Dual-mobility (DM) bearings are effective to mitigate dislocation in revision total hip arthroplasty (THA). However, data on its use for treating dislocation is scarce. Aim of this study was to compare DM bearings, standard bearings and constrained liner (CL) in revision THA for recurrent dislocation and to identify risk factors for re-dislocation. We reviewed 100 consecutive revision THAs performed for dislocation from 2012 and 2019. 45 hips (45%) received a DM construct, while 44 hips (44%) and 11 hips (11%) had a standard bearing and CL, respectively. Rates of re-dislocation, re-revision for dislocation and overall re-revision were compared. Radiographs were assessed for cup positioning, restoration of centre of rotation, leg length and offset. Risk factors for re-dislocation were determined by cox regression analysis. Modified Harris hip scores (mHHS) were calculated. Mean follow-up was 53 months (1 to 103). DM constructs were used more frequently in elderly patients (p=0.011) and hips with abductor deficiency (p< 0.001). The re-dislocation rate was 11.1% for DM bearings compared with 15.9% for standard bearings and 18.2% for CL (p=0.732). Revision-free survival for DM constructs was 83% (95% CI 0.77 – 0.90) compared to 75% (95% CI 0.68 – 0.82) for standard articulations and 71% (95% CI 0.56 – 0.85) for CL (p=0.455). Younger age (HR 0.91; p=0.020), lower comorbidity (HR 0.42; p=0.031), smaller heads (HR 0.80; p=0.041) and cup retention (HR 8.23; p=0.022) were associated with re-dislocation. Radiological analysis did not reveal a relationship between restoration of hip geometry and re-dislocation. mHHS significantly improved from 43.8 points to 65.7 points (p<0.001) with no differences among bearing types. Our findings suggest that DM bearings do not sufficiently prevent dislocation in revision THA for recurrent dislocation. Reconstruction of the abductor complex may play a key role to reduce the burden in these high-risk patients

Aims. While previously underappreciated, factors related to the spine contribute substantially to the risk of dislocation following total hip arthroplasty (THA). These factors must be taken into consideration during preoperative planning for revision THA due to recurrent instability. We developed a protocol to assess the functional position of the spine, the significance of these findings, and how to address different pathologies at the time of revision THA. Patients and Methods. Prospectively collected data on 111 patients undergoing revision THA for recurrent instability from January 2014 to January 2017 at two institutions were included (protocol group) and matched 1:1 to 111 revisions specifically performed for instability not using this protocol (control group). Mean follow-up was 2.8 years. Protocol patients underwent standardized preoperative imaging including supine and standing anteroposterior (AP) pelvis and lateral radiographs. Each case was scored according to the Hip-Spine Classification in Revision THA. Results. Survival free of dislocation at two years was 97% in the protocol group (three dislocations, all within three months of surgery) versus 84% in the control group (18 patients). Furthermore, 77% of the inappropriately positioned acetabular components would have been unrecognized by supine AP pelvis imaging alone. Conclusion. Using the Hip-Spine Classification System in revision THA, we demonstrated a significant decrease in the risk of recurrent instability compared with a control group. Without the use of this algorithm, 77% of inappropriately positioned acetabular components would have been unrecognized and incorrect treatment may have been instituted. Cite this article: Bone Joint J 2019;101-B:817–823

The aims of this study were to determine the functional impact and financial burden of isolated and recurrent dislocation after total hip arthroplasty (THA). Our secondary goal was to determine whether there was a difference between patients who were treated non-operatively and those who were treated operatively. . We retrospectively reviewed 71 patients who had suffered dislocation of a primary THA. Their mean age was 67 years (41 to 92) and the mean follow-up was 3.8 years (2.1 to 8.2). . Because patients with recurrent dislocation were three times more likely to undergo operative treatment (p < 0.0001), they ultimately had a significantly higher mean Harris Hip Score (HHS) (p = 0.0001), lower mean Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores (p = 0.001) and a higher mean SF-12 score (p < 0.0001) than patients with a single dislocation. Likewise, those who underwent operative treatment had a higher mean HHS (p < 0.0001), lower mean WOMAC score (p < 0.0001) and a higher mean SF-12 score (p < 0.0001) than those who were treated non-operatively. Recurrent dislocation and operative treatment increased costs by 300% (£11 456; p < 0.0001) and 40% (£5217; p < 0.0001), respectively. The operative treatment of recurrent dislocation results in significantly better function than non-operative management. Moreover, the increase in costs for operative treatment is modest compared with that of non-operative measures. Cite this article: Bone Joint J 2015; 97-B:1046–9

We treated 34 patients with recurrent dislocation of the hip with a constrained acetabular component. Roentgen stereophotogrammetric analysis was performed to assess migration of the prosthesis. The mean clinical follow-up was 3.0 years (2.2 to 4.8) and the radiological follow-up was 2.7 years (2.0 to 4.8). At the latest review six patients had died and none was lost to follow-up. There were four acetabular revisions, three for aseptic loosening and one for deep infection. Another acetabular component was radiologically loose with progressive radiolucent lines in all Gruen zones and was awaiting revision. The overall rate of aseptic loosening was 11.8% (4 of 34). Roentgen stereophotogrammetric analysis in the non-revised components confirmed migration of up to 1.06 mm of translation and 2.32° of rotation at 24 months. There was one case of dislocation and dissociation of the component in the same patient. Of the 34 patients, 33 (97.1%) had no further episodes of dislocation. The constrained acetabular component reported in our study was effective in all but one patient with instability of the hip, but the rate of aseptic loosening was higher than has been reported previously and requires further investigation

Between April 1992 and July 2005, 310 posterior lip augmentation devices were used for the treatment of recurrent dislocation of the hip in 307 patients who had received primary total hip replacements (THRs) using Charnley/Charnley Elite components with a cemented acetabulum. The mean number of dislocations before stabilisation with the device was five (1 to 16) with a mean time to this intervention from the first dislocation of 3.8 years (0 days to 22.5 years). The mean age of the patients at this reconstruction was 75.4 years (39 to 96). A retrospective clinical and radiological review was carried out at a mean follow-up of six years and nine months (4.4 months to 13 years and 7 months). Of the 307 patients, 53 had died at the time of the latest review, with a functioning THR and with the posterior lip augmentation device in situ. There were four revisions (1.3%), one for pain, two for deep infection and one for loosening of the acetabular component. Radiolucent lines around the acetabular component increased in only six cases after insertion of the device which was successful in eliminating instability in 302 patients, with only five further dislocations (1.6%) occurring after its insertion

Aims. Periprosthetic joint infection (PJI) in total hip arthroplasty in the elderly may occur but has been subject to limited investigation. This study analyzed infection characteristics, surgical outcomes, and perioperative complications of octogenarians undergoing treatment for PJI in a single university-based institution. Methods. We identified 33 patients who underwent treatment for PJIs of the hip between January 2010 and December 2019 using our institutional joint registry. Mean age was 82 years (80 to 90), with 19 females (57%) and a mean BMI of 26 kg/m. 2. (17 to 41). Mean American Society of Anesthesiologists (ASA) grade was 3 (1 to 4) and mean Charlson Comorbidity Index was 6 (4 to 10). Leading pathogens included coagulase-negative Staphylococci (45%) and Enterococcus faecalis (9%). Two-stage exchange was performed in 30 joints and permanent resection arthroplasty in three. Kaplan-Meier survivorship analyses were performed. Mean follow-up was five years (3 to 7). Results. The two-year survivorship free of any recurrent PJI was 72% (95% confidence interval (CI) 56 to 89; 18 patients at risk). There were a total of nine recurrent PJIs at a mean of one year (16 days to eight years), one for the same pathogen as at index infection. One additional surgical site infection was noted at two weeks, resulting in a 69% (95% CI 52 to 86; 17 patients at risk) survivorship free of any infection at two years. There were two additional revisions for dislocations at one month each. As such, the two-year survivorship free of any revision was 61% (95% CI 42 to 80; 12 patients at risk). In addition to the aforementioned revisions, there was one additional skin grafting for a decubitus ulcer, resulting in a survivorship free of any reoperation of 54% (95% CI 35 to 73; ten patients at risk) at two years. Mean Clavien-Dindo score of perioperative complications was two out of five, with one case of perioperative death noted at six days. Conclusion. Octogenarians undergoing surgery for PJI of the hip are at low risk of acute mortality, but are at moderate risk of other perioperative complications. One in two patients will undergo a reoperation within two years, with 70% attributable to recurrent infections. Cite this article: Bone Joint J 2023;105-B(2):135–139

Instability is a common indication for revision total hip arthroplasty (THA). However, even after the initial revision, some patients continue to have recurrent dislocations. This study investigates those at risk for recurrent dislocation after revision THA for instability at a single institution. Between 2009 and 2019, 163 patients underwent revision THA for instability at a single institution. Thirty-three of these patients required re-revision THA due to recurrent dislocation. Cox proportional hazard models with death as a competing event were used to analyze risk factors, including prosthesis sizing and alignment. Paired t-tests or Wilcoxon signed rank tests were used to assess patient outcomes (Veterans RAND 12 (VR-12) physical score, VR-12 mental score, Harris Hip Score, and hip disability and osteoarthritis outcome score for joint replacement). Duration of follow-up until either re-revision or final follow-up was a mean of 45.3 ± 38.2 months. The 1-year cumulative incidence for recurrent dislocation after revision was 8.7%, which increased to 19.6% at 5 years and 32.9% at 10 years postoperatively. In the multivariable analysis, high ASA score [HR 2.71], being underweight (BMI<18 kg/m. 2. ) [HR 36.26] or overweight/obese (BMI>25 kg/m. 2. ) [HR 4.31], use of specialized liners [HR 5.51–10.71], lumbopelvic stiffness [HR 6.29], and postoperative abductor weakness [HR 7.20] were significant risk factors for recurrent dislocation. Increasing the cup size decreased the dislocation risk [HR 0.89]. The dual mobility construct did not affect the risk for recurrent dislocation in univariate or multivariable analyses. VR-12 physical and HHS (pain and function) scores improved postoperatively at midterm. Patients requiring revision THA for instability are at risk for recurrent dislocation. Higher ASA scores, abnormal BMI, use of special liners, lumbopelvic stiffness, and postoperative abductor weakness are significant risk factors for re-dislocation

The purpose was to determine the lifetime risk of re-operation due to specific complications related to dual mobility using re-operation as a competing risk, excluding loosening, periprosthetic fracture, and infection. 1503 mono-block dual mobility total hip arthroplasty (DM-THAs). Defining the re-operation when anesthesia (for dislocation) and revision when the implant changed. Surgery (801 for primary, 702 for revision with 201 for recurrent dislocation and 501 for loosening) performed between 1990 and 2020 in average 81-year-old (range 50–102) patients, with 522 living patients at 10 years follow-up. During the first month, outer dislocation (60 cases; 4%) was the cause re-operation (1% among primary and 6 % among revisions). Twenty-four intra-prosthetic dislocations (IPD) were an iatrogenic consequence of a failed closed reduction (reduction maneuver dissociating the inner head) with 1.6% revision. Between 1 month and 1 year, 22 new outer dislocations, while 25 of the 60 “first month” dislocations had recurrent dislocation. Fifteen other IPDs as iatrogenic consequences were observed. At one year, the cumulative revision was 3% (49 of 82 dislocations). Between 1- 10-year FU, 132 other dislocations, and 45 other revisions for dislocations were observed. Corrosion was another cause of revision (37 cases): between the cobalt-chromium shell and the femoral neck (23 hips), or 14 crevice corrosion between the trunnion and the metal head (trunnion damage). In summary, at 10-year: dislocation first cause of re-operation (214 anesthesia, 14%), while among 131 revisions (8.9 %) the 55 iatrogenic intra-prosthetic dislocations were the first revision cause before 39 recurrent dislocations and 37 corrosions. The 522 patients followed ten years or more had a 15% risk revision due to DM specific complications during their lifetime and 10% more risk associated with loosening (6%), periprosthetic fracture (2%) and infection (2%)

This study aimed to verify the hypothesis that an antibiotic loaded hydrogel, defensive antimicrobial coating (DAC), reduces overall complication and infection rates when used for high-risk primary and revision total hip arthroplasty (THA). This was a retrospective study matched cohort study of 238 patients, treated with cementless implants with and without DAC. A sub-group analysis of patients undergoing 2nd stage revision THA for prosthetic joint infection (PJI) was also conducted. Re-infection rates within 2 years, complications necessitating surgical intervention and radiographic analysis for aseptic loosening was assessed. The mean age was 68.3±11.5 years, with 39 (32.8%) Macpherson class A, 64 (53.8%) class B and 16 (13.4%) class C patients. 4 (3.4%) patients in the DAC group developed complications including 1 PJI and 1 delayed wound healing, while 13 (10.9%) patients in the control group developed complications including 5 PJIs and 3 delayed wound healing (p=0.032). PJI rates (p=0.136) and delayed wound healing rates (p=0.337) were not statistically significant. For 2nd stage revision THA for PJI there were 86 patients in the DAC group and 45 in the control group. 1 (1.2%) patient in the DAC group developed complications with no recurrences of infection or delayed wound healing, while 10 (22.2%) patients in the control group developed complications including 4 recurrent PJI and 1 delayed wound healing (p=0.003). Recurrent PJI rates were statistically significant (p=0.005) while delayed wound healing rates were not (p=0.165). Patients treated with DAC also had lower rates of aseptic loosening (0% vs 6.7%; p=0.015). Antibiotic impregnated hydrogel coatings on cementless implants showed decreased complication rates after complex primary or revision THA. In 2nd stage revision THA for PJI, it was associated with reduced risk of re-infection and aseptic loosening

Dislocations have impact on quality of life, but it is difficult to quantify this impact for each patient. The Quality-of-Life Time Trade-Off assesses the percentage of a patient's remaining life that the patient would be willing to trade for perfect health [1]. This technique has been used for non-unions [2], but never proposed for dislocation. 154 patients (with 3 recurrent dislocations) undergoing revision were asked to choose between living with their associated dislocation risk or trading a portion of their life expectancy for a period of perfect health without dislocation, thus determining their Quality-of-Life score. This score may range from 0.1 (willing to trade nine years among 10) to 1.0 (unwilling to trade any years). Additionally, patients were assessed on their willingness to trade implant survival time for a reduced risk of dislocation, considering various implant options that might offer lower (but not necessary) survival time before revision than the theoretical best (for the surgeon) “standard” implant, thus determining a “Survival Implant Quality” score. Patients diagnosed with 3 hip dislocations have a low health-related quality of life. The score of our “dislocation” cohort was average 0.77 with patients willing to trade average 23% of remaining lifespan for perfect health (range 48% to 12%). This score is below that (0.88) of illnesses type-I diabetes mellitus [3] and just higher than tibial non-union (0.68) score [2]. The mean “Survival Implant Quality” score of our recurrent dislocation cohort was 0.71 (range 0.59 to 0.78) which means that patients accept to trade average 3 years (range 2 to 4 years) among 10 theoretical years of survival of the implant. Hip dislocation has a devastating impact that can be quantified for each patient when discussing revision and choice of implants for instability. For references, please contact the author directly

Aims. 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). Methods. Data were extracted from a single centre prospective database of patients with PD who were treated with a CTAC. Patients were included if they had a follow-up of two years. The Hip Disability and Osteoarthritis Outcome Score (HOOS), modified Oxford Hip Score (mOHS), EurQol EuroQoL five-dimension three-level (EQ-5D-3L) utility, and Numeric Rating Scale (NRS), including visual analogue score (VAS) for pain, were gathered at baseline, and at one- and two-year follow-up. Reasons for revision, and radiological and clinical complications were registered. Trends over time are described and tested for significance and clinical relevance. Results. A total of 18 females with 22 CTACs who had a mean age of 73.5 years (SD 7.7) were included. A significant improvement was found in HOOS (p < 0.0001), mOHS (p < 0.0001), EQ-5D-3L utility (p = 0.003), EQ-5D-3L NRS (p = 0.013), VAS pain rest (p = 0.008), and VAS pain activity (p < 0.0001) between baseline and final follow-up. Minimal clinically important improvement in mOHS and the HOOS Physical Function Short Form (HOOS-PS) was observed in 16 patients (73%) and 14 patients (64%), respectively. Definite healing of the PD was observed in 19 hips (86%). Complications included six cases with broken screws (27%), four cases (18%) with bony fractures, and one case (4.5%) with sciatic nerve paresthesia. One patient with concurrent bilateral PD had revision surgery due to recurrent dislocations. No revision surgery was performed for screw failure or implant breakage. Conclusion. CTAC in patients with THA acetabular loosening and PD can result in stable constructs and significant improvement in functioning and health-related quality of life at two years' follow-up. Further follow-up is necessary to determine the mid- to long-term outcome. Cite this article: Bone Jt Open 2023;4(2):53–61

Periprosthetic joint infections (PJI) are challenging complications following arthroplasty. Staphylococci are a frequent cause of PJI and known biofilm producers. Reoperations for PJI of the hip or knee between 2012 and 2015 performed at Sahlgrenska University Hospital were identified. Medical records were reviewed, and clinical parameters recorded for patients whose intraoperative bacterial isolates had been stored at the clinical laboratory. Staphylococcal strains isolated from reoperations due to first-time PJI were characterised by their ability to form biofilms using the microtiter plate test. The study group included 49 patients (70 bacterial strains) from first-time PJI, whereof 24 (49%) patients had recurrent infection. Strong biofilm production was significantly associated with recurrent infection. Patients infected with strong biofilm producers had a five-fold increased risk for recurrent infection. Strong biofilm production was significantly associated with increased antimicrobial resistance and PJI recurrence. This underscores the importance of determining biofilm production and susceptibility as part of routine diagnostics in PJI. Strong staphylococcal biofilm production may have implications on therapeutic choices and suggest more extensive surgery. Furthermore, despite the increased biofilm resistance to rifampicin, results from this study support its use in staphylococcal PJI

Aims. Two-stage exchange revision total hip arthroplasty (THA) performed in case of periprosthetic joint infection (PJI) has been considered for many years as being the gold standard for the treatment of chronic infection. However, over the past decade, there have been concerns about its safety and its effectiveness. The purposes of our study were to investigate our practice, collecting the overall spacer complications, and then to analyze their risk factors. Methods. We retrospectively included 125 patients with chronic hip PJI who underwent a staged THA revision performed between January 2013 and December 2019. All spacer complications were systematically collected, and risk factors were analyzed. Statistical evaluations were performed using the Student's t-test, Mann-Whitney U test, and Fisher's exact test. Results. Our staged exchange practice shows poor results, which means a 42% mechanical spacer failure rate, and a 20% recurrent infection rate over the two years average follow-up period. Moreover, we found a high rate of spacer dislocation (23%) and a low rate of spacer fracture (8%) compared to the previous literature. Our findings stress that the majority of spacer complications and failures is reflecting a population with high comorbid burden, highlighted by the American Society of Anesthesiology grade, Charlson Comorbidity Index, and Lee score associations, as well as the cardiac, pulmonary, kidney, or hepatic chronic conditions. Conclusion. Our experience of a two-stage hip exchange revision noted important complication rates associated with high failure rates of polymethylmethacrylate spacers. These findings must be interpreted in the light of the patient’s comorbidity profiles, as the elective population for staged exchange has an increasing comorbid burden leading to poor results. In order to provide better results for this specific population, our conclusion suggests that comparative strategy studies are required to improve our therapeutic indication. Cite this article: Bone Jt Open 2022;3(6):485–494

There is a paucity of data available for the use of Total Femoral Arthroplasty (TFA) for joint reconstruction in the non-oncological setting. The aim of this study was to evaluate TFA outcomes with minimum 5-year follow-up. This was a retrospective database study of TFAs performed at a UK tertiary referral revision arthroplasty unit. Inclusion criteria were patients undergoing TFA for non-oncological indications. We report demographics, indications for TFA, implant survivorship, clinical outcomes, and indications for re-operation. A total of 39 TFAs were performed in 38 patients between 2015–2018 (median age 68 years, IQR 17, range 46–86), with 5.3 years’ (IQR 1.2, 4.1–18.8) follow-up; 3 patients had died. The most common indication (30/39, 77%) for TFA was periprosthetic joint infection (PJI) or fracture-related infection (FRI); and 23/39 (59%) had a prior periprosthetic fracture (PPF). TFA was performed with dual-mobility or constrained cups in 31/39 (79%) patients. Within the cohort, 12 TFAs (31%) required subsequent revision surgery: infection (7 TFAs, 18%) and instability (5 TFAs, 13%) were the most common indications. 90% of patients were ambulatory post-TFA; 2 patients required disarticulation due to recurrent PJI. While 31/39 (79%) were infection free at last follow-up, the remainder required long-term suppressive antibiotics. This is the largest series of TFA for non-oncological indications. Though TFA has inherent risks of instability and infection, most patients are ambulant after surgery. Patients should be counselled on the risk of life-long antibiotics, or disarticulation when TFA fails

There is a paucity of long-term data on modular fluted tapered (MFT) stems for two-stage reimplantation following periprosthetic joint infection (PJI). The purpose of this study was to evaluate implant survivorship, radiographic results, and clinical outcomes in a large cohort of reimplantation THAs using MFT stems. We identified 236 reimplantation THAs from a single tertiary care academic institution from 2000 to 2020. Two designs of MFT stems were used as part of an established two-stage exchange protocol for the treatment of PJI. Mean age at reimplantation was 65 years, mean BMI was 32 kg/m. 2. , and 46% were female. Median stem diameter was 19 mm, and median stem length was 195 mm. Mean follow-up was 7 years. A competing risk model accounting for death was utilized. The 15-year cumulative incidence of any revision was 24%. There were 48 revisions, with the most common reasons being dislocation (n=25) and PJI (n=16). The 15-year cumulative incidence of any reoperation was 28%. Only 13 revisions involved the fluted tapered portion of the component (FTC), for a 15-year cumulative incidence of any FTC revision of 8%. Only 2 FTCs were revised for aseptic loosening, resulting in a 15-year cumulative incidence of FTC revision for aseptic loosening of 1%. Stem subsidence >5 mm occurred in 2% of unrevised cases, and all stems were radiographically stable at most recent follow-up. Mean HHS was 77 at most recent follow-up. This series demonstrated that MFT stems were durable and reliable even in the setting of two-stage reimplantation for infection. While the incidence of aseptic loosening was very low, the incidence of any revision was 24% at 15 years, primarily caused by dislocation and recurrent PJI. Level of Evidence: IV

The objective of this study was to assess the clinical and radiological results of patients who were revised using a new generation custom-made triflange acetabular component (CTAC) for component loosening and large acetabular defect (Paprosky 3A and 3B) after previous total hip arthroplasty (THA). New generation CTACs involve the use of patient-specific drill guides and incorporate three-dimensional printed bone models, enhancing precision during surgical implantation. Data were extracted from a single centre prospective database of patients with large acetabular defects who were treated with a new generation CTAC. Patients were included if they had a minimum follow-up of five years. The modified Oxford Hip Score (mOHS), EurQol EuroQoL five-dimension three-level (EQ-5D-3L) utility, and Numeric Rating Scale (NRS), including visual analogue score (VAS) for pain, were gathered at baseline, and at two- and five-year follow-up. Reasons for revision, and radiological and clinical complications were registered. Trends over time are described and tested for significance (p<0.05). A total of 49 (70%) of 70 patients with a mean age of 73.5 years (SD 7.7) had a complete follow-up of 5 years. A significant improvement was found in HOOS, mOHS, EQ-5D-3L utility and NRS, VAS pain rest and activity between baseline and final follow-up. Complications included 8 cases with loosening screws, 4 with bony fractures, 4 periprosthetic infections and 2 cases with dislocation. One patient with bilateral pelvic discontinuity had revision surgery due to recurrent dislocations. No revision surgery was performed for screw failure or implant breakage. New generation CTAC in patients with THA acetabular loosening and massive acetabular bone loss (Paprosky 3A and 3B) can result in stable constructs and significant improvement in functioning and health-related quality of life at five years’ follow-up

Pelvic discontinuity (PD) is a detrimental complication following total hip arthroplasty (THA). The aim of this study was to assess the clinical and radiological results of patients with PD who were revised using a custom-made triflange acetabular component (CTAC). This is a single centre prospective study of patients with PD following THA who were treated with a CTAC. The Hip Disability and Osteoarthritis Outcome Score (HOOS), modified Oxford Hip Score (mOHS), EurQol five-dimension three-level (EQ-5D-3L) utility, and Numeric Rating Scale (NRS), including visual analogue score (VAS) for pain, were gathered at baseline, and at one- and two-year follow-up. Clinical and radiological complications, including reasons for revisions were registered. Trends over time are described and tested for significance and clinical relevance. 18 females with 22 CTACs were included with a mean age of 73.5 years (SD 7.7). There were significant improvements between baseline and final follow-up in HOOS (p<0.01), mOHS (p<0.01), EQ-5D-3L utility (p<0.01), EQ-5D-3L NRS (p<0.01), VAS pain rest (p<0.01), and VAS pain activity (p<0.01). A minimal clinically important improvement in mOHS and the HOOS was observed in 16 patients (73%) and 14 patients (64%), respectively. Definite healing of the PD was observed in 19 hips (86%). Complications included six cases with broken screws (27%), four cases (18%) with bony fractures, and one case (4.5%) with sciatic nerve paresthesia. One patient with concurrent bilateral PD had revision surgery due to recurrent dislocations. No revision surgery was performed for screw failure or implant breakage. This is the first prospective assessment in clinical outcome of patients with PD who were treated with a CTAC. We have demonstrated that CTAC in patients with THA acetabular loosening and PD can result in stable constructs with no mechanical failures. Moreover, clinically relevant improvements in health-related quality of life at two years’ follow-up was observed

Uncemented femoral components have been used in total hip arthroplasties (THAs) for over three decades. Data on long-term performance of hydroxyapatite-coated femoral stems is however limited. This study reports the survivorship of a collarless, straight, hydroxyapatite-coated femoral stem (Omnifit HA, Osteonic) with a minimum of 20 years of follow-up. We reviewed the results of 165 THAs using Omnifit HA in 138 patients performed between August 1993 and December 1999. The mean age at surgery was 46 years (range 20 – 77 years). Avascular necrosis was the most common cause of THA, followed by ankylosing spondylitis and primary osteoarthritis. The mean follow-up was 22 years (range 20–31 years). At 20 and 25 years, 113 arthroplasties (91 patients) and 63 arthroplasties (55 patients) were available for follow-up respectively, while others had deceased or were lost to follow-up. Kaplan-Meier survivorship analysis was performed to evaluate the survival of the femoral component. Radiographs were reviewed at regular intervals, and implant stability was evaluated using Engh classification. Seven out of 165 stems were revised upon the latest follow-up; that included one case of aseptic loosening with revision done at 15 years, three peri-prosthetic fractures, two infections, and one recurrent dislocation. At 20 years, survivorship with revision of the femoral stem for any cause and aseptic loosening as the endpoint was 96.0% (95% CI, 92.6 – 99.5%) and 98.4% (95% CI, 96.2 – 100%) respectively. At 25 years, the corresponding survivorship rates were 94.5% (95% CI, 91.9 – 97.3%) and 98.1% (95% CI, 95.7 – 99.6%) respectively. Radiographic findings of stable bony fixation were seen in 86 stems (76.1%) and those of loosening in 4 stems (3.5%) at 20 years. All patients with radiographic signs of loosening were asymptomatic and did not require revision. The Omnifit HA femoral stem offered promising long-term survivorship into the third decade

The Lubinus SP II is an anatomical femoral stem with high survivorship levels notably described in the Swedish Arthroplasty Register. As the clinical and economic burden of revision total hip arthroplasty (THA) and periprosthetic fracture (PPF) continues to increase, it has been suggested that use of anatomical stems may facilitate more uniform cement mantles and improve implant survival. The primary aim of this study was to determine the long-term survivorship and PPF rate of the Lubinus SP II 150mm stem in a single UK centre. Between January 2007 and April 2012, 1000 consecutive THAs were performed using the Lubinus SP II femoral stem in our institution. Patient demographics and operative details were collected in a prospective arthroplasty database. Patient records and national radiographic archives were then reviewed at a mean of 12.3 years (SD 1.3) following surgery to identify occurrence of subsequent revision surgery, dislocation or periprosthetic fracture. Mean patient age at surgery was 69.3 years (SD 10.1, 24–93 years). There were 634 women (63%). Osteoarthritis was the operative indication in 974 patients (97%). There were 13 revisions in total (4 for recurrent dislocation, 3 for infection, 6 for acetabular loosening) and 16 dislocations (1.6%). Stem survivorship at 10 years was 99.6% (95 % confidence interval [CI], 99.5%–99.7%) and at 15 years was 98.8% (98.7%–98.9%). The 15-year stem survival for aseptic loosening was 100%. Analysis of all cause THA failure demonstrated a survivorship of 99.1% (99.0%–99.3%) at 10 years and 98.2% (98.1%–98.3%) at 15 years. There were 4 periprosthetic fractures in total (0.4%) at mean 12.3 year follow-up. The Lubinus SP II stem demonstrated excellent survivorship, low dislocation rates and negligible PPF rates up to 15 years following primary THA. Use of anatomical stems such as the Lubinus SPII would appear to be a wise clinical and economic investment for patients and healthcare systems alike

Contemporary acetabular reconstruction in major acetabular bone loss often involves the use of porous metal augments, a cup-cage construct or custom implant. The aims of this study were: To determine the reproducibility of a reconstruction algorithm in major acetabular bone loss. To determine the subsequent success of reconstruction performed in terms of re-operation, all-cause revision and Oxford Hip Score (OHS) and to further define the indications for custom implants in major acetabular bone loss. Consecutive series of Paprosky Type III defects treated according to a reconstruction algorithm. IIIA defects were planned to use a superior augment and hemispherical cup. IIIB defects were planned to receive either augment and cup, cup-cage or custom implant. 105 procedures in cohort 100 patients (5 bilateral) with mean age 73 years (42–94). IIIA defects (50 cases) − 72.0% (95%CI 57.6–82.1) required a porous metal augment the remainder treated with a hemispherical cup alone. IIIB defects (55 cases) 71.7% (95%CI 57.6–82.1) required either augments or cup-cage. 20 patients required a hemispherical cup alone and 6 patients received a custom-made implant. Mean follow up of 7.6 years. 6 re-revisions were required (4 PJI, 2 peri-prosthetic fractures & 1 recurrent instability) with overall survivorship of 94.3% (95% CI 97.4–88.1) for all cause revision. Single event dislocations occurred in 3 other patients so overall dislocation rate 3.8%. Mean pre-op OHS 13.8 and mean follow-up OHS 29.8. Custom implants were used in: Mega-defects where AP diameter >80mm, complex discontinuity and massive bone loss in a small pelvis (i.e., unable to perform cup-cage). A reconstruction algorithm can >70% successfully predict revision construct which thereafter is durable with a low risk of re-operation. Jumbo cup utilized <1/3 of cases when morphology allowed. The use of custom implants has been well defined in this series and accounts for <5% of cases