Introduction. There is a paucity of research investigating the effect of the experience of the operating surgeon on the long term function and survivorship of total hip replacements (THR). With the advent of individualised surgeon data being available to patients via the National Joint Registry, the desire to avoid complications and poor performance grows. This potentially reduces the availability of operative opportunities for trainees as consultants seek to ensure good results. Method & Results. A multicentre retrospective study of 879
Objectives. To investigate psychosocial and biomedical outcomes following
total hip replacement (THR) and to identify predictors of recovery
from
The timing of total hip replacement (THR) in
patients with active tuberculosis (TB) of the hip is controversial, because
of the potential risk of reactivation of infection. There is little
information about the outcome of
Total hip replacement (THR) has been shown to
be a cost-effective procedure. However, it is not risk-free. Certain conditions,
such as diabetes mellitus, are thought to increase the risk of complications.
In this study we have evaluated the prevalence of diabetes mellitus
in patients undergoing
There is little in the literature on the level
of participation in sports which patients undertake after total
hip replacement (THR). Our aims in this study were to determine
first, the level of sporting activity, second, the predictive factors
for returning to sporting activity, and third, the correlation between
participation in sports and satisfaction after
Total hip replacement (THR) after acetabular
fracture presents unique challenges to the orthopaedic surgeon.
The majority of patients can be treated with a standard
Pre-operative planning for total hip replacement
(THR) is challenging in hips with severe acetabular deformities, including
those with a hypoplastic acetabulum or severe defects and in the
presence of arthrodesis or ankylosis. We evaluated whether a Rapid
Prototype (RP) model, which is a life-sized reproduction based on
three-dimensional CT scans, can determine the feasibility of THR
and provide information about the size and position of the acetabular component
in severe acetabular deformities.
With greater numbers of younger patients undergoing
total hip replacement (THR), the effect of patient age on the diameter
of the femoral canal may become more relevant. This study aimed
to investigate the relationship between the diameter of the diaphysis
of the femoral canal with increasing age in a large number of patients
who underwent
The debate whether to use cemented or uncemented
components in primary total hip replacement (THR) has not yet been
considered with reference to the cost implications to the National
Health Service. We obtained the number of cemented and uncemented components
implanted in 2009 from the National Joint Registry for England and
Wales. The cost of each component was established. The initial financial
saving if all were cemented was then calculated. Subsequently the
five-year rates of revision for each type of component were reviewed
and the predicted number of revisions at five years for the actual
components used was compared with the predicted number of revisions
for a cemented
It has recently been reported that the transverse
acetabular ligament (TAL) is helpful in determining the position
of the acetabular component in total hip replacement (THR). In this
study we used a computer-assisted navigation system to determine
whether the TAL is useful as a landmark in
Autologous retransfusion and no-drainage are
both blood-saving measures in total hip replacement (THR). A new combined
intra- and post-operative autotransfusion filter system has been
developed especially for primary
It is accepted that resurfacing hip replacement
preserves the bone mineral density (BMD) of the femur better than total
hip replacement (THR). However, no studies have investigated any
possible difference on the acetabular side. Between April 2007 and March 2009, 39 patients were randomised
into two groups to receive either a resurfacing or a
Total hip replacement (THR) still is a rare intervention
in many African countries. In Burkina Faso it is not performed on
a regular basis. A visiting programme for
Objectives. The Oxford hip score (OHS) is a 12-item questionnaire designed
and developed to assess function and pain from the perspective of
patients who are undergoing total hip replacement (THR). The OHS
has been shown to be consistent, reliable, valid and sensitive to
clinical change following
We examined patient and surgical factors associated
with deep surgical site infection (SSI) following total hip replacement
(THR) in a large integrated healthcare system. A retrospective review
of a cohort of primary THRs performed between 2001 and 2009 was
conducted. Patient characteristics, surgical details, surgeon and
hospital volumes, and SSIs were identified using the Kaiser Permanente
Total Joint Replacement Registry (TJRR). Proportional-hazard regression
models were used to assess risk factors for SSI. The study cohort
consisted of 30 491 THRs, of which 17 474 (57%) were performed on
women. The mean age of the patients in the whole series was 65.5
years (13 to 97; . sd. 11.8) and the mean body mass index
was 29.3 kg/m. 2. (15 to 67; . sd. 5.9). The incidence
of SSI was 0.51% (155 of 30 491). Patient factors associated with
SSI included female gender, obesity, and American Society of Anesthesiologists
(ASA) score ≥ 3. Age, diagnosis, diabetes and race
were not associated with SSI. The only surgical factor associated
with SSI was a bilateral procedure. Surgeon and hospital volumes,
use of antibiotic-laden cement, fixation method, laminar flow, body
exhaust suits, surgical approach and fellowship training were not
associated with risk of SSI. A comprehensive infection surveillance system, combined with
a TJRR, identified patient and surgical factors associated with
SSI. Obesity and chronic medical conditions should be addressed
prior to
Peri-articular soft-tissue masses or ‘pseudotumours’
can occur after large-diameter metal-on-metal (MoM) resurfacing
of the hip and conventional total hip replacement (THR). Our aim
was to assess the incidence of pseudotumour formation and to identify
risk factors for their formation in a prospective cohort study. A total of 119 patients who underwent 120 MoM THRs with large-diameter
femoral heads between January 2005 and November 2007 were included
in the study. Outcome scores, serum metal ion levels, radiographs
and CT scans were obtained. Patients with symptoms or an identified
pseudotumour were offered MRI and an ultrasound-guided biopsy. There were 108 patients (109 hips) eligible for evaluation by
CT scan at a mean follow-up of 3.6 years (2.5 to 4.5); 42 patients
(39%) were diagnosed with a pseudotumour. The hips of 13 patients
(12%) were revised to a polyethylene acetabular component with small-diameter
metal head. Patients with elevated serum metal ion levels had a
four times increased risk of developing a pseudotumour. This study shows a substantially higher incidence of pseudotumour
formation and subsequent revisions in patients with MoM THRs than
previously reported. Because most revision cases were identified
only after an intensive screening protocol, we recommend close monitoring
of patients with MoM
We studied the migration of 58 cemented Hinek femoral components for total hip replacement,using roentgen stereophotogrammetric analysis over four years. The implants migrated faster during the first year than subsequently, and the pattern of migration in the second period was very different. During the first year they subsided, tilted into varus and internally rotated. After this there was slow distal migration with no change in orientation. None of the prostheses has yet failed. The early migration is probably caused by resorption of bone damaged by surgical trauma or the heat generated by the polymerisation of bone cement. Later migration may be due to creep in the bone cement or the surrounding fibrous membrane. The prosthesis which we studied allows the preservation of some of the femoral neck, and comparison with published migration studies of the Charnley stem suggests that this decreases rotation and may help to prevent loosening.
In developmental dysplasia of the hip (DDH),
a bone defect is often observed superior to the acetabulum after
the reconstruction at the level of the true acetabulum during total
hip replacement (THR). However, the essential amount of uncemented
acetabular component coverage required for a satisfactory outcome
remains controversial. The purpose of this study was to assess the
stability and function of acetabular components with a lack of coverage >
30% (31% to 50%). A total of 760 DDH patients underwent
We report an unusual complication of late dislocation of a total hip replacement. The femoral stem had completely migrated from the shaft. The insertion of a new long-stem prosthesis was successful.
We report the ten-year results for three designs of stem in 240 total hip replacements, for which subsidence had been measured on plain radiographs at regular intervals. Accurate migration patterns could be determined by the method of Einzel-Bild-Roentgen-Analyse-femoral component analysis (EBRA-FCA) for 158 hips (66%). Of these, 108 stems (68%) remained stable throughout, and five (3%) started to migrate after a median of 54 months. Initial migration of at least 1 mm was seen in 45 stems (29%) during the first two years, but these then became stable. We revised 17 stems for aseptic loosening, and 12 for other reasons. Revision for aseptic loosening could be predicted by EBRA-FCA with a sensitivity of 69%, a specificity of 80%, and an accuracy of 79% by the use of a threshold of subsidence of 1.5 mm during the first two years. Similar observations over a five-year period allowed the long-term outcome to be predicted with an accuracy of 91%. We discuss the importance of four different patterns of subsidence and confirm that the early measurement of migration by a reasonably accurate method can help to predict long-term outcome. Such methods should be used to evaluate new and modified designs of prosthesis.