score was 52,3 at 6 months and 53,2 at 12 months. Of the 38 followed, we had 2 dislocations in the third week post-op while the two patients were in a rehabilitation centre. Open reduction was carried out and in both cases the buffer was not dislodged. Discussion and conclusions. we believe the results with this new type of prosthesis are encouraging and comparable to if not better than other prosthetic options in the literature for this difficult-to-treat patient population

Introduction. Several short femoral stems have been introduced in primary total hip arthroplasty, supposedly in order to save proximal bone stock. We intended to analyse primary stability, changes in periprosthetic bone mineral density (BMD), and clinical outcome after insertion of the uncemented collum femoris preserving (CFP)-femoral device. Methods. A prospective cohort study on 30 patients scheduled for receiving the CFP-stem combined with an uncemented cup was carried out. Stem migration was analysed by radiostereometry (RSA). Preoperative total hip BMD and postoperative periprosthetic BMD in Gruen zones 1–7 was investigated by DXA, and the Harris hips score (HHS) was determined. The patients were followed up to 12 months. Results. 2 patients were intraoperatively excluded because their proximal femur was found to be unsuitable for insertion of the studied implant, 1 patient was later revised due to a deep infection. This left 27 patients for final analysis. RSA showed that only very little migration of the implant occurred, with the largest amplitude found in rotation around the y-axis (1.8°, SD 0.6, after 12 mths), representing minimal stem retroversion. DXA after 12 mths demonstrated substantial BMD loss in Gruen zones 7 (−30.8%), 6 (−19.1%) and 2 (−13.3%, p-values for all described changes <0.001 when comparing with baseline BMD determined immediately postoperatively). There was a moderate correlation of low preoperative total hip BMD with a higher amount of bone loss in Gruen zones 2 (Pearson correlation coefficient r = 0.6, p = 0.001), 6 (r = 0.5, p = 0.005) and 7 (r = 0.6, p = 0.003). In contrast, we found no correlation of periprosthetic bone loss in any of the Gruen zones 1–7 with logarithmically transformed maximal total point translation (MTPT) of the stem (p > 0.05 for all regions), neither after 3 nor after 12 mths. The mean HHS increased from 49 (SD 15) preoperatively to 99 (SD 2) after 12 mths. Interpretation. Based on these short-term data, we conclude that i) the studied implant seems to be stable within the first year, ii) substantial loss in periprosthetic BMD - with a predominance in the calcar region - occurs, iii) low preoperative total hip BMD predisposes towards greater loss of periprosthetic BMD after 12 months, iv) postoperative loss in periprosthetic BMD does not correlate with increased stem migration. Clinical results are excellent so far. Continuing follow-up will reveal whether this novel stem remains stable in the medium and long term, and whether the loss in BMD in the regions mentioned above can be recovered with time or whether it continues

Introduction. Metal-on-metal (MoM) articulations in total hip replacement (THR) have become an attractive option for young, active patients. Short-term reports have demonstrated elevated systemic metal ion levels in the blood and urine. Disseminated concentrations of cobalt and chromium have raised concern regarding cellular toxicity, chromosomal damage and adverse local soft tissue reactions. Long-term studies are required to support the increased use of MoM bearings in younger patients given their potential deleterious effects. The purpose of the current study was to report the 7–13 year clinical, radiographic, and metal ion results in patients following MoM THR. Methods. We prospectively followed 165 patients (196 hips) after second-generation MoM THR between July 1997 and November 2003. Functional outcome was measured using the Harris Hip Score (HHS) and the University of California Los Angeles (UCLA) Activity Score. Radiographic analysis was performed using Einzel-Bild-Roentgen-Analyse (EBRA) by two of the authors blinded to the study. Cobalt and chromium metal ions were measured from whole blood and analyzed using inductively coupled plasma-mass spectrometry. Results. 163 prostheses were analyzed. The mean age at surgery was 50.8 years (range, 17 to 66). There were 80 females and 83 males. The mean follow-up was 8.87 years (range, 7–13 years). Four hips (2.5%) were revised: 2 for infection at 0.2 and 7 years; 1 for a loose stem at 1.3 years; and 1 for a loose cup at 9 years. One patient received wound debridement for a superficial infection and did not have any components revised. The mean HHS and UCLA scores at the last follow-up were 91 and 6.8, respectively. The mean acetabular inclination and anteversion was 40 degrees (range, 24 to 57), and 19 degrees (range, 3 to 39), respectively. Median cobalt levels peaked at a value of 2.87 μg/L at 4 years (p<0.0001 vs. pre-operative) and subsequently decreased to 2.0 μg/L after 9 years (p=0.002 vs. 4-years). Median chromium levels maximally increased up to 0.75 μg/L after 5 years (p<0.0001 vs. pre-operative) and tended to decrease thereafter to values of 0.56 μg/L after 7 years. The Kaplan-Meier survivorship was 91.3% for revision for all causes, and 97.5% when excluding the hips revised for a manufacturer's defect at a mean of 8.87 years (range, 7–13 years). Conclusion. The present 7–13 years follow-up study of MoM THRs indicates that the clinical and radiological results are satisfactory with low revision rates. Furthermore, our study demonstrates the trend of metal ion levels in whole blood over a long-term. Both cobalt and chromium ion levels peaked at 4 and 5 years, respectively, and gradually decreased thereafter

Introduction. Large wear rate reductions have been shown for crosslinked PE in simulators and short- to mid-term clinical wear studies. However, concerns persist about long-term in-vivo oxidation (especially with annealed PE), late accelerating wear and the possibly higher osteolytic potential of crosslinked PE particle debris. This is the first long-term study comparing conventional to crosslinked PE investigating whether the wear reduction is maintained in the long-term and if reduced osteolysis becomes evident. Materials & Methods. In a prospective study 48 primary THA patients (Stryker ABG-II, 28mm CoCr heads) were randomized to either receive a first generation crosslinked PE (Stryker Duration: 3MRad gamma irradiation in N2, annealed) or then conventional, now “historic” PE (3MRad gamma irradiation in air). Both groups were statistically non-different (p>0.1) regarding age (63.9 years), gender, BMI, stem and cup size, cup inclination, liner thickness or pre- and post-op HHS leaving the insert material as the only variable. Patients were followed-up annually using the Harris Hip score, AP and lateral radiographs and digital wear measurements using Roman V1.70 [1, 2]. Wear and radiographic signs of osteolysis were analysed at a mean follow-up of 12.9 years (12.0–13.3). Groups were compared using the t-test (means) or the Fisher Exact test (proportions). Results. Thirty-one patients (18 conventional, 13 Duration) were left for analysis (8 deaths, 9 lost to FU). At 13yrs the total linear head penetration was sign. lower with Duration (0.70 ±0.36mm, range: 0.3–1.2mm) than conventional PE (1.56 ±0.83, range: 0.4–3.3mm, p=0.015). Also the annual wear rate was sign. lower (p=0.005) for Duration (0.063 ±0.027mm/yr) than conventional PE (0.122 ±0.065mm/yr). This reduction (−48%) compared well to the original simulator prediction (−45%) and even increased with time (−30% at 5yrs, −38% at 8yrs, −42% at 10yrs). In the Duration group only 1 patient had a wear rate >0.1mm/yr (osteolysis threshold) compared to 10 in the Conventional group (p=0.007). Patients with radiographic signs of acetabular osteolysis (cysts) on the AP x-ray were less frequent in the Duration (4/13=31%) than in conventional group (13/18=72%, p=0.023). This difference became even more pronounced when also the lateral view was evaluated and the affected DeLee-Charnley zones were counted (7 vs 22, p=0.017). Only in the conventional group a revision was performed (cup for wear). Discussion & Conclusions. At long-term FU the absolute wear rate of Duration crosslinked PE did not increase but decrease and the wear relative reduction did not deteriorate but increased. The incidence of osteolysis was sign. less. Thus No clinical evidence of degradation or elevated osteolytic potential for this annealed first generation crosslinked PE debris was found

Goal. The goal of this prospective, non-randomized study is to compare functional and life-quality changes in primary total hip replacement (THR) with minimally invasive anterior (MIA) and direct lateral (DL) approach in six months follow-up. Materials and Methods. Sixty (30 MIA and 30 DL) consecutive patients underwent primary THR were operated by the same senior surgeon. Patients completed functional and life-quality scores (Oxford Hip Score, Harris Hip Score, EQ-5D) before operation and four times (2 and 6 weeks, 3 and 6 months) after THR. Physical examination was taken all times. 15–15 patients underwent MRI examination to adjudge status of abductor muscles. The average patient age was approximately equal in both group. Results. The average OHS values were 13,4; 27,5; 40,9; 45,3; 47,5 in MIA and 15,3; 25,3; 39,7; 43,8; 45 in DL, the average HHS values 43,1; 68,7; 85,3; 91,9; 96,7 in MIA and 43; 58,2; 81,5; 90,2; 93,9 in DL, the average EQ-VAS 41,1; 72,5; 85,9; 87,8; 92,4 in MIA and 55,6; 67,8; 80,6; 84; 91,3 in DL consecutively. In MIA group both functional and life-quality scores showed better results, but for the 3rd postoperative month increases were approximately equal. Abductor muscle strength was significantly greater in MIA group in this period. In the 6th postoperative week Trendelenburg-sign was detected in 24 cases (80%) in DL and in 2 cases (6,7%) in MIA group, but in MIA patients were greater trochanter fractures, which had gone healing and limping was not detected 3 months after surgery. 3 months after surgery Trendelenburg-sign was detected in 2 cases in DL group. In follow-up period residual trochanteric pain was detected in 3 cases in DL but none in MIA group. Two weeks after THR climbing a flight of stairs was normal and public transport could be used by 80% of patients in MIA group. Distance walk was unlimited, support had not needed, daily activities were easy. There were 7 operative complications in MIA group, including 2 greater trochanter fracture, 1 haematoma and 4 transient lateral femoral cutaneous nerve palsy, which showed change for the better after 6 months. Postoperative hip dislocation was not detected. In DL group MRI represented fatty infiltration and atrophy of abductor muscles in most cases. Conclusions. Besides the fact that our learning curve may influence the results. It seems that earlier mobilisation and faster postoperative recovery can be achieved by MIA approach, which have many financial and social benefits. It preserves muscles and tendons, which probably can influence the long-term results. By preventing abductor muscles can assure better gait pattern. Of course additional long-term studies are needed

Aims

The aim of this study was to compare the functional and radiological outcomes in patients with a displaced fracture of the hip who were treated with a cemented or a cementless femoral stem.

Aims

Our aim in this study was to describe the long-term survival of the native hip joint after open reduction and internal fixation of a displaced fracture of the acetabulum. We also present long-term clinical outcomes and risk factors associated with a poor outcome.

Aims

The aim of this study was to record the incidence of post-traumatic osteoarthritis (OA), the need for total hip arthroplasty (THA), and patient-reported outcome measures (PROMS) after surgery for a fracture of the acetabulum, in our centre.