Aims. Although CT is considered the benchmark to measure femoral version, 3D biplanar radiography (hipEOS) has recently emerged as a possible alternative with reduced exposure to ionizing radiation and shorter examination time. The aim of our study was to evaluate femoral stem version in postoperative total hip arthroplasty (THA) patients and compare the accuracy of hipEOS to CT. We hypothesize that there will be no significant difference in calculated femoral stem version measurements between the two imaging methods. Methods. In this study, 45 patients who underwent THA between February 2016 and February 2020 and had both a postoperative CT and EOS scan were included for evaluation. A fellowship-trained musculoskeletal radiologist and radiological technician measured femoral version for CT and 3D EOS, respectively. Comparison of values for each imaging modality were assessed for statistical significance. Results. Comparison of the mean postoperative femoral stem version measurements between CT and 3D hipEOS showed no significant difference (p = 0.862). In addition, the two version measurements were strongly correlated (r = 0.95; p < 0.001), and the mean paired difference in postoperative femoral version for CT scan and 3D biplanar radiography was -0.09° (95% confidence interval -1.09 to 0.91). Only three stem measurements (6.7%) were considered outliers with a > 5° difference. Conclusion. Our study supports the use of low-dose biplanar radiography for the postoperative assessment of femoral stem version after THA, demonstrating high correlation with CT. We found no significant difference for postoperative femoral version when comparing CT to 3D EOS. We believe 3D EOS is a reliable option to measure postoperative femoral version given its advantages of lower radiation dosage and shorter examination time. Cite this article: Bone Joint J 2022;104-B(11):1196–1201

Modular dual mobility (DM) articulations are increasingly utilized during total hip arthroplasty (THA). However, concerns remain regarding the metal liner modularity. This study aims to correlate metal artifact reduction sequence (MARS) magnetic resonance imaging (MRI) abnormalities with serum metal ion levels in patients with DM articulations. All patients with an asymptomatic, primary THA and DM articulation with >2-year follow-up underwent MARS-MRI of the operative hip. Each patient had serum cobalt, chromium, and titanium levels drawn. Patient satisfaction, Oxford Hip Score, and Forgotten Joint Score-12 (FJS-12) were collected. Each MARS-MRI was independently reviewed by fellowship-trained musculoskeletal radiologists blinded to serum ion levels. Forty-five patients (50 hips) with a modular DM articulation were included with average follow-up of 3.7±1.2 years. Two patients (4.4%) had abnormal periprosthetic fluid collections on MARS-MRI with cobalt levels >3.0 μg/L. Four patients (8.9%) had MARS-MRI findings consistent with greater trochanteric bursitis, all with cobalt levels < 1.0 μg/L. A seventh patient had a periprosthetic fluid collection with normal ion levels. Of the 38 patients without MARS-MRI abnormalities, 37 (97.4%) had cobalt levels <1.0 μg/L, while one (2.6%) had a cobalt level of 1.4 μg/L. One patient (2.2%) had a chromium level >3.0 μg/L and a periprosthetic fluid collection. Of the 41 patients with titanium levels, five (12.2%) had titanium levels >5.0 μg/L without associated MARS-MRI abnormalities. Periprosthetic fluid collections associated with elevated serum cobalt levels in patients with asymptomatic dual mobility articulations occur infrequently (4.4%), but further assessment of these patients is necessary. Level of Evidence: Level IV

Introduction. Modular neck (MN) components in total hip arthroplasty (THA) offer intraoperative flexibility, but adverse local tissue reactions (ALTR) due to tribocorrosion at modular junctions are a potential complication of such designs. Serum ion levels and metal artifact reduction sequence (MARS) MRI are used to assess ALTR following modular THA. This study investigates serum ion levels and MARS MRI findings in a series of hips with MN components and differing articulating surfaces. Methods. We retrospectively evaluated a cohort of 184 primary THAs in 159 patients implanted with a dual modular femoral stem by one surgeon from 2005–2013. 121 THAs had a cobalt-chromium neck component and non-metal-on-metal articulation, while 63 THAs had a titanium neck component and metal-on-metal (MoM) articulation. Serum ion levels were recorded for all patients. MARS MRI scans were read by musculoskeletal-trained radiologists. Pseudotumor grade and location were measured. Results. Serum cobalt levels as a function of time post-operatively demonstrated no correlation. In THAs with non-MoM articulation, pseudotumors were visualized in 13 of 54 (24.1%) initial MARS MRIs performed 1–40 months post-operatively compared to 5 of 67 (7.5%) performed 41–120 months post-operatively (p=0.02), and findings typically remained consistent across multiple MARS MRI scans. Pseudotumors were generally located lateral to the hip joint in hips with non-MoM articulation compared to anteromedial following MoM arthroplasty. In the cobalt-chrome MN group, cobalt levels were elevated in 11 of 20 (55%) of patients with pseudotumor compared to 15 of 19 (79%) in the MoM group. Conclusion. Generation of ALTR leading to pseudotumor formation is a concern with cobalt-chrome MN designs. Psuedotumor characteristics differ between patients with cobalt-chrome designs versus MoM articulation. Normal serum ion levels did not exclude the presence of a pseudotumor and routine MARS MRI should be included in follow-up of patients with cobalt-chromium MN prostheses

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Hip arthroscopy has gained prominence as a primary surgical intervention for symptomatic femoroacetabular impingement (FAI). This study aimed to identify radiological features, and their combinations, that predict the outcome of hip arthroscopy for FAI.

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Hip dysplasia (HD) leads to premature osteoarthritis. Timely detection and correction of HD has been shown to improve pain, functional status, and hip longevity. Several time-consuming radiological measurements are currently used to confirm HD. An artificial intelligence (AI) software named HIPPO automatically locates anatomical landmarks on anteroposterior pelvis radiographs and performs the needed measurements. The primary aim of this study was to assess the reliability of this tool as compared to multi-reader evaluation in clinically proven cases of adult HD. The secondary aims were to assess the time savings achieved and evaluate inter-reader assessment.

Introduction. MAVRIC-SL (MVSL), a multi-spectral magnetic resonance imaging (MRI) sequence [1] used for visualization of tissues near hip arthroplasty, can be accelerated by a short calibration scan [2], permitting an isotropic acquisition in a clinically feasible scan time. Decreasing the repetition time (TR) can further reduce scan time. This study evaluated the feasibility of acquiring isotropic MAVRIC-SL images (MVISO) and reduced TR isotropic MAVRIC-SL images (TRMVISO) of hip arthroplasties to elucidate the added clinical benefit of such acquisitions. Methods. Following IRB approval, MVSL, MVISO and TRMVISO images were acquired for 93 hip arthroplasties (84 subjects). Images were reviewed by 2 radiologists to evaluate clinical and image quality features. Comparison of features between scanning sequences was assessed by mixed-effects ordinal logistic regression and odds ratios (OR). Inter/intra-rater agreement was determined using Gwet's agreement coefficient (AC). Results. A calibration scan permitted acquisition of isotropic image sets in under 8 minutes. MVISO and TRMVISO had decreased blurring and improved visualization of the synovium and periprosthetic bone as compared to MVSL (p<0.001, Fig. 1). MVISO and TRMVISO improved image quality features over MVSL, OR range: 1 to 968. MVISO acquisitions also had better image quality, visualization of synovium and bone, lesion conspicuity, and decreased blurring than TRMVISO (p<0.032). Substantial to perfect (0.61 ≥ AC ≥ 1.0) agreement was found for 86% of factors evaluated by the 2 readers. Conclusions. The isotropic acquisitions displayed clinically relevant features better than MVSL, with notable improvement of blurring and overall image quality. The TRMVISO altered the image contrast and contributed to poorer visualization of synovial reactions as compared to MVISO. The study demonstrated that isotropic MAVRIC scans are clinically feasible, and that MVISO scans added clinical value through improved visualization by reducing blurring. For any tables or figures, please contact the authors directly

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Pelvic discontinuity is a rare but increasingly common complication of total hip arthroplasty (THA). This single-centre study evaluated the performance of custom-made triflange acetabular components in acetabular reconstruction with pelvic discontinuity by determining: 1) revision and overall implant survival rates; 2) discontinuity healing rate; and 3) Harris Hip Score (HHS).

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The Birmingham Hip Resurfacing (BHR) arthroplasty has been used as a surgical treatment of coxarthrosis since 1997. We present 20-year results of 234 consecutive BHRs performed in our unit.

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The aim of this study was to assess the clinical and radiological results of patients who were revised using a custom-made triflange acetabular component (CTAC) for component loosening and pelvic discontinuity (PD) after previous total hip arthroplasty (THA).

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Total hip arthroplasty (THA) is considered the preferred treatment for displaced proximal femoral neck fractures. However, in many countries this option is economically unviable. To improve outcomes in financially disadvantaged populations, we studied the technique of concomitant valgus hip osteotomy and operative fixation (VOOF). This prospective serial study compares two treatment groups: VOOF versus operative fixation alone with cannulated compression screws (CCSs).

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This study reports mid-term outcomes after periacetabular osteotomy (PAO) exclusively in a borderline hip dysplasia (BHD) population to provide a contrast to published outcomes for arthroscopic surgery of the hip in BHD.

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We evaluated the national and regional trends from 2013 to 2022, in the prevalence of Perthes’ disease among adolescent males in South Korea.

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It has been well documented in the arthroplasty literature that lumbar degenerative disc disease (DDD) contributes to abnormal spinopelvic motion. However, the relationship between the severity or pattern of hip osteoarthritis (OA) as measured on an anteroposterior (AP) pelvic view and spinopelvic biomechanics has not been well investigated. Therefore, the aim of the study is to examine the association between the severity and pattern of hip OA and spinopelvic motion.

Aims. There are many guidelines that help direct the management of patients with metal-on-metal (MOM) hip arthroplasties. We have undertaken a study to compare the management of patients with MOM hip arthroplasties in different countries. . Methods. Six international tertiary referral orthopaedic centres were invited to participate by organising a multi-disciplinary team (MDT) meeting, consisting of two or more revision hip arthroplasty surgeons and a musculoskeletal radiologist. A full clinical dataset including history, blood tests and imaging for ten patients was sent to each unit, for discussion and treatment planning. Differences in the interpretation of findings, management decisions and rationale for decisions were compared using quantitative and qualitative methods. Results. Overall agreement between the orthopaedic centres and the recommended treatment plans for the ten patients with MOM hip implants was moderate (kappa = 0.6). Full agreement was seen in a third of cases, however split decisions were also seen in a third of cases. Units differed in their interpretation of the significance of the investigation findings and put varying emphasis on serial changes, in the presence of symptoms. Discussion. In conclusion, the management of raised or rising blood metal ions, cystic pseudotumours and peri-acetabular osteolysis led to inconsistency in the agreement between centres. Coordinated international guidance and MDT panel discussions are recommended to improve consensus in decision making. Take home message: A lack of evidence and the subsequent variation in regulator guidance leads to differences in opinions, the clinical impact of which can be reduced through a multi-disciplinary team approach to managing patients with MOM hip implants. Cite this article: Bone Joint J 2016;98-B:179–86

The direct anterior approach in total hip replacement anatomically offers the chance to minimise soft-tissue trauma because an intermuscular and internervous plane is explored. This motivated us to abandon our previously used transgluteal approach and to adopt the direct anterior approach for total hip replacement. Using MRI, we performed a retrospective comparative study of the direct anterior approach with the transgluteal approach. There were 25 patients in each group. At one year post-operatively all the patients underwent MRI of their replaced hips. A radiologist graded the changes in the soft-tissue signals in the abductor muscles. The groups were similar in terms of age, gender, body mass index, complexity of the reconstruction and absence of symptoms. Detachment of the abductor insertion, partial tears and tendonitis of gluteus medius and minimus, the presence of peri-trochanteric bursal fluid and fatty atrophy of gluteus medius and minimus were significantly less pronounced and less frequent when the direct anterior approach was used. There was no significant difference in the findings regarding tensor fascia lata between the two approaches. We conclude that use of the direct anterior approach results in a better soft-tissue response as assessed by MRI after total hip replacement. However, the impact on outcome needs to be evaluated further

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Pelvic tilt is believed to affect the symptomology of osteoarthritis (OA) of the hip by alterations in joint movement, dysplasia of the hip by modification of acetabular cover, and femoroacetabular impingement by influencing the impingement-free range of motion. While the apparent role of pelvic tilt in hip pathology has been reported, the exact effects of many forms of treatment on pelvic tilt are unknown. The primary aim of this study was to investigate the effects of surgery on pelvic tilt in these three groups of patients.

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Head-taper corrosion is a cause of failure in total hip arthroplasty (THA). Recent reports have described an increasing number of V40 taper failures with adverse local tissue reaction (ALTR). However, the real incidence of V40 taper damage and its cause remain unknown. The aim of this study was to evaluate the long-term incidence of ALTR in a consecutive series of THAs using a V40 taper and identify potentially related factors.

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With increasing burden of revision hip arthroplasty (THA), one of the major challenges is the management of proximal femoral bone loss associated with previous multiple surgeries. Proximal femoral arthroplasty (PFA) has already been popularized for tumour surgeries. Our aim was to describe the outcome of using PFA in these demanding non-neoplastic cases.

Introduction. Magnetic resonance arthrogram (MRA) is the investigation of choice in young adults with symptoms of femero acetabular impingement. The aim of the study is to assess the accuracy of MRA when correlated with surgical findings on hip arthroscopy. Materials and Method. Between June 2007 and January 2014, 136 patients had MRA followed by subsequent arthroscopy at our institution. The radiology information system was used to gather MRA data. All scans were reported by a consultant radiologist with a specialist interest in musculoskeletal radiology. Patient records were reviewed to gather surgical data. Assessment was made of labral injury, Camshaft (CAM) or Pincer lesion and degeneration of the cartilage. Results. Mean age at MRA was 34.5 years with a 2.5:1 female to male ratio. For labral pathology sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 89, 100, 100 and 22% respectively. For CAM (62, 80, 79 and 64% respectively) and Pincer lesions (15, 84, 81 and 18% respectively). MRA was specific for picking up Grade 3/4 degenerate changes in the articular cartilage (92.2%) but was not as sensitive (60%), PPV 55 and NPV 94. Conclusion. These findings demonstrate that MRA is a sensitive and specific imaging modality for assessing the labrum and articular surface, but not as good for assessing CAM and Pincer lesions. This could be due to the static nature of the MRA or a lack of firm definition as to what constitutes a CAM or Pincer lesion leading to under reporting. This maybe better assessed with plane X ray or Computed tomography with 3 dimensional reconstruction. Further to this it would be interesting to combine the plane X ray and MRA finding and see if sensitivity and specificity was improved

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Large-diameter metal-on-metal (MoM) total hip arthroplasty (THA) has demonstrated unexpected high failure rates and pseudotumour formation. The purpose of this prospective cohort study is to report ten-year results in order to establish revision rate, prevalence of pseudotumour formation, and relation with whole blood cobalt levels.