Background. Second-generation high-carbon CoCrMo-alloy metal-on-metal total hip arthroplasty (THA) was introduced in the late 1980s following reports of early loosening, impingement, pronounced wear, and hypersensitivity in the first-generation metal-on-metal articulations. There has been inconsistent data that specifically addresses the clinical performance and longevity of second-generation metal-on-metal THA. The purpose of this study was to evaluate the survival of second-generation metal-on-metal primary THA and to assess the influence of demographic factors on implant survival in a large patient cohort. Methods. One thousand two hundred and seventy second-generation 28 mm metal-on-metal primary THA in 1121 patients were performed at one institution from 1994 to 2004. According to the International Documentation and Evaluation System patients were followed routinely at one year, two years and every five years thereafter. Clinical and radiographic outcome data was prospectively recorded using a hospital joint registry. At a mean follow-up of 6.8 years postoperatively, the probability of survival of THA was estimated using the method of Kaplan and Meier. Relative risk factors for implant failure that included age, gender, BMI, type of implant fixation and size of implant components were calculated using the Cox proportional-hazards model. Results. Sixty three (5%) hips were revised because of aseptic loosening (28 hips), infection (8 hips), periprosthetic fracture (8 hips), recurrent dislocation (8 hips), pain without implant loosening (7 hips) and breakage of the cup (4 hips). The probability of survival at ten years, with revision for any reason as the endpoint, for the THA as a whole was 0.90 (95% confidence interval, 0.87 to 0.94). The probability of survival for the cup was 0.90 (95% confidence interval, 0.86 to 0.93) and for the stem 0.94 (95% confidence interval, 0.91 to 0.97). No demographic factors or covariates were found to significantly affect survivorship. Conclusion. Second-generation metal-on-metal primary THA did not demonstrate a superior probability of survival at ten years compared with previous reports on other weight-bearing surfaces. Based on these findings and with consideration of concerns that relate to putative local and systemic toxicity of metal debris, the use of second-generation metal-on-metal articulations for primary THA remains moot

INTRODUCTION. Management of neglected residually displaced acetabular fractures is a big challenge. ORIF is often doomed to failure so a primary total hip replacement is usually kept in mind as a method of choice. However THR is a technically difficult and results are quiet unpredictable. OBJECTIVE. To present our experience with THR in maltreated grossly displaced acetabular fractures and to discuss operative technique and prognostic factors in that complicated surgery. MATERIAL. THR was applied in 14 patients (11 males and 3 females, mean age 51 years) with at least three-months old and significantly displaced acetabular fractures. In 12 cases preceding treatment was conservative, and in 2 it was operative. Fracture nonunion was recognized in 5 cases, old hip dislocation in 4 and protusion in 3. Large interfragmentary gaps and local bone defect were detected in almost all cases. METHOD. THR was performed 3–31 months after injury. Extensile iliofemoral or Y-shaped approach with trochanteric osteothomy was used in most cases. Depending of particular situation a variety of techniques were applied to provide adequate bone stock for the cup, such as an approximate ORIF, periacetabular osteotomy, structural or morcelised bone grafting. Reinforcement ring was used in 6 cases. The cup fixation was cemented in 12 procedures and uncemented in 2. Cemented stem was introduced in 10 cases and uncemented in 4. Preoperative selective embolisation of superior gluteal artery was carried out in 1 patient. RESULTS. The operative duration was 3–7 hours and blood loss was 850–2200 ml. The only intraoperative accidentwas jatrogenic lesion of superior gluteal artery required embolisation. The follow up was a 16–94 months. Average postoperative Harris Hip Score was 78, compared with 54 before surgery (P<0.01). There was 2 aceptic and 1 septic loosenings with subsequent revisions (21.4%). In 2 cases sight asymptomatic migration of the cap was noted. DISCUSSION. The most difficult but most important stage of operation is a creating of sufficiently stable bone stock for the acetabular cap, impeded by by fragment displacement, nonunion or prolonged hip dislocation. If nonuion the achievement of bone healing is essential. Any instability should be overcomed by stable osteosynthesis. The gaps should be filled by ORIF or bone grafting. We consider cemented fixation possibly with reinforcement ring as a most secure way to provide strong cup anchorage. Uncemented pess-fit cup may be used in cases with lesser initial displacement. In spite of all late results are considerable worse than in conventional hip replacement. CONCLUSION. THR after neglected acetabular fractures is a challenging and demanding procedure. Successful outcome may be only expected if a solid bone stock is made using various surgical techniques

Primary total hip replacement (THR) surgery is a common procedure. Benchmarking studies in the last decade has shown that those patients have a substantial risk for blood transfusions. The orthopaedic department at Drammen Hospital had implemented a multimodal primary THR care pathway with a focus on minimising surgical trauma and negative trauma response. Neither blood salvage, autologuos blood predonation or erythropoietin has been used. We had reviewed 399 consecutive unselected cases with a mean age of 67 years (range 31–94). We performed a statistic analysis of pre- and postoperative haemoglobin level (g/l). A gender neutral 125 was used as cut point for anaemia. Preoperative haemoglobin level, mean 136 (SD 1.33), and postoperative haemoglobin, mean 113 (SD 1.41), showed an almost perfect Gaussian distribution. Eleven patients received 26 units of allogeneic blood in the first eight postoperative days. There had been a violation of transfusion policy in six of the eleven transfused patients. Mortality during the first 90 postoperative days was zero and 4 patients was readmitted due to cardiac disease during the first 90 postoperative days. All those readmitted due to cardiac disease had an haemoglobin level above 100 at discharge. By combining the Gaussian distribution of the postoperative haemoglobin level and a restrictive transfusion trigger (80 g/l), we calculated a two percent probability of transfusion. For the anaemic patients the calculated probability of transfusion were five percent. Applying a multimodal care pathway in primary THR almost abolish the need for blood transfusion without any preconditioning of anaemic patients. This study supports that an restrictive transfusion trigger are safe in an unselected total hip replacement patient population

Background. It is unclear which form of anaesthesia is the most favourable in primary total hip replacement (THR) surgery. A recently published systematic review of modern anaesthesia techniques in primary THR surgery (Macfarlane 2009) was not able to show any convincing benefit of regional or general anaesthesia. One retrospective study that examined anaesthesia and leg length (Sathappan 2008), found an increased incidence of leg length difference > 5 mm in those patients who were operated with regional anaesthesia. Our department used a mini invasive approach in supine as standard procedure in THR. The type of anaesthesia that is chosen is up to the individual anaesthetist. Purpose. We wanted to see if there was any correlation between type of anaesthesia and leg length, total time spent in theatre and recovery room, postoperative hospital stay, blood loss or operating time in primary THR surgery with a mini invasive approach in supine. Materials and Methods. Our study was a retrospective study of 170 primary THR patients. All patients received an uncemented Corail stem and a cemented Marathon cup. Patients with abnormal anatomy, BMI > 46, simultaneous removal of internal fixation or incomplete data were excluded in the analysis. Radiograpic leg length was measured using the inter teardrop line and the lesser trochanter. Results. 99 patients were operated on with spinal anaesthesia and 71 with total intravenous anaesthesia (TIVA). There were 65% women in both groups. Average age was 74 years (32–95) in the spinal anaesthesia group and 67 years (38–93) in the TIVA group. We found no significant difference in the average operating time (spinal 65 min, TIVA 64 min), drop in haemoglobin to the first postoperative day (spinal 16%, TIVA 16%), postoperative hospital stay (Spinal 1.4 days, TIVA 1.4) or in transfusion rate (spinal 1%, TIVA 1.4%). We found a significant difference in the proportion of patients with a leg length difference of more than 7 mm (Spinal 22%, TIVA 6%, p = 0.02) and the average total time spent in theatre and post-operative department (spinal 325 min, TIVA 293 min, p < 001). Discussion. The study is retrospective and is therefore fettered by the limitations inherent in such a study. Our study seems to confirm the earlier findings that the type of anaesthesia can affect leg length in primary THR. It is speculated that spinal anaesthesia has a more unpredictable effect on muscular tension which could explain this

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

Introduction

The anterior mini-invasive approach to performing total hip arthroplasty (THA) is associated with less soft tissue damage and a shorter postoperative recovery than other methods. In August 2008, our hospital abandoned the traditional lateral Hardinge approach in favor of this new method. The purpose of this study was to measure changes in short-term clinical and radiological results and complications after the changeover.

The Covid-19 pandemic restricted access to elective arthroplasty theatres. Consequently, there was a staggering rise in waiting times for patients awaiting total hip arthroplasty (THA). Concomitantly, rapidly destructive osteoarthritis (RDOA) incidence also increased. Two cohorts of patients were reviewed: patients undergoing primary THA, pre-pandemic (December 2017-December 2018) and patients with RDOA (ascertained by dual consultant review of pre-operative radiographs) undergoing THA after the pandemic started (March 2020 – March 2022). There were 236 primary THA cases in the pre-pandemic cohort. Out of the 632 primary THA cases post-pandemic, 186 cases (29%) had RDOA. Within this RDOA cohort, the pre-operative mean OHS, EQ5D3L and EQVAS (12.7, 10.5 and 57.6 respectively) were all poorer than in the pre-pandemic population (18.3, 9.4 and 66.7 respectively) (p<0.05). There was no significant difference between the RDOA and pre-pandemic cohort in Patient Reported Outcome Measures (PROMS) at 12 months, perhaps due to their ceiling effect. Within the RDOA cohort, 7 cases required acetabular augments, 1 of which also required femoral shortening. The rate of intra-operative fracture, dislocation, infection, return to theatre, and revision were 2.2%, 2.7%, 4.3%, 3.8% and 2.2% respectively, greater than those reported in the literature. No fractures nor dislocations occurred in robot assisted arthroplasties. With ever increasing waiting lists, RDOA prevalence will continue to rise. Increased surgical challenges and potential use of additional implants generated by its presence excludes these patients from waiting list initiative pathways, potentiating the complexity of the operative procedure. Going forwards, the economic burden and training implications must be considered

The objectives of our study were to compare patient reported outcome measures between manual and robotic-assisted total hip arthroplasty. Between 1st May 2021 and 31st August 2022, 539 consecutive patients who underwent 564 primary total hip arthroplasties were identified from the local registry database. Data were prospectively collected, and included patient demographics, American Society of Anaesthesiologists (ASA) grade, surgical approach, robotic-assistance, Oxford Hip Score (OHS), EQ-5D-3L and EQ-VAS pre-operatively and at twelve months. Robotic-assistance, compared against manual total hip arthroplasty, was associated with an enhanced median (interquartile range) OHS (46 [42 – 48] vs 43 [36 – 47], p-value < 0.001), EQ-5D-3L (5 [5 – 7] vs 6 [5 – 8], p-value 0.002), and EQVAS (90 [75 – 95] vs 80 [70 – 90], p-value 0.003) at twelve months after surgery. Robotic-assistance was confirmed to be an independent predictor of a greater OHS at twelve months on a multivariate linear regression analysis (p-value 0.001). Robotic assistance was superior to manual total hip arthroplasty in enhancing patient reported outcomes at twelve months after surgery

Aim of this study was to identify reoperation rates in patients with short oblique and transverse fractures around a well fixed cemented polished taper slip stem and to determine any associations with treatment failure. Retrospective cohort study of 31 patients with AO transverse or short oblique Vancouver B1 PFFs around THA (total hip arthroplasty) cemented taper slip stems: 12 male (39%); mean age 74±11.9 (range 44–91); mean BMI 28.5±1.4 (range 16–48); and median ASA 3. Patient journeys were assessed, re-interventions reviewed. The primary outcome measure was reoperation. Time from primary THA to fracture was 11.3±7.8yrs (0.5–26yrs). Primary surgical management was fixation in 27/31 and rTHA (revision total hip arthroplasty) in 4/31. 10 of 31 (32%) patients required reoperation, 9 within 2 years of fracture: 1 following rTHA and 8 following ORIF. The commonest mode of failure was non-union (n=6). No significant associations with reoperation requirement were identified. Kaplan-Meier free from reoperation was 67.4% (49.8–85.0 95% CI) at 2 years and this was unaffected by initial management with ORIF or rTHA (Log rank 0.898). Of those reoperated, 6/10 required multiple reoperations to obtain either bony union or a stable revision construct and 13% ultimately required proximal femoral endoprostheses. The relative risk of 1 year mortality was 1.6 (0.25 to 10.1 95%CI) among patients who required reoperation compared to those who did not. These are difficult fractures to manage, should not be underestimated and patients should be counselled that there is a 30% risk of reoperation and 20% of requiring multiple reoperations

Non-surgical osteoarthritis management includes analgesia escalation to oral opiates; however, tolerance can occur. This study aims to assess analgesic effects of opiate use pre-operatively and whether this influences outcome 1-year post-operatively in patients undergoing total hip/knee arthroplasty (THA/TKA). This prospective study assessed 1487 patients undergoing primary THA (n=729) or TKA (n=758) for osteoarthritis, with 95 respectively reporting pre-operative opiate use >1 month. THA opiate users had significantly higher BMI (p=0.007) and more likely to suffer associated comorbidities. TKA opiate users were significantly younger (p<0.001), with higher BMI (p=0.019) and more likely to suffer associated comorbidities. Pre-operative quality of life (QoL) and joint specific function were significantly worse (Hip EQ-5D 0.17 vs 0.41, p<0.001, OHS 14.6 vs 21.2, p<0.001; Knee EQ-5D 0.27 vs 0.44, p<0.001, OKS 16.4 vs 21.4, p<0.001). Pre-operative pain was significantly worse in those taking opioids (Hip Pain VAS 42.73 vs 50.70, p<0.001; Knee Pain VAS 50.93 vs 53.36, p=0.30). Post-operatively the THA opiate group had significant improvement in EQ-5D (0.175, p<0.001) and OHS (6.5, p<0.001) but were significantly less improved than opiate naïve patients after adjusting for confounding (EQ-5D 0.10, p<0.001; OHS 3.2, p<0.001). TKA opiate group also had significant improvement in EQ-5D (p<0.001) and OKS (p<0.001) but were significantly less (EQ-5D 0.089, p<0.001; OKS 3.9, p<0.001) than opioid naïve patients. Pre-operative opiate use was associated with significantly worse pre-operative QoL, joint specific function and worse subjective pain. Post-operatively, the opiate group had significantly lower improvement in their QoL and joint specific function

Aims

Femoral periprosthetic fractures are rising in incidence. Their management is complex and carries a high associated mortality. Unlike native hip fractures, there are no guidelines advising on time to theatre in this group. We aim to determine whether delaying surgical intervention influences morbidity or mortality in femoral periprosthetic fractures.

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

BACKGROUND & AIM. Most previous studies found that the rate of dislocation following primary THA was 2 to 3 % on average. It is expected that minimally invasive (MI) THA has fewer dislocations after surgery because it causes less muscle damage. To ascertain the risk factors of dislocation, we conducted a retrospective study of the occurrence of dislocation after MI-THA in Japanese patients. METHODS. From June 2003 when we began MI-THA to August 2010 primary MI-THAs were performed on 2,042 hips; 1,997 hips with mini-posterior approach (a mean incision of 7 cm) with the repair of posterior soft tissues and 45 hips with other approaches. The dislocation after MI-THA was studied with respect to age, sex, body mass index, the use of navigation system, femoral head size, cup size and approaches. The period of follow-up was from six weeks to seven years. RESULTS. The numbers of dislocation after MI-THA were 13 hips (0.6%). The numbers of posterior and anterior dislocation after MI-THA were nine and four hips, respectively. In the patients undergoing MI-THA, there was a significant difference between non-dislocated hips and dislocated hips, with respect to the average age (57 years vs. 66 years, p<0.017), the numbers of male patients (181 cases (9%) vs. 4 cases (31%), p<0.024), cup size (50 mm vs. 53 mm, p<0.007) and the numbers of cases which used navigation system (1,932 hips (95%) vs. 10 hips (77%), p<0.023). Whereas there was no significant difference between non-dislocated hips and dislocated hips with respect to the body mass index, femoral head size and approaches. DISCUSSION. Several risk factors of the dislocation after primary THA have been reported. In this study we found that MI-THA had fewer risk of dislocation as compared with historic controls. It is suggested that less soft tissue damage can decrease the risk of the dislocation after surgery. The incidence of dislocation was fewer in the younger and female patients undergoing MI-THA with the navigation system than in the older and male patients undergoing MI-THA without the navigation system. The posterior approach combined with the repair of posterior soft tissues did not increase the risk of dislocation after surgery as compared with other approaches. The position of implants is important to prevent dislocation after surgery, and the navigation system can help to obtain a good position of implants. CONCLUSIONS. We conclude that MI-THA can decrease the risk of dislocation after primary THA. Furthermore the combination of MI-THA and the navigation system is very useful to reduce the incidence of dislocation because the use of the navigation system during surgery can be helpful to acquire the precise position of implants

Aims

The aim of this study was to investigate the potentially increased risk of dislocation in patients with neurological disease who sustain a femoral neck fracture, as it is unclear whether they should undergo total hip arthroplasty (THA) or hemiarthroplasty (HA). A secondary aim was to investgate whether dual-mobility components confer a reduced risk of dislocation in these patients.

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

Monocyte-lymphocyte ratio (MLR) or neutrophil-lymphocyte ratio (NLR) are useful for diagnosing periprosthetic joint infection (PJI), but their diagnostic values are unclear for screening fixation-related infection (FRI) in patients for whom conversion total hip arthroplasty (THA) is planned after failed internal fixation for femoral neck fracture.

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

INTRODUCTION. The introduction of hard-on-hard bearings and the consequences of increased wear due to edge-loading have renewed interest in the importance of acetabular component orientation for implant survival and functional outcome following hip arthroplasty. Some studies have shown increased dislocation risk when the cup is mal-oriented which has led to the identification of a safe-zone1. The aims of this prospective, multi-centered study of primary total hip arthroplasty (THA) were to: 1. Identify factors that influence cup orientation and 2. Describe the effect of cup orientation on clinical outcome. METHODS. In a prospective study involving seven UK centers, patients undergoing primary THA between January 1999 and January 2002 were recruited. All patients underwent detailed assessment pre-operatively as well as post-op. Assessment included data on patient demographics, clinical outcome, complications and further surgery/revision. 681 primary THAs had adequate radiographs for inclusion. 590 hips received cemented cups. The primary functional outcome measure of the study was the change between pre-operative and at latest follow up OHS (OHS). Secondary outcome measures included dislocation rate and revision surgery. EBRA was used to determine acetabular inclination and version. The influence of patient's gender, BMI, surgeon's grade and approach on cup orientation was examined. Four different zones tested as possibly ± (Lewinnek Zone, Callanan's described zone and zones ± 5 and ±10 about the study's mean inclination and anteversion) for a reduced dislocation risk and an optimal functional outcome. RESULTS. There were 21 dislocations (3.1%) and 8 (1.2%) patients required revision at a mean follow up of 7 years. Experienced surgeons (2=0.047) and those operating with the patient in the lateral decubitus position (p=0.04) were more likely to achieve a cup orientation within any of the tested zones. Surgical approach (2=0.14) and patient's BMI (2=0.93) had no influence on whether a cup was within or outside any zone. There was no difference in dislocation rate between the posterior and anterio-lateral approaches (2=0.88). None of the zones tested had a significantly reduced dislocation risk (2=0.13), nor revision risk (2=0.55). OHS was not different for patients with cups within or outside any of the zones tested (p=0.523). DISCUSSION. There was a wide variation in cup orientation. Despite the wide scatter in cup orientation, no safe zone could be identified that would reduce dislocation and revision rate, nor improve patient reported outcome (OHS). Hence, these data suggest that acetabular component orientation should not be considered predictive of patients' early/mid-term complication/revision rate and outcome following THA

This study reports on the natural history of acetabular fracture dislocations. We retrospectively reviewed patients who sustained an acetabular fracture associated with a posterior hip dislocation from a prospective database. Patient characteristics, complications and the requirement for further surgery were recorded. Patient outcomes were measured using the Oxford Hip score and Short Form SF-12 health survey. A total of 99 patients were treated over a 24 year period. The mean age was 41 years. Open reduction and internal fixation was performed in the majority (n=87), 10 were managed conservatively following closed reduction and two underwent primary total hip replacement (THR). At a median follow up of 12.4 years (range 4–24 years) patient outcomes were available for 53 patients. 12 patients had died. 19 patients went onto have a THR as a secondary procedure, of which 11 had confirmed avascular necrosis. Median time to THR was 2 years (range 1–17 years). The mean Oxford hip score was 35 (range 2–48), SF-12 physical component score (PCS) was 40 and a third of the patients used a walking aid. In THR group the mean Oxford score was 32 (range 3–46), SF-12 PCS was 39 and almost all required a walking aid. This is the first study to present the long term outcomes following an acetabular fracture dislocation. Our study suggests there is considerable disability in this group of patients and the requirement for subsequent THR has inferior patient reported outcomes

Leg length discrepancy (LLD) can adversely affect functional outcome and patient satisfaction after total hip arthroplasty. We describe a novel intraoperative technique for femoral component insertion. We aimed to determine if this technique resulted in the desired femoral placement, as templated, and if this was associated with a reduced LLD. A series of fifty consecutive primary total hip replacements were studied. Preoperative digital templating was performed on standardised PA radiographs of the hips by the senior surgeon. The preoperative LLD was calculated and the distance from the superior tip of the greater trochanter to the predicted shoulder of the stem was calculated (GT-S). Intraoperatively, this length was marked on the rasp handle and the stem inserted to the predetermined level by the surgeon. This level corresponded to the tip of the greater trochanter and formed a continuous line to the mark on the rasp handle. Three independent blinded observers measured the GT-S on the postoperative radiographs. We assessed the relationship between the senior author's GT-S (preoperative) and the observers' GT-S (postoperative) using a Person correlation. The observers also measured the preoperative and postoperative LLD, and the inter-observer variability was calculated as the intra-class correlation coefficient. There was a strong correlation of preoperative and postoperative GT-S (R=0.87), suggesting that the stem was inserted as planned. The mean preoperative and postoperative LLD were −4.3 mm (−21.4–4) and −0.9 mm (−9.8–8.6), respectively (p<0.001). This technique consistently minimised LLD in this series. This technique is quick, non-invasive and does not require supplementary equipment