Hip resurfacing has grown rapidly since its introduction in the United States, as an alternative to total hip replacement in the younger, active patient. Some studies have suggested a steep learning curve and a higher complication rate when compared to THR. Existing studies have originated from the pioneering surgeons, using a specific type of resurfacing implant. The purpose of this study was to look at the experience of a single, non-inventor surgeon with the adoption of hip resurfacing, using 3 different implants. M&M. All consecutive hip resurfacings performed by the senior surgeon between 2004 and 2008 were included, providing a minimum 2 year followup period. 3 different implant types were used; 2 of these were used as part of the clinical trials, and 1 was used after US FDA approval. A total of 560 hip resurfacings were eligible for the study based upon a minimum of 2 year followup. Results. Nine revisions were performed in this cohort (1.6%). 2 were femoral conversions to endoprostheses for femoral neck fracture; 3 additional femoral conversions were done for osteonecrosis of the femoral head. 1 acetabular revision only was performed for malposition. 2 revisions to THR of both the acetabular and femoral components were done for acetabular loosening and excessive metal production (edge loading). There was 1 revision for metal hypersensitivity. Overall, the K-M survival curve is 98.1% at 4 years. There was no difference with regard to survival from additional surgery with regard to the different implant types. Radiographic signs of failure were also documented. In this cohort, 3 femoral and 1 acetabular components were identified to be radiographically loose, giving a K-M survival from clinical and radiographic failure to be 96.8% at 4 years. Discussion. Hip resurfacing can be adopted successfully with a low rate of reoperation, by the use of careful patient selection. A single surgeon's experience with 3 different types of implants demonstrated no difference in clinical results between the devices

Introduction. Controversy exists as to whether the short external rotator tendons and capsule of the hip should be repaired after posterior approach primary total hip arthroplasty (THA). Recent studies using radiopaque markers have demonstrated that reimplantation of these muscle tendons fail early and may not prevent post operative dislocation. Methods. Using dynamic ultrasound examination we evaluated the patency of repair in 68 tendon groups (piriformis/conjoint tendon and obturator externus). We demonstrate short and medium term success in the reimplantation of these tendons using the double transosseous drill hole technique of reattaching the tendons and capsule to the greater trochanter. We followed up 21 of our total hip replacements and 13 hip resurfacings and undertook a dynamic ultrasound examination of the external rotators by an experienced musculoskeletal radiologist to assess their integrity at a minimum of 60 days and 100 days and an average of 213 days after the operation. Results. There were 34 hips assessed in 33 patients. 21 were total hip replacements and the rest were hip resurfacings. Each patient underwent a standard posterior approach by the senior surgeon. The piriformis and conjoint tendons (Group 1) and the obturator extenus (Group 2) were reattached with modified kessler sutures using a transosseous reimplantation technique. The capsule was reattached with a running suture using the same technique. The total hip replacement group had 16 out of 21 hips (76.2%) where both external rotator groups were intact at follow up, compared with 3 out of 13 hips (23.1%) for the hip resurfacing group (Chi-squared 9.188, p=0.002). Group 1 tendons were intact in 81% of the THR group while only in 53.8% in the rsurfaing group. We compared the hip replacement group with the hip resurfacing group using survival analysis techniques (log rank test), which take into account the different follow-up times. The hip replacement group showed a significantly longer time to the event of either rotator group not being intact at follow-up than the hip resurfacing group (log rank 5.568, p=0.018). Conclusions. Our results do appear to suggest that this technique may be of benefit in patients undergoing primary THA but may not be as successful after resurfacing procedures. We propose that the increased incidence of external rotator detachment seen in the resurfacing group may be due to the increased strain imparted on the tendons due to the greater distance to travel, as they wind around the large resurfaced femoral head and neck as compared to the relatively thinner THA femoral neck and smaller head component

Background. Hip resurfacing arthroplasty (HRA) has seen a recent revival with third generation Metal-on-Metal prostheses and is now widely in use. However, safety and effectiveness of hip resurfacing are still questioned. We systematically reviewed peer-reviewed literature on hip resurfacing arthroplasty to address these issues. Objective. To evaluate implant survival and functional outcomes of hybrid Metal-on-Metal hip resurfacing arthroplasty (HRA). Method. Electronic databases and reference lists were searched from 1988 to May 2010. Identified abstracts were checked for inclusion or exclusion by two independent reviewers. Data were extracted and summarized by one reviewer and verified by a second reviewer. Main study endpoint was implant survival, which we compared with the National Institute of Clinical Excellence (NICE) benchmark. We also evaluated radiological and functional outcomes, failure modes and other adverse events. The quality of evidence was judged using the Grading of Recommendations Assessment, Development and Evaluation system (GRADE). Results. We identified 539 articles, of which 29 met the inclusion criteria. The studies included one randomised clinical trial, 27 prospective case series and one retrospective case series. Data were extracted from these 29 articles, totalling 10621 resurfaced hips, providing details on five out of 11 resurfacing devices on the market. Mean follow up ranged from 0.6 to 10.5 years and implant survival ranged from 84% to 100%. Of the 10621 hips, 370 were revised (3.5%), with aseptic loosening as most frequent failure mode. None of the HRA implants used to date met the full 10 year NICE benchmark. Thirteen studies showed satisfactory implant survival percentages compared to the three year NICE entry-benchmark. These 13 studies used the BHR implant (eight studies), the Conserve plus (two studies), the Durom implant (one study), the Cormet 2000 implant (one study) or both the McMinn and the BHR implant (one study)

Hip resurfacing arthroplasty is an established and effective intervention for osteoarthritis of the hip in the young active patient, relying on the principle of femoral bone-stock preservation. A recognised mode of failure is neck thinning leading to radiological evidence of neck collapse and clinical failure. We report on a series of these slow-neck-failure patients and highlight the increased incidence of this phenomenon in post-menopausal female patients. This is a single operator, single implant series; 172 cases were identified from databases at our institution. 76 were female, mean (SD) age 52 (7) years. 96 were male, mean (SD) age 51(12) years. 15 (8.7%) patients required revision. 12 (80%) were female, 9 (75%) of these were due to slow neck failure. In the men one patient developed ALVAL requiring removal of his bilateral hip resurfacings, the other failure mode was early femoral neck failure. Mean time to failure was 6 months in men and 37 months in women. This difference in failure rates is also seen in the NJR figures. This review confirms the relatively high incidence of premature failure in post-menopausal females. NICE guidance in 2003, currently under review, stated that resurfacing is indicated in male patients up to 65 and female patients up to 60. As a result of this study we are currently advising post-menopausal patients that this risk of early failure may make total hip replacement a preferable option to resurfacing arthroplasty

Introduction. Although femoral neck fractures remain a concern in short term failures for hip resurfacing, acetabular component position and fixation are increasingly being recognized as causes of mid term failures for hip resurfacing. This study aimed to evaluate the migration pattern of a cobalt chrome, beaded acetabular component for a metal on metal hip resurfacing. Methods. 130 patients underwent metal on metal hip resurfacing: 66 hips in 60 patients had sufficient films to be included in this analysis. Forty-eight patients were male and 12 were female, with a mean age of 50 (range, 32–66). Ninety-five percent of the procedures were performed for osteoarthritis. In all cases acetabular migration was measured both vertically and horizontally, on serial radiographs using the computer-assisted Ein Bild Röntgen Analyse method. A minimum of three comparable radiographs is necessary for calculating the migration curves. We scored medial migration as negative horizontal movement. Results. At a mean follow up 25.3 months (24–36 months), each hip had an average of 5.1 radiographs for analysis. 12.5% of the cups showed more than 1 mm migration in the medial-lateral axis and 45.3% more than 1 mm in the vertical axis. 23% of the cups showed a combined migration of greater than 2 mm in the observation period. Two of these cases required revision for aseptic loosening at 34 months. Discussion and Conclusion. Previous studies have shown EBRA to have an excellent sensitivity and positive predictive value for mid to long term cup failure. This data raises concern about the initial stability if this acetabular component. Continued follow-up is needed to monitor the longer term survival of this implant

Introduction. Acetabular cup positioning has been linked to dislocation and increased bearing surface wear. A previous study found correlations between patient and surgical factors and acetabular component position. The purpose of this study was to determine if acetabular cup positioning improves when surgeons receive feedback on their performance. Methods. Post-op anteroposterior (AP) pelvis and cross-table lateral radiographs were previously obtained for 2061 patients who received a total hip arthroplasty (THA) or hip resurfacing from 2004–2008. The surgeries were performed by 7 surgeons. AP radiographs were measured using Hip Analysis Suite to calculate the cup inclination and version angles. Acceptable ranges were defined for abduction (30–45 °) and version (5–25 °). The same surgeons performed a THA or hip resurfacing on 385 patients from January 2009 through June 2010. Cup inclination and version angles for this set of surgeries were compared to surgeries from 2004–2008 to determine if cup inclination and version angles improved in response to previous acetabular cup positioning studies. Improvement in accuracy was assessed by the chi-square test. Results. Time 1, from 2004 through 2008, had 1952 qualifying hips with 1845 having both version and abduction, and Time 2, from 2009 through June 2010, had 385 qualifying hips, all of which had both version and abduction angles. For Time 1, 1192 (62%) acetabular cups were within the abduction range, 1422 (79%) were within the version range, and 908 (49%) were within the range for both. For Time 2, 276 (72%) acetabular cups were within the abduction range, 250 (65%) were within the version range, and 217 (56%) were within the ranges for both. Accuracy of abduction angle improved (p<0.01) while accuracy of version angle decreased (p<0.01). Accuracy of acetabular cup positioning being within range for both abduction angle and version angle improved significantly (p=0.01), by 7%. Conclusions. Increased awareness and feedback on the resulting abduction and version measurements from THA surgery over time improves the positioning of the acetabular component. A system where objective measurements are presented to the surgeon can significantly improve cup placement which could improve the clinical outcome of THR patients

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

Introduction. Metal on metal hip resurfacing (MMHR) has been advocated for the younger patient for several reasons including for the preservation of bone stock and ease of revision to total hip replacement (THR), thus ‘buying an additional operation’ for the patient. This rationale however assumes a good functional outcome after the revision to a THR and that the results of the ‘revision primary’ will not be compromised by the resurfacing which preceded it. We present our data on a consecutive series of 68 revised MMHRs. Methods. Between September 1997 and September 2009, 927 consecutive patients underwent a hip resurfacing procedure performed by one of three senior surgeons at our institution. The Cormet resurfacing system was used for all patients. Sixty-eight of these patients had their resurfacing revised. Oxford hip score (OHS) obtained at a minimum of 12 months follow-up was used as the primary outcome measure. Results. Average age at time of index procedure was 51.9 (24 to 68) years. The MMHRs were revised an average of 49 (1 to 121) months after index procedure. At time of writing OHS post revision was 21.4 (range 12 to 48) at an average of 42 months post revision (range 16 to 111 months). Patients with a primary diagnosis of dysplasia were at an increased risk of revision RR 3.7 (1.9–7.1, p < 0.05).). No other primary diagnosis significantly increased risk of revision. Five patients underwent a second revision procedure. Discussion. We present the fuctional outcome scores of a large series of revised MMHRs. Despite MMHRs offering the advantage of preservation of bone stock we have found revision of MMHRs to THRs technically difficult. Our functional outcome scores in patients post revision were disappointing. We cannot support the concept that MMHR “buys patients another operation”

Background. Medical complications and death are rare events following elective orthopaedic surgery. Diagnostic and operative codes are routinely collected on every patient admitted to hospital in the English NHS (hospital episode statistics, HES). This is the first study investigating rates of these events following total joint replacement (TJR) on a national scale in the NHS. Methods. All patients (585177 patients) who underwent TJR (hip arthroplasty [THR], knee arthroplasty [TKR], or hip resurfacing) between January 2005 and February 2010 in the English NHS were identified. Patients were subdivided based on Charlson co-morbidity score. HES data in the form of OPCS and ICD-10 codes were used to establish 30-day medical complication rates from myocardial infarction (MI), cerebrovascular event (CVA), chest infection (LRTI), renal failure (RF), pulmonary embolus (PE) and inpatient 90-day mortality (MR). Results. The overall 90-day MR after THR was 0.44% (1116 of 256013 patients), after hip resurfacing 0.06% (17 in 27314), and after TKR 0.34% (1023 of 301850). MI rate was 0.39% (2257 of 585177). Of these 15.8% (356) died. CVA rate was 0.01% (53). Of these 32.1% (17) died. LRTI rate was 0.60% (3389). Of these 12.1% (410) died. RF rate was 0.35% (2066). Of these 13.9% (287) died. PE rate was 0.71% (4144). Of these 3.9% (161) died. For patients with no co-morbidities, no personal history of PE or DVT, and no post-operative complications (70.8% of all patients in this study, 414061 of 585177), MR was 0.09% (394 patients). Discussion. This national data analysis allows a greater understanding of mortality risk following post-operative complications, and provides robust information for the consenting process. It also shows that the risk of mortality for fit patients without post-operative complications was very low - a group which is thought to have a high rate of ‘silent’ fatal PEs

Introduction. It was the purpose to evaluate the biomechanical changes that occur after optimal and non-optimal component placement of a hip resurfacing (SRA) by using a subject specific musculoskeletal model based on CT-scan data. Materials and Methods. Nineteen hips from 11 cadavers were resurfaced with a BHR using a femoral navigation system. CT images were acquired before and after surgery. Grey-value segmentation in Mimics produced contours representing the bone geometry and identifying the outlines of the 3 parts of the gluteus medius. The anatomical changes induced by the procedure were characterised by the translation of the hip joint center (HJCR) with respect to the pelvic and femoral bone. The contact forces during normal gait with ‘optimal’ component placement were calculated for a cement mantle of 3 mm, a socket inclination of 45° and anteversion of 15°. The biomechanical effect of ‘non-optimal placement’ was simulated by varying the positioning of the components. Results. There was a significant (p<0.01) shortening of the muscle length with the ‘optimal’ component placement for all parts of the gluteus medius with the largest shortening of the posterior part by 6mm. This was caused by a significant shortening of the femoral offset by 2.3mm (p<0.01). Because of a significant (p<0.01) medialisation of the HJCR by 4 mm, there was no significant increase in contact force. The hip joint contact forces increased by 0.5% per mm HJCR displacement. Each millimeter of cranial and lateral displacement of the femoral HJCR increased the contact force by 0.5% and 1%, respectively. The contact stresses changed significantly by 0.8% and 0.2% per degree of socket inclination and anteversion. The contact force increased 1% per mm lateral displacement of the acetabular HJCR. Discussion. Optimal placement of the SRA components did not completely restore the biomechanics of the native hip joint. The contact forces were not increased due to the compensatory effect of the medialisation of the acetabular HJCR. This suggests that reaming to the acetabular floor should be conducted in SRA. Femoral component displacement in the cranial and lateral direction significantly increased the hip joint loading. Errors of socket placement in the coronal and sagital plane significantly increased the contact stresses. Accumulative errors of both component displacements could lead to increased contact stresses of 18% to 23% with socket inclinations of 50° and 55°. Surgeons should reconsider continuing the SRA procedure if a neck length loss and lateralisation of the HCJR by >5 mm is anticipated as this would increase the contact stresses by >12%

INTRODUCTION. Ceramic-on-metal hip replacements (COM, where the head is a Biolox Delta ceramic and liner is Co Cr alloy), have demonstrated reduced wear under standard conditions in vitro compared to metal-on-metal (MOM) [1]. Early clinical results are also encouraging [2]. Recently concerns have been raised regarding the poor clinical performance of MOM hip resurfacings [3], particularly when cups are steeply inclined. Laboratory hip simulator testing has been used to replicate edge loading, also demonstrating elevated wear [4]. Therefore, a range of conditions to replicate sub-optimal use clinically to better predict in vivo performance should be used. The aim of this study was to compare the wear rates of MOM and COM under adverse edge loading conditions in an in vitro hip simulator test. METHODS. Ceramic-on-metal (n=3) and metal-on-metal (n=3) 36mm hip prostheses (supplied by DePuy International Ltd, UK) were tested in the Leeds Physiological Anatomical Hip Joint Simulator. Liners were mounted to provide a clinical angle of 45o, and stems positioned anatomically. A simplified gait cycle and microseparation was applied as previously described [5] for two million cycles in 25% new born calf serum. Gravimetric analysis was completed every million cycles and wear volumes calculated. RESULTS. The overall mean volumetric wear rate of COM bearings was 0.36 ± 0.55mm3 per million cycles, this was significantly less than the MOM bearing wear (1.32 ± 0.91mm3 per million cycles). For both COM and MOM bearings wear under these edge loading conditions was significantly greater if compared to previously reported wear under standard conditions [1]. DISCUSSION. The reduced wear of COM has been attributed to the differential hardness decreasing adhesive wear and reduced corrosive wear [6]. Wear under the harsh edge-loading conditions in this study is also reported to be significantly less in COM bearings compared to MOM. In MOM bearings in edge contact conditions, the wear zone becomes starved of lubrication, this elevates wear and increases damage at the edge of the cup. In COM bearings the harder head does not become damaged when there is lubricant starvation and hence wear does not accelerate in the same way. In conclusion, COM bearings show reduced wear compared to MOM bearings under standard and adverse conditions and there is some early evidence to support this finding clinically. ACKNOWLEDGEMENTS. Supported by DePuy International Ltd. SW is supported by a Royal Academy of Engineering/EPSRC (UK) fellowship

INTRODUCTION. The advantages of large diameter metal on metal total hip arthroplasty (MoM THA) and hip resurfacing arthroplasty are decreased wear rate, preservation of bone stock, anatomical restoration and enhanced stability. Large amounts of metal wear particles and metal ions are released which may induce adverse reactions including local soft tissue toxicity, hypersensitivity reactions, bone loss and risk of carcinogenesis. Aseptic loosening can be the result of a peri-prosthetic osteolysis generated as a result of a biological response to particulate wear debris. No reports in the literature exist as to whether circulating levels of Chromium (Cr) and Cobalt (Co) decrease upon removal of a symptomatic large diameter MoM implant or whether levels remain high due to the effect of metal ions debris left behind in the soft tissues after revision surgery. PATIENTS AND METHODS. Between June 2006 and June 2009 we undertook 44 revision surgeries of both large head MoM THAs (femoral head diameter 38mm) and metal-on-metal hip resurfacings for suspected metallosis. Mean time from original implant to revision was 4 years, 8 months (1yr 4mo–7yr 9mo). The mean follow up evaluation was 2 years and 2 months (1yr 2mo–4 years). Blood samples were taken for whole blood Cr and serum Co according to a recognised protocol and compared with reference levels indicated by the Medicines and Healthcare Regulatory Agency recommendation of less than 7ppb for Cr (130nM/L) and Co (119nM/L). RESULTS. 42 patients were found to have histological evidence of either metal allergy, metal toxicity or foreign body reaction. 2 patients had evidence of infection with no features of metal reaction. 3 patients suffered early dislocation requiring closed reduction. 1 patient had infective complications necessitating Girdlestones. 11 patients were lost to follow up, 8 patients were diagnosed pre operatively on Co and Cr levels in urine or synovial fluid aspirate alone. 23 patients had pre revision blood or serum metal ion level results available for direct comparison. Median serum Co level pre revision was 176.6nM/L, falling post revision to 5.1nM/L (p=<0.001∗). The median whole blood Cr level pre revision was 117nM/L and 19nm/L post revision (p=<0.001∗). Mean Oxford Hip Score was 23.7. DISCUSSION. This study demonstrates that at greater than one year post removal of a large diameter MoM hip implant for the indication of symptomatic metallosis or metal hypersensitivity, metal ion levels fall to almost normal levels and that outcome of revision surgery in terms of patient satisfaction is not adversely affected

INTRODUCTION. Whilst there is a great deal of research on hip implants, few studies have looked at implant orientation and the subsequent effect upon the wear performance of a hip resurfacing. This study aimed to measure implantation angles through radiographic analysis and linear wear for retrieved acetabular cups in order to investigate possible causal links between wear and implant orientation. MATERIALS & METHODS. Seventy Birmingham Hip Resurfacing (Smith & Nephew, UK) cups with known time in vivo were analysed. Linear wear of retrieved cups were assessed using a Talyrond 290 roundness machine. Deviations from the characteristic manufactured profile, was identified as a region of wear. Polar measurements across the wear region were taken to determine wear. The linear wear rate (LWR) of a component was defined as the linear wear (μm) divided by the duration of the implant life in vivo (years). Cups which showed the wear crossing over the edge of the cup were classified as edge loaded (EL). For all non-edge loaded (NEL) cups, the wear area was within the bearing surface. Cup orientation angles were conducted for 31 cups. This was determined by superimposing BHR models of appropriate size, generated by CAD ProEngineer Wildfire 4, onto anterior-posterior x-rays. Anatomical landmarks and specific features of the BHR were used as points of reference to determine cup version and inclination angles. RESULTS. Forty two cups were classed as EL, showing regions of wear extending beyond the edge of the cup. Twenty eight were classed as NEL. The EL group had an average LWR of 25.4(±8.05 95% CL) μm/yr, whilst the NEL group generated an average LWR of 1.45 (±0.34 95% CL) μm/yr, a statistically significant difference (p<0.05).a Following radiographic analysis, 23 cups were classed as EL, showing regions of wear extending beyond the edge of the cup. Eight were classed as NEL. Cups in the EL group showed average inclination and version angles of 54.35° (±5.37° 95% CL) and 22.43° (±5.23° 95% CL). Average inclination and version angles of cups in the NEL group were 45° (±7.20° 95% CL), and 14.88° (±3.38° 95% CL) respectively. Inclination and version angles between the two groups were statistically significant (p<0.05). DISCUSSION. Through linear wear and radiographic analysis, the current study has shown that mal-positioned resurfacing devices classed as EL had higher linear wear than the NEL cups. Edge loaded cups examined in this study showed significantly higher inclination and anteversion (p<0.05) than the non-edge loaded devices. This indicates that component wear is closely associated with in vivo orientation. The success of any implant is dependent upon implant orientation both in version and inclination angles. The correct implant orientation will help to ensure that wear occurs within the bearing surfaces, maintaining an optimal lubrication regime and low wear

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

We investigated whether patients who underwent internal fixation for an isolated acetabular fracture were able to return to their previous sporting activities.

We studied 52 consecutive patients with an isolated acetabular fracture who were operated on between January 2001 and December 2002. Their demographic details, fracture type, rehabilitation regime, outcome and complications were documented prospectively as was their level and frequency of participation in sport both before and after surgery. Quality of life was measured using the EuroQol-5D health outcome tool (EQ-5D).

There was a significant reduction in level of activity, frequency of participation in sport (both p < 0.001) and EQ-5D scores in patients of all age groups compared to a normal English population (p = 0.001). A total of 22 (42%) were able to return to their previous level of activities: 35 (67%) were able to take part in sport at some level. Of all the parameters analysed, the Matta radiological follow-up criteria were the single best predictor for resumption of sporting activity and frequency of participation.