We describe the clinical and radiological results of thirty eight consecutive total hip replacements, using the JRI Furlong Hydroxyapatite ceramic coated femoral component (JRI Instrumentation Ltd, London, UK) in patients under the age of 50 at the time of surgery. The mean age at the time of operation was 42 years (range 22 to 49 years). The average length of follow up was 10 years (range 63 to 170 months). All patients receiving a Furlong HAC THR were included regardless of their primary aetiology. These included patients on whom previous hip joint surgery had taken place.

The mean Harris hip score improved from 44 pre-operatively to 92 at the latest post-operative review. The mean WOMAC and Oxford scores at the latest review for this study were 29 and 16 respectively. Using the Charnley modification of the Merle d’Aubign_ and Postel hip score, at the latest follow up the mean scores were as follows: Pain 5.37, Function 5.47, and Range of Motion 5.71.

The mean pain visual analogue score was 1.1 and 94% of patients returned to outdoor activities or sports. There were no reports of thigh pain at any review. There was no loss to follow-up. There were no revisions of any femoral component. Radiological review of the femoral components revealed no continuous or progressive radiolucent lines around the stem. No osteolysis was noted. Using revision or impending revision as the end point at 12 years the cumulative survival for the stem was 100% (95% CI 89 to 100).

We present excellent clinical, radiological and survivrship results with the use of HAC components in young, active patients with varying primary pathology, after ten years use.

Young patients undergoing THA or hip used. HOS and iHOT33 have demonstrated to be useful in hip preservation surgery but never used in THA.

The aim of the study was to evaluate long-term clinical outcomes with HOS and iHOT33 in hip arthroscopy and THA

We conducted a retrospective study with prospective data collection of 118 consecutive young patients (<65 y.o.) between 2008 to 2012 who underwent hip arthroscopy or THA. The mean follow-up was 12.05 years. All surgeries were done by the same senior surgeon. PROMs used were iHOT-33 and HOS preoperatively, at one year and 10 years. SPSS Statistics Grad Pack 28.0 software was used for statistical analysis

Arthroscopy Group (57 patients): Mean age 35.36 years. 55.93% were male. iHOT33 mean differential improvement was 24.43 at 1 year, 70,17% exceed MCID and 49,1% SCB. HOS mean differential improvement was 16.26 at one year. 54,38 % patients exceed MCID and 49,36% SCB. At 10 years, iHOT33 mean differential improvement was 14,36 and 12.56 for HOS. Regarding complications, 3 patients underwent THA (5.26%) and 10 (17.54%) continued with groin pain.

THA Group (61 patients): Mean age 52,54 years. 55.73% were male. Cementless THA was used in all patients with ceramic on ceramic used in 77%. iHOT33 mean differential improvement was 41,57 at 1 year. 95,08% patients exceed MCID and 85,25% SCB. HOS mean differential improvement was 16.57 points at one year. 85,25% patients exceed MCID and 81,97% SCB. At 10 years, iHOT33 mean differential improvement was 20,15 and 14.12 for HOS. Regarding complications, 1 patient underwent DAIR for infection (1.64%) and 1 dislocation with close reduction (1.64%).

iHOT33 or HOS scores should be considered to be used in young active patients after hip preserving surgery or THA, with more predictable results at long-term in THA group.

To investigate the clinical results of capsular arthroplasty in the treatment of young patients with unilateral hip dislocation.

We retrospectively evaluated all patients who had the capsular arthroplasty from June 2012 to September 2016 in our department. Hips were evaluated using hip Harris score (HHS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. The Tonnis osteoarthritis grade and Severin classification were used to access the radiographic outcomes.

Fifty-nine patients (10 males and 49 females) with an average of 16.8y (range: 8–26y) were followed by a mean of 32.1 months (range: 12.5–66.0 months). The mean HHS was 83.4 (range: 31.2–99) and WOMAC score was 12.3 (range: 0–49) at the final follow up. Multivariate analysis revealed that the poor capsular quality (OR=8.29) was associated with the poor result. The thicker capsule (OR=0.83) and bigger femoral head (OR=0.73) were associated with the good result. There were 15 patients (25.4%) identified as Tonnis grade 0, 21 patients (35.6%) as grade 1, 18 patients (30.5%) as grade 2 and 5 patients (8.5%) as grade 3. According to Severin classification, 28 patients (47.6%) were regarded as class I, 22 patients (37.3%) as II, 7 patients (11.9%) as III and 2 patients (3.4%) as IV. One patient underwent THA after 41.5 months. The joint stiffness was the most common complication (10.2%).

We confirmed the efficacy of the capsular arthroplasty in the treatment of young patients with unilateral hip dislocation. The capsular quality and the size of femoral head were associated with the clinical results.

Introduction

Total knee arthroplasty (TKA) has proven clinical success with reported longterm survivorship of 92% in the elderly population. Concerns regarding increased loosening rates and potential need for multiple revision surgeries in patients younger than 60 years have traditionally discouraged TKA in younger patients. The purpose of this study was to review the longterm clinical and radiographic results of patients under the age of 45 yrs who underwent a total knee replacement.

Introduction Hip arthritis in the young has been a problem area in orthopaedics and thrust plate prosthesis (TPP) was developed as an option. TPP is an implant with fixation in proximal femur metaphysis transmitting hip forces to the resected neck. In young patients undergoing a hip replacement such prosthesis preserves proximal femoral bone stock, which is vital for a revision procedure. The purpose of the study was to evaluate the results of the Thrust Plate Prosthesis as a treatment option for osteoarthritis of the hip in young patients. Patients & Methods Of the fifty patients (63 hips) reviewed, 31 (62%) were males and 19 (38%) females. Pre-operative diagnosis included primary osteoarthritis (23), developmental dysplasia (8), avascular necrosis (7), Perthes (4), post-traumatic arthritis (3), rheumatoid arthritis (2), ankylosing spondylitis (1), psoriatic arthropathy (1) and slipped upper femoral epiphysis (1). All components were implanted uncemented with metal-on-metal articulation. The average follow-up was 4.04 years (range 12 months–8.5 years). Results The mean age of the patients was 42.3 years (range 21–57 years). The mean pre-operative Harris Hip Score was 41.9 (range 12–89) and at final follow-up 89.91 (range 41–100). In 25 hips with ≥ 5yr follow-up, the average HHS at final follow-up was 84.5 (range 50–100). Complications included dislocation (2), transient sciatic nerve palsy (1), discomfort from lateral strap (2), implantation of wrong femoral head (1), revision 3 (4.76%) and implant loosening (4) (6.35%). Conclusion The thrust plate prosthesis is a useful alternative in young patients with hip arthritis and the results are comparable with other uncemented hip replacements. The added advantage is preservation of the proximal femoral bone stock, which can prove useful in future revisions

Cementless arthroplasty has progressed substantially in the recent decades from pressfit implantation to porous-coated and later HA-coated implant fixation as its ultimate current state-of-the-art incarnation. As a consequence ever younger and older patients have received the benefits of hip and other arthroplasty although attention to age-related factors is key to success. Key factors for success, from the implant perspective, are adequate primary stability of the device in the bone supported by design and surface structure variables that together with optimal implant biocompatibility result in durable osseo-integration of the device. The high activity levels of younger patients but similarly the generally inferior muscular condition of elderly patients require special attention for the stability of the hip joint with avoidance of impingement. Also bone quality may be a topic for consideration to avoid problems. Excellent survival rates past twenty years are documented in both literature and registries with quantitative studies confirming the excellent implant stability and bone quality. With an optimal consideration for patient related factors as well as anatomic reconstruction of the arthroplasty, modern cementless arthroplasty provides every patient an outlook on both excellent long term functionality and survival.

Introduction

Hip resurfacing arthroplasty (HRA) is an alternative to traditional total hip arthroplasty (THA) in young active patients. While comparative implant survival rates are well documented, there is a paucity of studies reporting the patient mortality rates associated with these procedures. The purpose of this study was to evaluate the mortality rates in patients age 55 years and younger who underwent HRA versus THA and to assess whether the type of operation was independently associated with mortality.

Different pathologies, deformities, bone defects, previous surgeries and polyethylene wear limit the survival of total hip arthroplasty (THA) in young patients. We compare preoperative status and outcome in 171 young and very young patients (207 hips) who underwent a ceramic-on-ceramic THA. Sixty-three (77 hips) were less than 30 years old (group 1) and 108 (130) were between 30 and 40 years old. Mean follow-up was 11.3 years. Two-way ANOVA with repeated measures were used to analyse clinical and radiological changes.

Juvenile rheumatoid arthritis (JRA) was the most frequent diagnosis in group 1 and avascular necrosis in group 2. Charnley class type C, low activivity, previous surgery and osteoporotic bone were more frequent in group 1 patients. There were 2 cup revisions for aseptic loosening in group 1 and 4 in group 2. Survivorship analysis at 15 years was 96.7% (95% IC 92.2 a 100) for group 1 and 96.1% (95% IC 92.2 to 100) for group 2 (p=0.749). Despite the worse preoperative status in group 1 patients, clinical outcome was similar in both groups. Severe dysplasia had the worst clinical result and avascular necrosis the best. Patients with Charnley class C and JRA showed the most improvement. Radiographic reconstruction of the abduction angle was worse in group 1 (p=0.02). No osteolysis or complications derived from ceramic use were found.

We conclude that despite the worse preoperative status in group 1 patients, clinical and radiographic results were good in both groups of patients who received a ceramic-on-ceramic THA.

We performed 82 primary unicompatental, medial knee replacements in patients under the age of 50, using a fixed bearing, metal backed tibial design and a conforming anatomic femoral component. Patients were followed prospectively for a minimum of 2 years (range, 24 to 48 months). All patients were rated both clinically and radiographically using Knee Society Scores, SF-36 and standard radiographic instruments. Patients also completed a validated questionnaire that examined activity level, functional outcomes and ability to return to sports.

Methods: The senior author performed all procedures using a minimally invasive technique with subvastus approach to the medial aspect of the joint. Inclusion criteria were patients under 50 with documented, medial compartment osteoarthritis and a retained ACL. All patients received the same fixed bearing, metal backed design implanted with cement. All patients had osteophytes removed from the medial border of the patella if present.

Results: At last follow up, the mean Knee Society functional score was 96. There was one early infection that was converted to a total knee replacement without further complication. There were no fractures, thromboembolic events or other major complications in this group. Patients reported excellent pain relief and few activity limitations. There was no loss of radiographic alignment or signs of loosening on the most recent radiographs.

Conclusion: Unicompartmental medial knee arthroplasty in a younger patient population can be performed with excellent results. Functional outcomes were superior to total knee replacement designs previously reported in this patient population. The authors can recommend this design in younger patients with medial osteoarthritis that is resistant to non-operative treatment, but full evaluation of this prosthesis will require longer-term results.

Introduction:

Total hip arthroplasty has became one of the most successful standard procedures in the orthopaedic surgery. With a more frequent use in young and active patients bone saving procedures become more important. On the other hand, the ever increasing trend toward minimal excision of the healthy bone during implantation of the total hip replacement has led to a range of implants that can be classified according their means of anchorage in the various anatomic segments. The Nanos-short-stem endoprothesis presented here requires metaphyseal anchorage.

Introduction and Objectives: Hallux valgus is one of the most frequent causes of consultation seen by the Trauma and Orthopedic Specialist in feet. Many techniques have been described for its treatment, amongst them Keller-Brandes resection arthroplasty, although there are still doubts about its efficacy in young patients.

Materials and Methods: We reviewed a total of 29 patients, 40 feet, in patients under 63 years of age operated using the Keller-Brandes technique. Anteroposterior and lateral X-rays were taken of both feet when weight-bearing and the intermetatarsal, metatarsalphalangeal, interphalangeal angles and proximal articular set angle (PASA) were measured and compared with their preoperative values. The metatarsophalangeal and interphalangeal joint balances were assessed clinically, pain was assessed using a visual analog scale and using the specific OAFAS questionnaire for the metatarsophalangeal joint.

Results: Mean age at surgery was 56 years of age. The follow-up was 6.88 years. Pre and postoperative X-ray measurements were analyzed statistically and no significant differences were found. The mean value obtained using the AOFAS questionnaire was 72.18, whereas pain was quantified at a mean value of 2.7 using the visual analog scale.

Discussion and Conclusions: We have obtained good results using the Keller-Brandes technique as far as residual pain, both of the hallux and of the other lesser toes, and moderate results in relation to mobility of the articulation of the first toe. In spite of these results, we must consider the repercussion and biomechanical results of this technique.

Re-positioning osteotomy in the treatment of un-united fracture neck of femur in young patients improves the biomechanical pre-conditions to promote bone union of the Pseudarthrosis. This operative procedure is the method of choice for Pseudarthrosis of the neck of the femur with a viable femoral head. It is also the method of choice in children and in adolescents even if there is avascular necrosis of the femoral head.

The operative technique permits exacts planning, stable osteosynthesis both of the un-united fracture of the neck of the femur as well as the osteotomy and allows early mobilisation. In this series of 56 cases, only six (10%) had collapse of the femoral head due to avascular necrosis, six (10%) patients had severe pain in the hip and nine (16%) patients had severe restriction of hip movement. The overall success of the operation in this series was 84%.

Introduction: There has been an introduction of short femoral stems with the aim of conserving bone. We present the short term results of short metaphyseal cement-less stem(Proxima^®, Depuy).

Material and methods: 25 patients in age group (25–40yrs), 15 males,10 females were implanted with a short metaphyseal cementless stem (Proxima^®, Depuy) and cementless acetabular cup. The average follow up was 2.3 years (1.4–2.5 yrs). Clinical evaluation using Harris Hip Score, Radiological evaluation and Bone Mineral Density were evaluated at 2weeks, 6 months, 12 months and yearly thereafter. a new zonal method suitable for short stem was used for radiological evaluation.

Results: The mean Harris Hip score improved from 44 to 95 at final follow up. There was no evidence of any radiolucent lines or osteolysis around the stems. All the stems showed evidence of osseointegration at one year follow up. There was no decrease in bone mineral density around the stems.

Discussion: The Short Metaphyseal cementless femoral stem is a bone conserving as well as bone preserving option for young patients especially in those in whom surface replacement is not an option.

Treatment of the femoral head necrosis with severe extensive collapse in young adults and adolescents are still challenging. We thought preserve the joint and bone stock were important factor for the treatment of femoral head necrosis in young patients. We reviewed the posterior rotational osteotomy for younger patients with severe osteonecrosis. The advantages of posterior rotational osteotomy are; the necrotic area is moved to non-weight bearing portion. The posterior column artery is shifted medially without vascular damage by rotation. Postoperative uncollapsed anterior viable areas are moved to the loaded portion below the acetabular roof in flexed positions. Eighty five hips of 66 young adults (less than 50 years old, mean age; 31 years) with extensive necrosis treated by posterior rotational osteotomy were reviewed with more than 5 year follow up with a mean of 9 years. Results of 13 hips of 12 adolescents (mean age; 14 years) with extensive collapsed necrosis treated by this procedure were also studied with a mean of 6.5 years. A mean degree of posterior rotation was 121. Recollapse was prevented in 77 hips (91%) of adults, and all 13 hips of adolescents on final AP radiographs. Collapsed lesion was remodeled well and resphericity of the postoperative transferred medial collapsed femoral head on final AP radiographs was observed. However, some of the cases were out of indication of the joint preserving procedure showing extensive lesion. In these cases, we performed the MAYO conservative stem for preserving bone stock. Radiological results of 26 hips with osteonecrosis treated by MAYO stem (mean age 42 years, minimum 5 year follow-up. mean; 6.7 years) showed that 2 mm subsidence in one, osteointegration of zone 2, 6 in 93%, no entire lucent line. No hips were revised for late loosening associated with osteolysis. CT imaging indicated that spot welds of zone 2, 6 were found in 100ï¼ï¿½, stress shielding of zone 1, 5 (23.5ï¼ï¿½). These operations were useful particularly for younger patients.

We compared the long-term clinical and radiological results of hybrid total hip replacement (THR) with metal-on-metal Birmingham hip resurfacing (BHR) in two groups of 54 young patients matched for age, gender, body mass index and pre-operative levels of activity.

The clinical outcome was assessed by the University of California, Los Angeles (UCLA) activity score, the Oxford Hip Score (OHS) and the EuroQol scores. Radiologically, all hips were assessed for migration and osteolysis, the hybrid THRs for polyethylene wear and the BHRs for a pedestal sign.

The mean follow-up of the patients with a hybrid THR was 16 years and for those with a BHR, 15 years. 12 patients with a hybrid THR and 6 with a BHR had died. 2 patients with a BHR refused follow up but remain unrevised and 5 were lost to follow-up, as was 1 with a hybrid THR. The revision rate of the hybrid THRs was 28% (15 of 54) and of the BHRs 11% (6 of 54) (p = 0.029). Radiographs of a further 13 hybrid THRs demonstrated wear and osteolysis but are functioning well and are under observation. Of the unrevised BHRs 96% had radiological changes, of which approximately 17% had progressed over the previous 6 years. All hybrid THRs demonstrated linear polyethylene wear with a mean of 1.84mm (0.06 to 2.6). The BHRs recorded superior OHS (p = 0.03), UCLA (p = 0.0096), and EuroQol visual analogue scores (p = 0.03).

After 15 years, patients with BHRs remained more active and had a lower rate of revision and death than those with hybrid THRs. Both groups demonstrated progressive radiological changes at long-term follow-up.

Introduction

Total hip arthroplasty (THA) is becoming a common procedure because it dramatically relieves the patient's pain. Accordingly, young patients who hope to take THAs are also increasing. The results of THAs in the young patients have historically shown relatively poor survivorship. However several improvements of components may promise good long term results in active young patients. There was no consensus about the appropriate time for performing THA. The purpose of this study is to review the results of THAs younger than 40 years.

Retrospective data over an eight-year period was collected on twenty-four young patients with non-union of a femoral neck fracture who were followed to union. The cause of each nonunion was identified and a classification of the nonunions was established in order clarify treatment options. Patients were treated by a single surgeon. The treatment protocol was based on the classification of the femoral neck nonunion. There were no nonunions in the treated patients; however two patients who showed signs of avascular necrosis prior to treatment ultimately developed AVN.

Femoral neck nonunion occurs in 20–30% of displaced femoral neck fractures. If the femoral head is viable, the treatment goal is femoral neck union to maintain it. Treatment options depend on the cause of nonunion. To clarify treatment options, a classification of nonunions was developed.

The treatment regime developed was based on the type of nonunion. We believe that subclassification of the femoral nonunion improves the selection of treatment options. This classification-based treatment does not reduce the incidence of avascular necrosis, but does seem to guarantee union while permitting excellent function of the hip joint

A classification system based on the cause of the non-union clarifies treatment options to maintain the femoral head and produce union of the femoral neck.

Based on the analysis a classification proposal relating to treatment was developed. In the original treatment group there were no nonunions but two cases of ultimate avascular necrosis— both showed signs of AVN on bone scan prior to treatment.

Classifications:

Type I – Inadequate fixation or non-anatomic reduction (eight patients)

Type II – Loss of fixation with displacement (fourteen patients)

Type III (Rare) – Fibrous nonunion with no displacement and intact fixation (two patients)

Twenty-four patients were treated by one surgeon and followed to union over eight years. The results were examined retrospectively to categorize cause of non-union and treatment protocol. A classification system that describes classes of nonunions and treatment for each type was developed.

25 patients in age group (25–40yrs), 15 males, 10 females were implanted with a short metaphyseal cementless stem (‘Proxima’®, Depuy) and cementless acetabular cup. The average follow up was 2.3 years (1.4–2.5 yrs). Clinical evaluation using Harris Hip Score, Radiological evaluation and Bone Mineral Density were evaluated at 2weeks, 6 months, 12 months and yearly thereafter. a new zonal method suitable for short stem was used for radiological evaluation.

The mean Harris Hip score improved from 44 to 95 at final follow up. There was no evidence of any radiolucent lines or osteolysis around the stems. All the stems showed evidence of osseointegration at one year follow up. There was no decrease in bone mineral density around the stems.

The Short Metaphyseal cementless femoral stem is a bone conserving as well as bone preserving option for young patients especially in those in whom surface replacement is not an option.

Background : A composite femoral stem was introduced with a structural stiffness similar to that of the native femur to promote proximal load transfer. This consisted of a cobalt-chromium alloy core surrounded by an injection-moulded layer of polyaryletherketone covered with a porous titanium mesh.

Material and Methods: 31 consecutive primary total hip replacement stems were implanted in 26 patients with an average age of 37 years (range 17–57) using the Epoch stem (Zimmer, Warsaw, IN) as part of a prospective multi-centre trial. A cementless Harris-Galante I acetabular component with a 28mm polyethylene insert (Zimmer) was used in 29 cases, a Plasmacup with 28mm polyethylene insert (Aesculap, Tuttlingen, Germany) in 1 case and a bipolar head in 1 case. Annual follow-up with Harris Hip Scores and radiographic evaluation was performed for a mean of 10.1 years.

Results : Harris Hip Scores improved from a mean of 52 points preoperatively to 90 at the time of last follow-up. Radiographs showed no stem migration or loosening. 4 cases with polyethylene wear showed trochanteric osteolysis. Specific radiographic features noted were a sclerotic halo in Gruen zones 1 in 8 cases, calcar rounding in 10 cases and improvement in calcar appearance with squaring of the calcar in 4 cases. Calcar resorption was seen in 1 case associated with polyethylene wear. There have been 8 instances of revision of the head or acetabular component- 3 liner exchanges for polyethylene wear, 3 acetabular component revisions for liner dissociation with associated cup damage, 1 acetabular component revision for infection and 1 bipolar head revised to unipolar head with cementless acetabular component for pain. No stem has required or requires revision.

Conclusion : The Epoch stem resulted in an excellent clinical outcome with evidence of radiographic stability and proximal bone preservation, and no cases of stem revision in a cohort of young patients with long-term follow-up.

Introduction: A composite femoral stem was introduced with a structural stiffness similar to that of the native femur to promote proximal load transfer. This consisted of a cobalt-chromium alloy core surrounded by an injection-moulded layer of polyaryletherketone covered with a porous titanium mesh.

Materials and Method : 31 primary total hip replacement stems were implanted in 26 patients with an average age of 37 years (range 17–57) using the Epoch Stem (Zimmer, Warsaw, IN) as part of a prospective multicentre trial. A cementless Harris-Galante I acetabular component with a 28mm polyethylene insert was used in 28 cases, a Plasma cup (Aesculap) in 1 case and a bipolar head in 2 cases. Annual follow-up using Harris Hip Scores and radiographic evaluation was performed for a mean of 10.1 years.

Results: Harris Hip Scores improved from a mean of 56 points preoperatively to 90 at the time of last follow-up. Radiographs showed no stem migration or loosening. 4 cases with polyethylene wear showed trochanteric osteolysis. Specific radiographic features noted were calcar rounding in 10 cases and improvement in calcar appearance with squaring in 4 cases. Calcar resorption was seen in 1 case associated with polyethylene wear. There have been 9 instances of revision of the head or acetabular component – 3 liner exchanges for polyethylene wear, 3 liner exchanges for dissociation, 1 acetabular component revision for infection and 2 bipolar heads revised to unipolar heads with cementless acetabular component for pain. No stem has required or requires revision.

Discussion: The Epoch stem resulted in an excellent clinical outcome, with evidence of radiographic stability and proximal bone preservation, and no cases of stem revision in a small cohort of young patients at 10-year follow-up. The limitation of reconstruction in this cohort of young patients has been the acetabular component.