Aims. There are limited long-term studies reporting on outcomes of the Zimmer Modular Revision (ZMR) stem, and concerns remain regarding failure. Our primary aim was to determine long-term survival free from all-cause revision and stem-related failure for this modular revision stem in revision total hip arthroplasty (THA). Secondary aims included evaluating radiological and functional outcomes. Methods. We retrospectively identified all patients in our institutional database who underwent revision THA using the ZMR system from January 2000 to December 2007. We included 106 patients (108 hips) with a mean follow-up of 14.5 years (2.3 to 22.3). Mean patient age was 69.2 years (37.0 to 89.4), and 51.9% were female (n = 55). Indications for index revision included aseptic loosening (73.1%), infection (16.7%), fracture (9.3%), and stem fracture (0.9%). Kaplan-Meier analysis was used to determine the all-cause and stem-related failure revision-free survival. At most recent follow-up, Oxford Hip Scores (OHS) were collected, and radiological stem stability was determined using the Engh classification. Results. A total of 17 hips (15.7%) underwent re-revision of any component. Indications for re-revision were stem failure (35.3%; n = 6), infection (29.4%; n = 5), instability (29.4%; n = 5), and acetabular aseptic loosening (5.9%; n = 1). The five- and 15-year all-cause survival was 89.7% (95% confidence interval (CI) 86.7 to 92.7) and 83.3% (95% CI 79.6 to 87.0), respectively. There were six re-revisions (5.6%) for stem failure; five for stem fracture and one for aseptic loosening. The five- and 15-year survival free from stem-related failure was 97.2% (95% CI 95.6 to 98.8) and 94.0% (95% CI 91.6 to 96.4), respectively. At final follow-up, the mean OHS was 36.9 (8.0 to 48.0) and 95.7% (n = 66) of surviving modular revision stems were well-fixed in available radiographs. Conclusion. Femoral revision with the ZMR offers satisfactory long-term all-cause revision-free survival, good survival free of stem-related failure, and favourable clinical outcomes. Stem fracture was the most common reason for stem-related failure and occurred both early and late. This highlights the importance of both early and long-term surveillance for stem-related failure. Cite this article: Bone Joint J 2024;106-B(5 Supple B):112–117

Cite this article: Bone Joint Res 2023;12(5):309–310.

Aims

This study investigates the use of the metabolic equivalent of task (MET) score in a young hip arthroplasty population, and its ability to capture additional benefit beyond the ceiling effect of conventional patient-reported outcome measures.

Aims

Femoral cement-in-cement revision is a well described technique to reduce morbidity and complications in hip revision surgery. Traditional techniques for septic revision of hip arthroplasty necessitate removal of all bone cement from the femur. In our two centres, we have been using a cement-in-cement technique, leaving the distal femoral bone cement in selected patients for septic hip revision surgery, both for single and the first of two-stage revision procedures. A prerequisite for adoption of this technique is that the surgeon considers the cement mantle to be intimately fixed to bone without an intervening membrane between cement and host bone. We aim to report our experience for this technique.

It is unclear whether patients with early radiographic osteoarthritis (OA) but severe hip symptoms benefit from total hip replacement (THR). We aimed to assess which factors were associated with successful THR in this patient group. From a consecutive series of 1,935 patients undergoing THR we identified 70 (3.6%) patients with early OA (Kellgren and Lawrence (KL) grades 0-2). These were compared with 200 patients with advanced OA (KL grades 3–4). Outcomes were Oxford Hip Scores (OHS), EQ5D and EQ-VAS scores; compared pre-operatively with one year post-operatively. We investigated which clinical and radiographic (plain x-ray, CT, MRI) features predicted successful THR in the early OA group. Success was defined as reaching a postoperative OHS≥42. The early OA group were significantly younger (61 vs 66 years; P=0.0035). There were no significant differences in body mass index, ASA grade or gender. After adjusting for confounders, the advanced OA group had a significantly greater percentage of possible change (PoPC) in OHS (75.8% versus 50.4%; P<0.0001) and improvement in EQ5D (0.151 versus 0.002; P<0.0001). There were no significant differences in complication, revision or readmission rates. In the early OA group, we identified 16/70 (22.9%) patients who had a ‘successful’ THR. Of those with early OA, 38 patients had pre-operative CT or MRI scans. Patients who had a ‘successful’ THR were significantly more likely to have subchondral cysts on CT/MRI (91.7% versus 57.7%; P=0.0362). The presence of cysts on CT/MRI was associated with a significantly greater PoPC in OHS (61.6% versus 38.2%; P=0.0353). The combination of cysts and joint space width (JSW) <1mm was associated with a PoPC of 68%. Plain radiographs were found to significantly underestimate the narrowest JSW compared to CT/MRI (2.4mm versus 1.0mm; P<0.0001). We advise caution in performing THRs in patients with early OA (KL grades 0-2) on plain radiographs. We advocate pre-operative cross-sectional imaging (CT or MRI) in these patients. In the absence of cysts on cross-sectional imaging, a THR seems unlikely to provide a satisfactory outcome

Constrained acetabular inserts provide a solution for both complex primary and revision hip arthroplasty, but there have been ongoing concerns for high risk of failure and their longevity. The Stryker® Trident acetabular insert is pre-assembled with its constrained ring. We believe this to be the largest series of constrained acetabular inserts with a minimum of 5 year follow-up. We retrospectively reviewed all Stryker® Trident ‘All-Poly’ constrained acetabular inserts cemented into bone in our unit between 2008 and 2016. We collated demographic details and reviewed all patients’ radiographs and clinical notes. Indications for surgery, latest Oxford Hip Scores (OHS) and clinical and radiographic complications were identified. 117 consecutive Stryker® Trident ‘All-Poly’ constrained inserts were cemented into bone in 115 patients during the study period with a mean age of 80 (47–97). Most common indications for surgery were recurrent dislocation (47), complex primary arthroplasty (23), revision arthroplasty (19) and failed hemiarthroplasty (12). 41 patients required revision of the acetabular component only. Follow-up was a minimum of 5 years (mean 8.6, range 5–13). There were three 30-day mortalities and six 1-year mortalities. The mean latest OHS was 37 (24–45). Four cups failed in three patients, one at the cement-bone interface, two at the cement-prosthesis interface and one at the bipolar interface. These were treated conservatively in three patient and with excision arthroplasty in one patient. There were four peri-prosthetic fractures, one Vancouver C distal femur fracture treated conservatively and three Vancouver B1 fractures, two treated conservatively and one treated with open reduction internal fixation. There was breakage of one constrained ring with no adverse effects and one superficial wound infection requiring oral antibiotics only. This series demonstrated that despite the elderly and complex nature of these patients’ clinical situations, constrained acetabular inserts offer a useful and pragmatic solution, with relatively low complications, including in our series a cup failure rate of 3% and peri-prosthetic fracture rate of 3%

Aims. “Get It Right First Time” (GIRFT) and NHS England’s Best Practice Tariff (BPT) have published directives advising that patients over the ages of 65 (GIRFT) and 69 years (BPT) receiving total hip arthroplasty (THA) should receive cemented implants and have brought in financial penalties if this policy is not observed. Despite this, worldwide, uncemented component use has increased, a situation described as a ‘paradox’. GIRFT and BPT do, however, acknowledge more data are required to support this edict with current policies based on the National Joint Registry survivorship and implant costs. Methods. This study compares THA outcomes for over 1,000 uncemented Corail/Pinnacle constructs used in all age groups/patient frailty, under one surgeon, with identical pre- and postoperative pathways over a nine-year period with mean follow-up of five years and two months (range: nine months to nine years and nine months). Implant information, survivorship, and regular postoperative Oxford Hip Scores (OHS) were collected and two comparisons undertaken: a comparison of those aged over 65 years with those 65 and under and a second comparison of those aged 70 years and over with those aged under 70. Results. Overall revision rate was 1.3% (13/1,004). A greater number of revisions were undertaken in those aged over 65 years, but numbers were small and did not reach significance. The majority of revisions were implant-independent. Single component analysis revealed a 99.9% and 99.6% survival for the uncemented cup and femoral component, respectively. Mean patient-reported outcome measures (PROMs) improvement for all ages outperformed the national PROMs and a significantly greater proportion of those aged over 65/69 years reached and maintained a meaningful improvement in their OHS earlier than their younger counterparts (p < 0.05/0.01 respectively). Conclusion. This study confirms that this uncemented THA system can be used safely and effectively in patient groups aged over 65 years and those over 69 years, with low complication and revision rates. Cite this article: Bone Jt Open 2021;2(5):293–300

Objectives. A possible solution for the management of proximal femoral bone loss is a modular femoral endoprosthesis (EPR). Although the outcome of EPRs in tumour surgery has been well described, the outcome of their use in revision hip surgery has received less attention. The aim of this study was to describe the outcome of using EPR for non-neoplastic indications. Methods. A retrospective review of 79 patients who underwent 80 EPRs for non-neoplastic indications was performed, including the rates of complication and survival and the mean Oxford Hip Scores (OHS), at a mean of five years post-operatively. The mean age at the time of surgery was 69 years (28 to 93) and the mean number of previous operations on the hip was 2.4 (0 to 17). The most common indications for EPR implantation were periprosthetic joint infection (PJI) (n = 40), periprosthetic fracture (n = 12) and failed osteosynthesis of a proximal femoral fracture or complex trauma (n = 11). Results. Salvage was achieved in all patients. A total of 25 patients (25 EPRs, 31.6%) had a complication, the most common being infection (n = 9) and dislocation (n = 3). Further surgery was required for 18 EPRs (22%), nine of which were revision procedures. The five year survival of the EPR was 87% (95%CI: 76% to 98%). The mean OHS was 28 (4 to 48). Inferior survival and outcomes were seen in EPRs which were performed for the treatment of infection. However, the eradication of infection was achieved in 33 of the 40 (82.5%) which were undertaken for this indication. Conclusion. We recommend the continued use of proximal femoral EPRs for non-neoplastic indications, including PJI. Cite this article: Bone Joint J 2016;98-B:1463–70

INTRODUCTION. Additive manufacturing (3D printing) is used to create porous surfaces that promote bone ingrowth in an effort to improve initial stability and optimize long-term biological fixation. The acetabular cup that was studied is manufactured with titanium alloy powder via electron beam melting. Electron beam melting integrates the porous and solid substrate rather than sintering a porous coating to a solid surface. The 3D-printed acetabular cup's high surface coefficient of friction (up to 1.2), combined with its geometry, creates a predictable press-fit in the acetabulum, improving initial mechanical stability and ultimately leading to reproducible biologic fixation. The objective of this study was to evaluate the early clinical outcomes and implant fixation of this 3D-printed acetabular cup in total hip arthroplasty (THA). METHODS. Four hundred twenty-eight subjects from 8 US and international research sites underwent primary THA with the 3D-printed acetabular cup. All sites received IRB approval prior to conducting the study, and all participants signed the informed consent. Screw usage and number used during surgery were used as a surrogate measurement for initial implant fixation. Clinical performance outcomes included pre- and post-operative Harris Hip Scores (HHS) and Oxford Hip Scores (OHS), patient satisfaction, and revision assessment. 215 patients had a minimum 1-year post-operative follow-up visit. Student t-tests were used to identify significant mean differences (p<0.05). RESULTS. Acetabular screws were used in 206 of 428 cases (48.1%); 85.9% used 1 screw, 12.6% used 2 screws, and 1.5% used 3 screws. For patients with a 1-year post-operative visit, the HHS improved by 49.8 points to 91.9 from 42.1, and the OHS improved by 27.7 points to 44.4 from16.7. Patient satisfaction scores at the 1-year post-operative visit were 9.7±0.7 (n=94). There was no significant difference between genders with regard to BMI, the 1-year post-operative HHS, OHS, or patient satisfaction scores. However, the males were significantly younger (59.8 vs. 62.9 years) and had significantly higher pre-operative HHS (45.7 vs. 37.9) and OHS scores (17.8 vs. 15.3). There were 9 revisions reported. DISCUSSION. For initial implant fixation, compared to a similar, non-3D-printed acetabular cup in the same product line, the 3D-printed cup used significantly fewer screws per case (n=1 for 85.9% cases vs. n=2 for 85.7% of cases) in a fewer percentage of cases (48.1% vs. 70.4%), suggesting greater initial stability and “scratch fit”. The 3D-printed acetabular cup also displayed positive early clinical results as evidenced by the pronounced improvement in clinical outcome scores from the pre-operative visit to the 1-year post-operative visit. These 1-year improvements are better than moderate clinically important improvements reported in the literature (40.1 points for HHS). Patient satisfaction scores were also excellent (9.7/10). There were nine revisions; however, four of these were due to patient falls and one was due to infection. SIGNIFICANCE. The 3D-printed acetabular cup evaluated in this study demonstrated improved implant fixation and positive early clinical outcomes for THA

Aims. Advocates of debridement, antibiotics and implant retention (DAIR) in hip periprosthetic joint infection (PJI) argue that a procedure not disturbing a sound prosthesis-bone interface is likely to lead to better survival and functional outcome compared with revision. This case-control study aims were to compare outcome of DAIRs for infected primary total hip arthroplasty (THA) with outcomes following primary THA and two-stage revision of infected primary THAs. Patients and Methods. We retrospectively reviewed all DAIRs, performed for confirmed infected primary hip arthropasty (n = 82) at out institution, between 1997 and 2013. Data recorded included full patient information and type of surgery. Outcome measures included complications, mortality, implant survivorship and functional outcome. Outcome was compared with two control groups matched for gender and age; a cohort of primary THAs (n = 120) and a cohort of two-stage revisions for infection (n = 66). Results. Mean age at DAIR was 69 years (33 to 87) and mean follow-up was eight years (2 to 17; standard deviation (. sd). 5). A total of 52 (63%) of DAIRs were for early PJI (less than six weeks). Greater success in the eradication of infection with DAIR was identified with early PJI, comprising an interval less than a week between onset of symptoms and exchange of modular components with the DAIR procedure. Eradication of infection, complications and re-operation rates were similar in the DAIR and two-stage revision groups. For hips with successful eradication of infection with DAIR, the five-year survival (98%; 95% confidence interval (CI) 94 to 100) was similar to the primary THA group (98%; 95% CI 95 to 100) (n = 43; p = 0.3). The DAIR group had inferior mean Oxford Hip Scores (OHS) (38; 12 to 48) compared with the primary THA group (42; 15 to 48) (p = 0.02) but a significantly better mean OHS compared with the two-stage revision group (31; 0 to 48) (p = 0.008). Patients who required only one DAIR for eradication of infection had a similar mean OHS (41; 20 to 48) to the primary THA group (p = 0.2). Conclusion. The DAIR procedure is associated with a similar complication rate and ability to eradicate infection as two-stage revision. This study emphasises the need for exchange of modular components for improved chances of eradication of infection. This is the first study showing that DAIR is better than a two-stage revision regarding functional outcome. Cite this article: Bone Joint J 2017;99-B:614–22

Hip resurfacing arthroplasty (HRA) in patients with a varus deformity of the femoral neck-shaft angle (NSA) is associated with poorer outcomes. Our experience has not reflected this. We examined the Oxford Hip Scores (OHS), Harris Hip Scores (HHS) and outcomes of patients with varus hips against a normal cohort to ascertain any significant difference. We identified 179 patients. Measurement of the femoral neck-shaft angle was undertaken from antero-posterior radiographs pre-operatively. The mean NSA was 128.5 degrees (SD 6.3). Patients with a NSA of less than 122.2 were deemed varus and those above 134.8 valgus. These parameters were consistent with published anatomical studies. The varus cohort consisted of 23 patients, mean NSA 118.7 (range 113.6-121.5), mean follow-up 49 months (range 13-74). Mean OHS and HHS were 16 and 93.5 respectively. Complications included 2 cases of trochanteric non-union; no femoral neck fractures, early failures or revisions. Normal cohort consisted of 125 patients, mean NSA 128 degrees, mean follow-up 41 months (range 6-76). The OHS and HSS were 18.8, 88.9 respectively. Complications included 5 trochanteric non-unions and 1 revision due to an acetabular fracture following a fall. Statistical analysis demonstrated no statistical difference between the cohorts OHS (p=0.583) or HHS (p=0.139). Our experience in patients with a varus femoral neck has been positive. Our analysis has demonstrated no statistical difference in hip scores between the cohorts. We have not yet experienced any femoral neck fractures, which we believe is due to the use of the Ganz trochanteric flip and preservation of blood supply

Introduction. Although total hip replacement (THR) has been described as the operation of the century, there is still room for improvement. There is therefore continued effort for advanced implants and bearing surfaces, moreover so, for the younger patient with a longer life expectancy and increased needs. Objectives. This prospective case-series study aims to present the preliminary, minimum three-years, results of a novel uncemeted stem, the Leader StemÒ (Vadin Implants Ltd, London, U.K.). The Leader StemÒ is a titanium, tapered stem for immediate three-point fixation. There is a metaphyseal porous-coating with titanium microspheres for bone in-growth. It has anti-rotational ribs in the metaphyseal - diaphyseal junction to promote initial stability and a grit blasted diaphyseal region for bone on-growth. The distal tip is polished and shortened to minimize thigh pain, while the whole design and concept is one to eradicate stress shielding. Methods. Between June 2010 and May 2012 we operated on 20 males and 29 female patients (53 THRs, mean age 66±13 years). The diagnosis was osteoarthritis in 39 patients (41 THRs), developmental dysplasia in six patients (eight THRs), avascular necrosis in two patients (two THRs) and chondrolysis in two patients (two THRs). Operations were performed by the posterior approach by two hip surgeons. The bearing surface was ceramic on ceramic in six patients (eight THRs), metal on polyethylene in 22 patients (22 THRs) and ceramic on polyethylene in 21 patients (23 THRs). Patients' demographic data, Harris Hip Scores (HHS) and Oxford Hip Scores (OHS) were collected prospectively, preoperatively, postoperatively, and at six months intervals thereafter. Radiographic evaluation was performed on standard anteroposterior and lateral X-rays at the same time intervals. Results. At last follow-up, mean 50 months after surgery, no revision for any reason has been reported. Six patients were lost to follow-up and one deceased three years post-operatively from an unrelated reason with a stable and untroubled prosthesis. There was one periprosthetic fracture two years after the initial operation but with a stable prosthesis, which was treated with open reduction – internal fixation. Three patients had complained of thigh pain, which had resolved at last follow up. At the most recent follow-up, the average HHS improved from 33.9±13.6 preoperatively to 89.35±12.72 and OHS from 12.7±5.6 to 41.6±7.2. No clinical score was significantly correlated to any demographic index, but the latest HHS was well correlated to the pre-operative score (R=0.41, p=0.007). Radiographically, no radiolucent lines in any of the Gruen zones and no stem subsidence were observed at any time interval, while cortical hypertrophy was observed at the diaphyseal zone in two patients. Conclusions. This study showed that this new press-fit stem design had excellent short-term clinical and radiological results in all followed-up patients, irrespective of their age, gender, and body mass index. Longer follow-up is needed to evaluate its long-term survival and effectiveness

There has been controversy about whether limb length discrepancy (LLD) affects outcome after total hip replacement (THR). We examined input variables and outcomes of over 1200 patients who received primary THR with the Exeter stem and a variety of acetabular components in the Exeter Primary Outcomes Study. This was a non randomized prospective multi centre study. We examined whether specific groups of patients or surgeons were more likely to have LLD at one year after surgery. Data for leg length measured on clinical assessment were available for 1207 patients at 1 year. 237 patients were recorded as having a leg length difference of 1 cm or more, and 73 a difference of 2 cm or more. 138 were longer on the operated side and 99 were shorter. The likelihood of having LLD of 2 cm or more was not significantly affected by the grade of surgeon (consultant or trainee), BMI, age of patient, position of patient during surgery or surgical approach, or the use of regional or general anaesthetic. We examined the effect of LLD on outcomes at 3 months and 1,2,3 and 4 years. Patients with LLD > 1cm had significantly worse Oxford Hip Scores (OHS) at 1, 2, 3 and 4 years (p< 0.01), with the OHS generally being an average 2 points worse in those with LLD. The most consistent difference between those with and without LLD was a patient reported limp on the Oxford Hip Questionnaire. We conclude that LLD is a common problem after THR and that all patient groups may be affected. It is associated with a significantly worse functional outcome as measured by a validated hip score. Systematic adoption of accurate intra-operative measures of leg length might pay dividends in minimizing this complication

Introduction: Management of periprosthetic fractures following total hip arthroplasty (THA) represents a difficult clinical problem, requiring expertise in both trauma and revision surgery. Estimates of the prevalence of postoperative fracture range from 0.1% to 2.1%, and with rising numbers of patients in the population living with hip prostheses in situ there is evidence that their frequency is increasing. There remains a paucity of data on the functional outcome of these injuries, and the objective of this study was to analyse outcomes for revision THA following periprosthetic fracture, and compare these to elective revision surgery. Methods: 233 patients (234 hips) undergoing revision THA for femoral fracture were identified from the New Zealand National Registry, and clinical outcomes were measured using Oxford Hip Scores (OHS) completed six months post operatively. A control group of 234 patients undergoing elective revision THA was selected and matched for age, sex, and time since index operation. Results: Comparative analysis of the registry patients showed clinical outcomes were significantly worse following revision THA for fractured femur than in controls (mean OHS 28.6 vs 23.6, p=0.006), though this difference was not apparent in patients under the age of 65 years (mean OHS 26.1 vs 23.8, p =0.6). A higher mortality rate was found among fracture patients (17.1% versus 10.7 %, p=0.05), and a statistically significant higher number of periprosthetic fracture patients died within 6 months of their surgery in comparison to controls (7.3% versus 0.9%, p=0.003). A higher rate of re-revision was observed in the fracture group (7.7% versus 2.6%, p=0.02). Conclusions: To our knowledge this study represents the largest comparative series of periprosthetic fractures in THA with functional outcome data yet reported. Management of patients with periprosthetic fractures requires recognition of the challenging nature of these injuries, their associated poor prognosis, and high complication rate

Concerns recently arose regarding hip resurfacing arthroplasty (HRA), mainly referring to the metal-on-metal articulation that results in increased metal ion concentrations and that may be associated with weird soft tissue reactions. Although a number of short-term reports highlighted excellent and encouraging outcomes after HRA, mid- to long-term follow-up studies are sparse in the current literature. This study aimed to determine the five-year results of HRA using the Durom. ®. prosthesis in the first consecutive 50 cases. We prospectively assessed clinical and radiographic data for all patients undergoing HRA with this implant. Follow-ups were scheduled at six weeks, one year, two years and five years after surgery. All complications, revisions and failures were noted. Harris Hip Scores (HHS) and the range of motion (ROM) were determined preoperatively and at each follow-up. Oxford Hip Scores (OHS) and University of California at Los Angeles (UCLA) activity levels were determined at the last control. Comparisons were performed using paired t-tests after testing for normal distribution. The cohort comprised 13 women and 36 men (50 hips) with a mean age of 53.3 ± 10.7 years and a mean BMI of 25.9 ± 3.7 kg/m2. After a mean follow-up of 60.5 ± 2.3 months five hips had to be revised, corresponding to a resvision rate of 10%. There occurred two femoral neck fractures (after two and eleven months) and one aseptic loosening of the femoral component (after 68 months). One implant was exchanged to a conventional stem-type design due to persistent hip pain (after eight months), and one hip underwent a femoral offset correction due to a symptomatic impingement between the neck and the cup (after 29 months). There occurred no intra- or other postoperative complications. Clinically, ROM significantly improved after surgery. Hip flexion increased from 91.1 ± 15.8° to 98.9 ± 6.5° (p=0.0007), internal rotation from 5.5 ± 6.9° to 11.1 ± 8.1° (p=0.0005), external rotation from 19.2 ± 12.5° to 28.8 ± 9.1° (p=0.0001), and abduction from 27.3 ± 10.5° to 40.2 ± 11.0° (p< 0.0001). The HHS significantly increased from 55.9 ± 12.3 points to 96.5 ± 8.5 points. The OHS averaged 14.3 ± 3.0 points, and UCLA activity levels averaged 7.7 ± 1.7. The present results demonstrate that despite satisfactory clinical outcomes in terms of patient scores and ROM, the high revision rate of 10% after a mid-term follow-up is disappointing

Aims

The aim of this study was to determine if the Oxford Knee and Hip Score (OKHS) can accurately predict when a primary knee or hip referral is deemed nonsurgical versus surgical by the surgeon during their first consultation, and to identify nonsurgical OKHS screening thresholds.

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Previous research has demonstrated increased early complication rates following total hip arthroplasty (THA) in obese patients, as defined by body mass index (BMI). Subcutaneous fat depth (FD) has been shown to be an independent risk factor for wound infection in cervical and lumbar spine surgery, as well as after abdominal laparotomy. The aim of this study was to investigate whether increased peritrochanteric FD was associated with an increased risk of complications in the first year following THA.

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It is not known whether change in patient-reported outcome measures (PROMs) over time can be predicted by factors present at surgery, or early follow-up. The aim of this study was to identify factors associated with changes in PROM status between two-year evaluation and medium-term follow-up.

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The aim of this study was to assess the functional gain achieved following hip resurfacing arthroplasty (HRA).

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Short-stemmed femoral implants have been used for total hip arthroplasty (THA) in young and active patients to conserve bone, provide physiological loading, and reduce the incidence of thigh pain. Only short- to mid-term results have been presented and there have been concerns regarding component malalignment, incorrect sizing, and subsidence. This systematic review reports clinical and radiological outcomes, complications, revision rates, and implant survival in THA using short-stemmed femoral components.