Aims. Eccentric reductions may become concentric through femoral head ‘docking’ (FHD) following closed reduction (CR) for developmental dysplasia of the hip (DDH). However, changes regarding position and morphology through FHD are not well understood. We aimed to assess these changes using serial MRI. Methods. We reviewed 103 patients with DDH successfully treated by CR and spica casting in a single institution between January 2016 and December 2020. MRI was routinely performed immediately after CR and at the end of each cast. Using MRI, we described the labrum-acetabular cartilage complex (LACC) morphology, and measured the femoral head to triradiate cartilage distance (FTD) on the midcoronal section. A total of 13 hips with initial complete reduction (i.e. FTD < 1 mm) and ten hips with incomplete MRI follow-up were excluded. A total of 86 patients (92 hips) with a FTD > 1 mm were included in the analysis. Results. At the end of the first cast period, 73 hips (79.3%) had a FTD < 1 mm. Multiple regression analysis showed that FTD (p = 0.011) and immobilization duration (p = 0.028) were associated with complete reduction. At the end of the second cast period, all 92 hips achieved complete reduction. The LACC on initial MRI was inverted in 69 hips (75.0%), partly inverted in 16 hips (17.4%), and everted in seven hips (7.6%). The LACC became everted-congruent in 45 hips (48.9%) and 92 hips (100%) at the end of the first and second cast period, respectively. However, a residual inverted labrum was present in 50/85 hips (58.8%) with an initial inverted or partly inverted LACC. Conclusion. An eccentric reduction can become concentric after complete reduction and LACC remodelling following CR for DDH. Varying immobilization durations were required for achieving complete reduction. A residual inverted labrum was present in more than half of all hips after LACC remodelling. Cite this article: Bone Joint J 2023;105-B(2):140–147

The treatment of developmental dysplasia of the hip diagnosed after the first year of life remains controversial. A series of 36 children (47 hips), aged between one and 4.9 years underwent gradual closed reduction using the Petit-Morel method. A pelvic osteotomy was required in 43 hips (91.5%). The patients whose hips did not require pelvic osteotomy were among the youngest. The mean age at final follow-up was 16.1 years (11.3 to 32). The mean follow-up was 14.3 years (10 to 30). At the latest follow-up, 44 hips (93.6%) were graded as excellent or good according to the Severin classification. Closed reduction failed in only two hips (4.3%) which then required open reduction. Mild avascular necrosis was observed in one (2.1%). The accuracy of the reduction and associated low complication rate justify the use of the Petit-Morel technique as the treatment of choice for developmental dysplasia of the hip in patients aged between one and five years

Aims. When the present study was initiated, we changed the treatment for late-detected developmental dislocation of the hip (DDH) from several weeks of skin traction to markedly shorter traction time. The aim of this prospective study was to evaluate this change, with special emphasis on the rate of stable closed reduction according to patient age, the development of the acetabulum, and the outcome at skeletal maturity. Methods. From 1996 to 2005, 49 children (52 hips) were treated for late-detected DDH. Their mean age was 13.3 months (3 to 33) at reduction. Prereduction skin traction was used for a mean of 11 days (0 to 27). Gentle closed reduction under general anaesthesia was attempted in all the hips. Concurrent pelvic osteotomy was not performed. The hips were evaluated at one, three and five years after reduction, at age eight to ten years, and at skeletal maturity. Mean age at the last follow-up was 15.7 years (13 to 21). Results. Stable closed reduction was obtained in 36 hips (69%). Open reduction was more often necessary in patients ≥ 18 months of age at reduction (50%) compared with those under 18 months (24%). Residual hip dysplasia/subluxation occurred in 12 hips and was significantly associated with avascular necrosis (AVN) and with high acetabular index and low femoral head coverage the first years after reduction. Further surgery, mostly pelvic and femoral osteotomies to correct subluxation, was performed in eight hips (15%). The radiological outcome at skeletal maturity was satisfactory (Severin grades 1 or 2) in 43 hips (83%). Conclusions. Gentle closed reduction can be attempted in children up to three years of age, but is likely to be less successful in children aged over 18 months. There is a marked trend to spontaneous improvement of the acetabulum after reduction, even in patients aged over 18 months and therefore simultaneous pelvic osteotomy is not always necessary

To compare complications, survivorship and results in 2 groups of Furlong-HAP Active, one with ceramic-ceramic and the other with metal-XLPE friction pair. Prospective, non-randomized, comparison of 2 series of JRI uncemented prosthesis, implanted with identical protocol by 1 surgeon in 1 hospital from 2006 to 2014. Friction pair was ceramic (Biolox Forte or Delta) in 35 patients of 53.7+/−10.6 years (25–69) (21 males, 60%), and CrCo-XLPE in 65 cases of 69.0+/−8.9 years (42–81) (36 males, 55%); there were significant differences in age (p<0.00001) but not in sex (p=0.6565). Head diameter: Ce-Ce with 19 of 28mm, 9 of 32 and 7 of 36mm; Me-PE with 63 of 28mm, 1 of 32 and 1 of 36. Follow-up averaged 10.5+/−3.1 years (1–15) in ceramic and 9.8+/−3.8 years (2–15) in XLPE group. Pearson, Fisher, Kolmogorov-Smirnov, Student, Mann-Whitney, calculated with the informatic tools Microsoft Excel 2007 and . https://www.socscistatistics.com/tests/. . Complications in ceramic joints: 2 late infections (Fisher exact test=0.6101) (1 DAIR, 1 one-stage exchange); 1 dislocation (Fisher exact test=0.2549) (closed reduction); 1 Vancouver C fracture (ORIF) (Fisher exact test=0.6548). Complications in Me-XLPE joints: 2 late infections (Fisher=0.6101) (1 DAIR, 1 two-stage exchange); 7 dislocations (Fisher=0.2549) (2 early, open reduction) (5 late: 3 closed reduction, 1 cup revision, 1 constrained cup); 4 Vancouver B fractures (Fisher=0.6548) (2 intraoperative, cerclages; 2 late, exchange). Final follow-up: Harris Hip Score averaged 93.2+/−13.7 (23–100) in ceramic and 94.3+/−8.7 (65–100) in XLPE joints (p=0.64552). Wear: 0.06+/−0.38mm (0–1.5) in ceramic and 0.16+/−0.5mm (0–2) in Me-PE THAs (p=0.30302). Osteolysis in Charnley-De Lee zones: 8 zones (6 patients) (17%) in ceramic cups, 25 zones (15 patients) (23%) in XLPE cups (p=0.980127). Survivorship without any surgery or closed reduction after 15 years: 91.0% in ceramic joints, 83.8% in Me-XLPE joints. Survivorship without component exchange after 15 years: 93.9% in ceramic joints, 93.6% in Me-XLPE joints. At least after 10 years follow-up of Furlong-HAP Active, metal-XLPE and ceramic-ceramic joints present no significant differences in complications, clinical score, wear, acetabular osteolysis, or survivorship without component exchange. On the contrary, survivorship without any surgery or closed reduction is different because of the high rate of dislocation in 28mm metal-poly joints

Aims. The aim of this study was to estimate the clinical and economic burden of dislocation following primary total hip arthroplasty (THA) in England. Methods. This retrospective evaluation used data from the UK Clinical Practice Research Datalink database. Patients were eligible if they underwent a primary THA (index date) and had medical records available 90 days pre-index and 180 days post-index. Bilateral THAs were excluded. Healthcare costs and resource use were evaluated over two years. Changes (pre- vs post-THA) in generic quality of life (QoL) and joint-specific disability were evaluated. Propensity score matching controlled for baseline differences between patients with and without THA dislocation. Results. Among 13,044 patients (mean age 69.2 years (SD 11.4), 60.9% female), 191 (1.5%) had THA dislocation. Two-year median direct medical costs were £15,333 (interquartile range (IQR) 14,437 to 16,156) higher for patients with THA dislocation. Patients underwent revision surgery after a mean of 1.5 dislocations (1 to 5). Two-year costs increased to £54,088 (IQR 34,126 to 59,117) for patients with multiple closed reductions and a revision procedure. On average, patients with dislocation had greater healthcare resource use and less improvement in EuroQol five-dimension index (mean 0.24 (SD 0.35) vs 0.44 (SD 0.35); p < 0.001) and visual analogue scale (0.95 vs 8.85; p = 0.038) scores, and Oxford Hip Scores (12.93 vs 21.19; p < 0.001). Conclusion. The cost, resource use, and QoL burden of THA dislocation in England are substantial. Further research is required to understand optimal timing of revision after dislocation, with regard to cost-effectiveness and impact on QoL. Cite this article: Bone Joint J 2022;104-B(7):811–819

Sequelae of Legg-Calve -Perthes disease (LCPD) and treatment of developmental dysplasia of the hip (DDH) can present a coxa breva or coxa magna deformity, sometimes associated with coxa vara. This unique deformity decreases the efficiency of the abductor mechanism, causing a Trendelenburg gait and hip pain, leg length discrepancy and leads to intra- and extra-articular impingement, and eventually osteoarthritis. Several surgical techniques have been advocated to treat this kind deformity, such as great trochanter transfer, relative femoral neck lengthening. We evaluated primary results of true femoral neck-lengthening osteotomy (TFNLO) in combination with periacetabular osteotomy (PAO) for treatment of Coxa Breva through surgical hip dislocation (SHD). Fourteen patients with Coxa Breva received true femoral neck lengthening osteotomy in combination of PAO through SHD between March 2020 and October 2023. Ten patients with minimum 1 year followed-up were retrospectively reviewed clinically and radiographically. Eight patients had Perthes disease, 2 had DDH received closed reduction and fixation during childhood. The mean age at surgery was 16 years (range, 12 to 31 years). Clinical findings, radiographic analyses including the change in horizontal femoral offset and the leg length discrepancy as well as complications were assessed. Horizontal femoral offset improved 19.5mm(6–28mm). Limb length increase 16.8mm(11–30mm). Mean HHS increased from 80.6(66–91) to 91.8(88–96). Complication: screw broken in 1(no need operation). Asymptomatic fibrous union of the great trochanter was found in 1. No infection and joint space narrow as well as nerve palsy happened. TFNLO combined with PAO can be effective for the treatment of patients with Coxa breva. But long term follow up is warranted

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%)

Background. Sub-trochanteric fractures are challenging to treat due to various anatomical and biomechanical factors. High tensile forces contribute to the challenge of fracture reduction. Intramedullary nailing has become the treatment of choice. If anatomical reduction is not achieved, any mal-alignment will predispose to implant failure. Open reduction with cerclage wires can add to construct stability and improve the quality of reduction. There is no consensus or classification to guide surgeons on when to perform open reduction, which is often performed intra-operatively when closed reduction fails often with no planning. This can lead to intraoperative delays as theatre staff would not have prepared the correct equipment necessary for open reduction. Objectives. The purpose of this study was to assess outcomes of closed and open reduction of traumatic sub-trochanteric fractures treated with intramedullary nailing and to propose a new classification system to dictate management. Methods. After a review of current classification systems, a 3-tier classification was proposed (Type 1, 2 and 3). Type 1 indicated a transverse fracture, Type 2 was a spiral fracture with an intact posterior and medial wall and a Type 3 fracture were fractures with no posterior and/or medial walls. Over a two-year period (2013–2015), patients with sub trochanteric fractures were classified into Type 1, 2 or 3 injuries based on radiographic appearances by two senior clinicians. Patients with Type 3 injuries were divided into two groups based on whether they were treated with open or closed reduction. A clinical and radiographic review was performed. The primary outcome measure was the incidence of implant failure, whereas secondary outcome measures were related to fracture reduction. Statistical analysis was performed using GraphPad Prism Version 6 (GraphPad Software Inc. California, USA). Fisher's exact test was used for independent categorical data and Mann–U Whitney for continuous nonparametric data. Statistical significance was set at p<0.05. Results. 75 patients had intramedullary nailing for subtrochanteric fractures over the study period with a mean age of 82.6 years. There were 48 patients who had a Type 3 fracture pattern with a deficient medial and/or posterior wall. Reduction was achieved open with cerclage wires in 42% of patients (n=20 and closed in 58% (n=28). Overall there were a total of 18 (37.5%) major complications. In patients treated with closed reduction, 9 patients suffered mechanical complications (6 distal locking screw failures, 3 lag screw cut outs). There was a significantly increased risk of implant failure in patients treated with closed reduction compared to open reduction (p=0.006). No cases with cerclage wire had implant failure. Open reduction with cerclage wires improved the quality of reduction (p=0.0001) compared with closed reduction. There was no significant increase in operating time in patients treated with cerclage wires (p=0.4334). Conclusions. Open reduction with cerclage wires should be considered in patients with Type 3 sub-trochanteric fractures as it has shown to significantly reduce the risk of implant failure and improve the quality of reduction with no significant increase in operating time

To estimate the clinical and economic burden of primary total hip arthroplasty (THA) dislocation in England. Retrospective propensity score-matched evaluation of patients with and without dislocation following primary THA using the UK Clinical Practice Research Datalink linked and Hospital Episode Statistics datasets with a 2-year follow-up. 13,044 patients with total hip replacements met the inclusion criteria (mean age 69.2, 60.9% female) of which 154 (1.18%) suffered at least one postoperative hip dislocation. The mean number of dislocations per patient was 1.44 with a maximum of 4. Approximately one-third of the patients with dislocation (32.5%) had more than one dislocation. Among patients with a hip dislocation 148 patients (96.7%) had at least one closed reduction and 20 patients (13.1%) had revision surgery. Two-year median direct medical costs were £14,748 (95% confidence interval [CI] £12,028 to £20,638) higher with vs. without dislocation (+227%). On average, patients with a dislocation had significantly greater healthcare resource utilization and significantly less improvement in EuroQol-5D (EQ-5D) index (0.24 vs. 0.45; p<0.001) and Visual Analogue Scale (VAS) (1.58 vs. 11.23; p=0.010) scores and Oxford Hip Scores (13.02 vs. 21.98; p<0.001). This is the first study to estimate the economic burden of dislocation in the UK throughout the entire patient pathway. Dislocation following total hip replacement is a costly complication, both in terms of economic costs and to the functional quality of life of the patient. Efforts to reduce the risks of dislocation should remain at the forefront of hip research

Thru purpose of this study was to evaluate the clinical outcomes of a consecutive series of conversion total hip arthroplasty (cTHA) following previous hip fractures. A retrospective chart review of patients who underwent cTHAs from 2008–2017 at an urban academic teaching institution was performed. Eighty-eight patients were included in this study. The mean age at the cTHA was 66 years (range 27 to 89). 67% of the patients wre women. The mean BMI was 28 kg/m. 2. (range 17 to 41). The mean Charlson Comorbidity Index was 3 (range 0 to 9). The mean follow-up was 49 months (range 24 to 131). The mean duration from the hip fracture fixation to the cTHA was 51 months (range 10 to 144). The mean operating time was 188 minutes, (range 71 to 423) with a mean estimated blood loss of 780 ml (range 300 to 2500). Revision-type (long-stem) designs were used in 65% of the cases. The mean length of hospital stay was 8 days (range 2 to 61). The readmission rate was 37% within 90 days after the CTHAs. Of these, 57% were due to non-orthopaedic complications. There were 10 orthopaedic complications: 7 PJIs, all of which required I&D and 3 required staged revision. There were 2 dislocations treated with closed reduction and 1 case of intraoperative periprosthetic femur fracture during femoral component insertion. There was no revision for aseptic loosening within the follow-up period. The one-year mortality rate was 0%. cTHAs were associated with longer operating time, more blood loss, longer length of hospital stay, and higher readmission rates than the primary THAs in our institutional database. We believe utilizing a multi-disciplinary care protocol to optimize these patients is needed to reduce the high rate of readmissions, and the complications in this patient population

Instability continues to be a troublesome complication after THA and has been reported to be the main indication for revision in the United States, accounting for 22.5% of revisions. Risk factors associated with dislocation include: age of 75 years or older, body mass index (BMI) of 30 kg/m2 or greater, alcohol abuse, and neuro-degenerative diseases such as multiple sclerosis or Parkinson's disease. Dual-mobility articulations have become an increasingly popular option for these “at risk” primary THAs. Few studies have assessed their use in this complex patient population. The purpose of this study was to assess dislocation rate, radiographic outcomes and complications of the dual-mobility articulation in the setting of primary THA for patients at high risk for dislocation at a minimum follow up of 2 years. We retrospectively reviewed 151 dual mobility acetabular components, that had been performed using a single design (ADM Stryker, Mahwah, NJ) between 2010 and 2014 at a single institution by a single surgeon. The mean age at time of index surgery was 82 years (range, 73–95), 114 patients were female, and mean BMI was 26.2 kg/m2 (range, 16.1–60.9). Dislocation rate and complications associated with dual mobility cups were reviewed, along with the radiographic outcomes after an average follow-up period of 3.6 years (range, 1.9–6.1 years). The indication for hip replacement was osteoarthritis in all cases. We had one traumatic dislocation which required component revision after intraprosthetic dislocation following an attempt of closed reduction. There were no further dislocations in this cohort. No progressive radiolucencies or component positional changes were seen on radiographic assessment. At short-term follow-up dual mobility provides a stable reconstruction in patients at high risk of dislocation with excellent radiographic results. Longer follow-up is needed to confirm the durability of these reconstructions

Aims

Dislocation remains a leading cause of failure following revision total hip arthroplasty (THA). While dual-mobility (DM) bearings have been shown to mitigate this risk, options are limited when retaining or implanting an uncemented shell without modular DM options. In these circumstances, a monoblock DM cup, designed for cementing, can be cemented into an uncemented acetabular shell. The goal of this study was to describe the implant survival, complications, and radiological outcomes of this construct.

Dislocation is one of the most common complications after revision THA using the posterolateral approach. Although the cause of dislocation after revision THA is multifactorial, the historically high dislocation rates have been shown to be significantly reduced by closing the posterior capsule and by the use of large diameter (36 and 40 mm) femoral heads. The relative importance of each of these strategies on the rate of dislocation remains unknown. We undertook a study to determine if increasing femoral head diameter, in addition to posterior capsule closure would influence the dislocation rate following revision THA. We retrospectively reviewed 144 patients who underwent a revision THA. We included all patients who underwent revision THA with closure of the posterior capsule and who had at least a 2-year minimum follow-up. We excluded patients undergoing a revision THA for dislocation or multistage revision for infection since these patients would likely have deficient posterior tissues. Forty-eight patients had a 28 mm femoral head, 47 had a 32 mm head and 49 patients had a 36 mm femoral head. At a minimum follow-up of 2 years, there were 3 dislocations. There were no dislocations in the 28 mm group (0%), 2 in the 32 mm group (4%) and 1 in the 36 mm group (2%). All patients were successfully treated with a closed reduction. No patients had recurrent dislocation. Head size alone was not found to significantly decrease the risk of dislocation (28mm vs 32mm p=0.12; 28mm vs 36mm p=0.27; 32mm vs 36mm p=0.40). Both large diameter heads and careful attention to surgical technique with posterior capsule closure can decrease the historically high dislocation rate after revision THA when utilizing the posterolateral approach. The additional use of a large diameter head did not have a significant impact on the already low dislocation rate. Capsular closure outweighs the effect of femoral head diameter in preventing dislocation following revision THA through a posterolateral approach

Tissue sparing hip replacements have recently gained popularity, in an attempt to provide shorter hospital stay, faster recovery time and potentially to reduce morbidity and complications. Direct anterior approaches (DAA) have been shown to allow faster recovery, but also appear to be associated with a higher incidence of complications, especially during the learning curve. Mini-posterior approaches have the advantage of increased familiarity, however may not be maximally muscle sparing. Prospective and retrospective data was collected following a published protocol. This included patient demographic data, theatre time, units of blood transfused, length of stay, functional scores and radiological parameters. Rates of conversion to posterior approach and complications were also documented. The results of our first 100 cases completed are presented: Within this initial cohort, three patients suffered major complications: These included an anterior dislocation, which was successfully reduced with closed reduction under general anaesthetic, an early (day 6) periprosthetic fracture, which was successfully revised to a cemented prosthesis, and a case of stem subsidence. Our results also suggest a learning curve effect, limited to theatre time and blood loss. Complications were evenly distributed throughout the period of study and are of similar frequency to standard approaches. As the first European centre to adopt the SuperPATH approach, we have shown that the published results from America can be reproduced. In contrast to DAA, the learning curve is not associated with higher rates of femoral fracture and other complications. The fact that the approach is extensile, being the superior part of the posterior approach, allows for all of the advantages of muscle preservation with the safety of potential extension when necessary

Aims

Adverse spinal motion or balance (spine mobility) and adverse pelvic mobility, in combination, are often referred to as adverse spinopelvic mobility (SPM). A stiff lumbar spine, large posterior standing pelvic tilt, and severe sagittal spinal deformity have been identified as risk factors for increased hip instability. Adverse SPM can create functional malposition of the acetabular components and hence is an instability risk. Adverse pelvic mobility is often, but not always, associated with abnormal spinal motion parameters. Dislocation rates for dual-mobility articulations (DMAs) have been reported to be between 0% and 1.1%. The aim of this study was to determine the early survivorship from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) of patients with adverse SPM who received a DMA.

We present our experience with a double-mobility acetabular component in 155 consecutive revision total hip replacements in 149 patients undertaken between 2005 and 2009, with particular emphasis on the incidence of further dislocation. The mean age of the patients was 77 years (42 to 89) with 59 males and 90 females. In all, five patients died and seven were lost to follow-up. Indications for revision were aseptic loosening in 113 hips, recurrent instability in 29, peri-prosthetic fracture in 11 and sepsis in two. The mean follow-up was 42 months (18 to 68). Three hips (2%) in three patients dislocated within six weeks of surgery; one of these dislocated again after one year. All three were managed successfully with closed reduction. Two of the three dislocations occurred in patients who had undergone revision for recurrent dislocation. All three were found at revision to have abductor deficiency. There were no dislocations in those revised for either aseptic loosening or sepsis. These results demonstrate a good mid-term outcome for this component. In the 29 patients revised for instability, only two had a further dislocation, both of which were managed by closed reduction

The purpose of this prospective study was to evaluate the long-term clinical and radiological outcomes of revision of the femoral component of a total hip replacement using impaction bone grafting. Femoral revision with an impacted allograft was performed on 29 patients (31 hips). In all, 21 hips (68%) had grade III or IV femoral defects according to the Endo-Klinik classification. A total of 11 patients (12 hips) died before the ten-year follow-up period. Of the remaining patients, 18 patients (19 hips) were followed for 10 to 15 years; three further patients died during this time. None of the 31 stems underwent further revision of their stem. However, four stems showed extensive subsidence (> 15 mm). One of these patients had a femoral fracture that required fixation. Three other patients had a femoral fracture, two of which required fixation and the other was treated conservatively. Patients with a femoral fracture and/or severe subsidence had significantly more grade IV defects (six of seven hips; p = 0.004). One patient needed a closed reduction for dislocation. Impaction allografting in revision hip surgery gives good long-term results for femora with grades I, II and III Endo-Klinik-classified defects. Extensive subsidence and femoral fractures were seen mainly in patients with grade IV damaged femora

Aims

Developmental dysplasia of the hip (DDH) describes a pathological relationship between the femoral head and acetabulum. Periacetabular osteotomy (PAO) may be used to treat this condition. The aim of this study was to evaluate the results of PAO in adolescents and adults with persistent DDH.

Aims

Several different designs of hemiarthroplasty are used to treat intracapsular fractures of the proximal femur, with large variations in costs. No clinical benefit of modular over monoblock designs has been reported in the literature. Long-term data are lacking. The aim of this study was to report the ten-year implant survival of commonly used designs of hemiarthroplasty.

Aims

The purpose of this study is to report our updated results at a minimum follow-up of 30 years using a first generation uncemented tapered femoral component in primary total hip arthroplasty (THA).