Background. A few patients undergoing a total hip replacement need a subsequent revision of the cup. In some of these cases, the treating surgeon may be confronted with Unexpected Positive Intraoperative Cultures (UPIC). The exact incidence of this finding is unclear. Moreover, it is unknown what the clinical outcome of these patients is when the stem is left in situ. The aim of our study was to describe the incidence of UPIC in patients undergoing cup revision and to determine the need for total revision in this patient group during follow-up. Methods/design. In this retrospective multicenter cohort study, we included all consecutive patients that underwent a cup revision between 2015–2017 and had a minimal follow-up of 2 years. Patients were divided in 3 cohorts: i) no positive intra operative cultures; ii) one UPIC; iii) two or more UPIC. Cases in whom 2 or fewer cultures were obtained during cup revision were excluded from the analysis. Results. From the 334 evaluated cases, 77 were excluded because an inadequate number of cultures were obtained. From the total of 257 included cases, the incidence of UPIC was 16% (n=39). 21 cases had one (8%), and 18 cases had two or more UPIC (7%). After two years of follow up, implant survival in the no UPIC group was 88% (95% CI 0.83 – 0.93), in the one UPIC group 95% (95% CI 0.86 – 1.0), and in the two or more UPIC group 77% (95% CI 0.57 – 0.97). Survival analysis showed no statistically significant differences between the cohorts as determined by cox regressive analysis and log rank test (P = 0.19). Conclusion. The incidence of UPIC in patients who undergo cup revision is relatively high but does not seem to have a major influence on the need for total revision of the hip during a follow-up of 2 years

Purpose. Cementless cup with structural allograft is one of option for acetabular revision in the cases which has severe bone loss. This study was performed to verify that the structural allograft with cementless cup could be one of good options for revision of acetabular cup with severe bone defect and to verify that the allograft resorption affect the stability of cementless acetabular cup. Materials and Methods. We reviewed 25 cases of 25 patients who underwent acetabular cup rvision using cementless porous coated hemispherical cup with structural allograft from May 1992 to July 2011 July 2011. There were nine males and sixteen females with an average age of 50.0 years. The average follow-up period was 76.7(28∼212) months. The clinical evaluation was performed using Harris Hip Score(HHS) and UCLA activity score. Radiologically, the degree of resorption of grafted bone, incorporation of allograft bone with normal bone, osteolysis and cup loosening were evaluated. Results. Clinically, the average Harris hip score was improved from 54 preoperatively to 93.4 at the last follow-up. The average UCLA activity score was also improved from 4.3 preoperatively to 6.4 at the last follow-up. Radiologically, the incorporation of allograft was accomplished in 11.4 months and the resorption of grafted bone was noted in 3 cases(12%), but the allograft resorption had not progressed to moderate degree even in long term follow-up. There was no cup loosening and average survivor rate was 100% in 6 years. There was no infection, allograft nonunion, osteolysis. Conclusion. Cementless cup with structural allograft in acetabular cup reconstruction can provide excellent mi-term results in both clinical and radiological aspects. Structural allograft can provide strong mechanical support for the bone ingrowth of cementless cup. The clinical result of this study auggest that cementless cup with structural allograft can be a good option for acetabular cup revision with severe bone defect. Resorption of structural allograft rarely occurred, and the resorption of structural allograft does not affect stablility of cup even in long term follow-up

A number of studies have reported satisfactory results from the isolated revision of an acetabular component. However, many of these studies reported only the short- to intermediate-term results of heterogeneous bearing surfaces in a mixed age group.

We present our experience of using a ceramic-on-ceramic (CoC) bearing for isolated revision of an uncemented acetabular component in 166 patients (187 hips) who were under the age of 50 years at the time of revision. There were 78 men and 88 women with a mean age of 47.4 years (28 to 49). The most common reason for revision was polyethylene wear and acetabular osteolysis in 123 hips (66%), followed by aseptic loosening in 49 hips (26%).

We report the clinical and radiological outcome, complication rate, and survivorship of this group. The mean duration of follow-up was 15.6 years (11 to 19).

The mean pre-operative Harris hip score was 33 points (1 to 58), and improved to a mean of 88 points (51 to 100) at follow-up. The mean pre-operative total Western Ontario and McMaster Universities Osteoarthritis Index score was 63.2 (43 to 91) and improved to 19.8 points (9 to 61) post-operatively. Overall, 153 of 166 patients (92%) were satisfied with their outcome. Kaplan–Meier survivorship analysis, with revision or radiological evidence of implant failure (13 patients, 8%) as end-points, was 92% at 15 years (95% confidence interval 0.89 to 0.97).

Isolated revision of a cementless acetabular component using a CoC bearing gives good results in patients under 50 years of age.

Cite this article: Bone Joint J 2015;97-B:1197–1203.

Hydroxyapatite-coated acetabular cup were used in revision hip arthroplasty without using bone grafts or bone substitutes to achieve osseointegration in 30 consecutive hips (29 patients). The mean age was 72.5 years (range 54 to 88). Primary prosthesis was 14 Charnley’s, 12 Capital 3M, one Furlong, one Exeter and one MacKee Farrar. Indication for revision was aseptic loosening in 20, recurrent dislocation in four, periprosthetic fracture in two, prosthesis fracture in one, and three infected hips. Patients were assessed clinically using Harris Hip Score, satisfaction questionnaire and quality of life SF 36 questionnaire, and radiologically using DeLee and Charnley, Harris-Barrack, and Hodgkinson’s Engh’s classification, and Bassetlaw Digital Scoring System (BDSS) that we have devised. The acetabular defects were assessed preoperatively using the American Academy of Orthopaedic Surgeons (AAOS) classification. Mean follow up was 38.7 months (range 18.5–76.4). Ninety present of acetabular cups had preoperative radiolucency in all DeLee and Charnley’s zones. 26 hips (87%) had no superior or lateral cup migration. Two hips had 3 mm superior migration at one year then remained stable. Mean improvement of Harris hip score was 42.2. 83.3% of hips had no or slight pain at final follow up. Five patients had dislocations one of which was recurrent that required acetabular cup revision. Two patients had postoperative foot drop that recovered fully. Two patients had postoperative wound infection that healed with antibiotics apart from one who died due to multi-organ failure. Four patients died due to unrelated causes. Postoperative radiographs showed stable fixation of all acetabular cups. 83.3% of hips had no or slight pain at final follow up. Early results show that stable fixation in revision hip surgery can be obtained with HAC acetabular cups without bone grafts or bony substitute

Purpose

To assess acetabular component fixation by bone ongrowth onto a titanium plasma sprayed surface as used in revision total hip arthroplasty. Acetabular bone defects, a common finding in revision surgery, and their relation to outcome were also investigated.

Purpose: Massive cavitary and segmental bone defects of the medial wall in revision arthroplasty are usually managed with large auto and/or allograft in association with a cemented or a cementless cup. To obtain a satisfactory hip center reconstruction with such a procedure can be sometimes challenging and the complications rate can be high. One other option is the use of a cup with a medial expansion (“protrusio cup”) to treat the medial bone defect.

Method: We carried out a retrospective study including 21 consecutive acetabular revisions arthroplasties using a cementless Converge Protrusio™ cup (Zimmer, Warsaw, IN, USA). Clinical outcomes were assessed by Harris Hip Score (HHS), WOMAC index and SF-12. Hip centre was assessed on anteroposterior (AP) view and the reconstruction was considered as satisfying when its location was located from − 10 to + 10 mm proximally (y axis) and/or medially (x axis) in comparison with ideal theoretical hip center location. Cup migration and modification of abduction angle were considered as significant when there were respectively > 4mm and to > 4° in comparison with the immediate postoperative AP view.

Results: At the last follow up [radiological data: 71.6 months (24–128.3) and clinical data: 72.1 months (24–129.5)], two patients were died and there were no lost of follow up. The mean HHS was 79.4% (52–100), WOMAC 82% (46–100), SF-12 52 (23–71) and 44 (18–65). Bone defect were filled with cancellous bone chips allograft in 16 cases and bulk bone allograft was used in only two cases to manage a large segmental defect of the roof. Bone graft integration was completed in all cases. The mean abduction cup angle was 43.6° (32–60). A satisfying hip centre positioning was obtained in 19 cases on x axis and in 10 cases on y axis, in all the remaining cases, we noted an improved implant positioning. The complications were: recurrent dislocation in one case (successfully revised with a constrained liner), infection in two cases (1 treated conservatively and the other one revised in two times procedure) and Brooker’s type III and IV ectopic ossifications in three cases. A significant cup migration occurred in only one case at nine years but was not revised because of painless. No case required revision for aseptic loosening.

Conclusion: Protusio cups appear as a reliable procedure to manage bone loss in acetabular revision. The revision procedure is widely simplified by reducing the use of the massive allograft and by promoting a satisfying hip center reconstruction to allow an optimal biomechanical joint functioning. Moreover, the cementless fixation in contact with patient acetabular bone makes more easy bone integration.

Background: Acetabular implant revision with large bone defects, can be challenging. One of the reconstruction options is a “jumbo cup” (outer diameter ≥62mm in women and ≥66mm in men). We hypothesized that cementless jumbo cups is a reliable technique to reconstruct hip joint with satisfying radiological and clinical outcomes.

Material and Methods: Fifty-two consecutive acetabular revisions arthroplasty where a cementless jumbo cup was used were assessed. Clinical outcomes were assessed by Harris Hip Score (HHS), WOMAC index and SF-12. Hip centre was assessed on anteroposterior (AP) view according to Pierchon’s criteria. The reconstructed hip center was considered as satisfying when its location was located from −10 to + 10 mm proximally (y axis) and/or medially (x axis) in comparison with ideal theoretical hip center location. Cup migration and modification of abduction angle were considered as significant when there were respectively ≥5mm and to ≥5° in comparison with the immediate postoperative AP view.

Results: Mean component size was 67.6 mm (min 62, max 81). According to Paprosky classification, there were 5 cases of type 1, 11 type 2A, 12 type 2B, 11 type 2C, 11 type 3A and 2 type 3B. Cancelous bone chips allograft were used in 34 cases and bulk bone allograft in 14. Immediate postoperative AP view showed a mean abduction cup angle of 41.3° (26–53), a satisfying hip centre positioning in 78% on x axis and in 70 % on y axis. In the remaining cases, we noted an improved implant positioning. For the patients with intact contra-lateral hip (n=29), we noted, in comparison with normal side, a mean lateralisation of the hip center of 3 mm (−10 – +16) and a mean ascension of 7 mm (−10 – +33) associated with an average limb length discrepancy of – 4 mm (−19 – +9). At the last follow up [radiological data: 79 months (24–236) and clinical data: 88 months (27–241)], 6 patients were died and 3 were lost of follow up. The mean HHS was 82% (15–100), WOMAC 86% (27–100), SF-12 46 (14–61) and 53 (15–63). Bone graft integration was completed in all but 3 cases. Significant cup migration (≥5mm) occurred in only one case. The complications were: dislocation in 5 cases (4 revisions with constrained liner), infection in 4 cases (2 treated conservatively and 2 revised in 2 times procedure) and Brooker’s type III or IV ectopic ossifications in 11 cases. No case required revision for aseptic loosening.

Discussion: Jumbo cups appear as a reliable procedure to manage bone loss in acetabular revision. The complication rate is comparable with other reconstruction procedures (massive allograft, reinforcement rings, high hip center…). Cementless fixation and satisfying hip center restoration promote respectively the bone integration and allow an optimal biomechanical joint functioning. These are the main conditions for high long term survival rate.

Introduction

To report the short to medium term results of acetabular reconstruction using reinforcement/reconstruction ring, morcellised femoral head allograft and cemented metal on metal cup.

Revision hip arthroplasty for severe acetabular deficiency is a technically challenging operation. Many different methods have been described for the management of acetabular deficiency. These include augmentation with bone cement, structural allografts, impaction grafting, support rings with graft and reconstruction with a high centre of rotation. The long term results of many of these methods were variable.

We reviewed the outcome of a stemmed acetabular cup (McMinn cup, Link UK) used with morsellised bone graft for revision hip arthroplasty with severe acetabular deficiency. The implant was used only in the most severe cases of acetabular deficiency where it was impossible to achieve stable fixation using simpler methods. This device was used in only 13 out of 265 revision arthroplasties performed by the senior author.

Between 1995 and 2002 13 acetabulae were reconstructed using a stemmed acetabular cup and non-structural morsellised bone graft. All were revision procedures with the number of previous operations on the same hip ranging between 1 and 4. 2 patients died from causes not related to surgery. 1 hip was revised for persistent discharge although no organisms were identified on repeated cultures. The mean follow-up of the remaining 10 hips was 72 months (range 46 – 108 months)

All patients were satisfied with the results and their function improved significantly post-operatively. 8 of the 10 people report no pain from the hip and 2 reported slight or occasional pain which did not interfere with their activities at last follow-up. The mean Harris Hip Score was 84.6 (range 70 to 99.8). Radiological assessment showed regeneration of acetabular bone stock. Some X-Rays showed proximal migration of the cup but with no evidence of loosening at last follow-up.

Acetabular reconstruction using the McMinn stemmed acetabular cup is a useful technique in revision hip arthroplasty with severe acetabular deficiency.

Aim: The purpose of this study was to assess the results with use of a newly developed, conical, titanium, ribbed shaft socket designed for cementless pressþt into the dorsocranial ilium for revision total hip arthroplasty Methods: 25 hips had an acetabular revision with a pedestal cup (Centerpulse). All of the patients had a type III defect according the AAOS classiþcation. There was an average follow-up of 4.3 years, with a range of 3 to 5 years. One patient died during the study period. All patients were evaluated radiographically, by CT-Scan and clinically. Results: At the time of follow-up, 22 (91.7%) of 24cups were stable. Both loosenings affected patients with an low-grade infect. In this group none aseptical loosening occurred. The average Harris Hip Score improved from 41 points (range: 16–78 points) preoperatively to 84 points (range 56–98 points) postoperatively. Complications included four dislocations without recurrency. The radiological follow-up examinations revealed osteointegration of 21 implants. Conclusion: The presented þndings show the short-term efþcancy of the prcedure with respect to implant þxation and clinical results in large acetabular defects, but longer follow-ups and a larger number of patients are needed before the durability of this reconstructive technique can be assessed. Our results should be considered encouraging.

There remains concern with the use of constrained liners (CL) implanted at the time of acetabular cup revision in revision total hip replacement (rTHA). The aim of this study was to determine the implant survival in rTHA when a CL was implanted at the same time as acetabular cup revision. We reviewed our institutional database to identify all consecutive rTHAs where a CL was implanted simultaneously at the time acetabular cup revision from 2001 to 2021. One-hundred and seventy-four revisions (173 patients) were included in the study. Mean follow-up of 8.7 years (range two – 21.7). The most common indications for rTHA were instability (35%), second-stage periprosthetic joint infection (26.4%), and aseptic loosening (17.2%). Kaplan Meier Analysis was used to determine survival with all-cause re-revision and revision for cup aseptic loosening (fixation failure) as the endpoints. A total of 32 (18.3%) patients underwent re-revision at a mean time of 2.9 years (range 0.1 – 14.1). The most common reasons for re-revision were instability (14), periprosthetic joint infection (seven), and loosening of the femoral component (four). Three (1.7%) required re-revision due to aseptic loosening of the acetabular component (fixation failure) at a mean of two years (0.1 – 5.1). Acetabular component survival free from re-revision due to aseptic loosening was 98.9% (95% CI 97.3 – 100) at five-years and 98.1% (95% CI 95.8 – 100) at 10-years. There were no acetabular component fixation failures in modern highly porous shells. CLs implanted at the time acetabular cup revision in rTHA have a 98.1% 10-year survival free from acetabular cup aseptic loosening (fixation failure). There were no cup fixation failures in modern highly porous shells. Thus, when necessary, implanting a CL during revision of an acetabular component with stable screw fixation is safe with an extremely low risk of cup fixation failure

The increasing number of total hip arthroplasty (THA) used in young patients will inevitably lead to more revision procedures at younger ages, especially since the outcome of primary THA in young patients is already inferior compared to older patients. However, these data are lacking in literature. The aim of this study was to determine the survival of both acetabular and femoral components placed during primary and revision hip arthroplasty in patients under 55 years using Dutch Arthroplasty Register (LROI) data. All primary THA registered in the LROI between 2007–2018 in patients under 55 years were selected (n=25,682). Subsequent cup- and stem revision procedures were included. Kaplan-Meier survival analyses were used to estimate the survival probability of primary and revised cup- and stem components. Mean follow-up of primary cups and stems was 5.8 years (SD 3.2) and 5.9 years (SD 3.2), respectively. In total, 659 cup revision procedures and 532 stem revision procedures were registered. Most common reason for cup revision was acetabular loosening (n=163), most common reason for stem revision was femoral loosening (n=202). Primary cup survival for any reason at 10 years follow-up was 96.1% (95%CI: 95.7–96.4). For primary stems, 10 year survival for any reason was 97.1% (95%CI: 96.7–97.3). Mean follow-up of all revision procedures was 4.1 years (SD 2.9). Out of 659 cup revisions, 113 cup re-revisions were registered. Survival of revised cups, with end-point cup re-revision for any reason was 82.2% (95%CI: 78.8–85.1) at 5 years follow-up. Out of 532 stem revisions, 89 stem re-revisions were registered. For revised stems, survival at 5 year follow-up, with endpoint stem re-revision for any reason was 82.0% (95%CI: 78.2–85.2). The outcome of revised acetabular and femoral components is worrisome, with a survival of 82% at 5 years follow-up. This information is valuable to provide realistic expectations for these young patients at time of primary THA

Dual mobility (DM) components are increasingly used to prevent and treat dislocation after total hip arthroplasty (THA). Intraprosthetic dissociation (IPD) is a known rare complication of these implants and has reportedly decreased with modern implants. The purpose of this paper is to report the diagnosis and treatment of modern DM IPD. 1453 DM components were implanted between 2010 and 2021. 695 in primary and 758 in revision THA. 49 hips sustained a dislocation of the large head and 5 sustained an IPD at presentation. 6 additional IPD occurred at the time of reduction of large head. The average age was 64, 54% were female and the mean follow-up was three years. Of the 11 IPD, 8 had a history of instability, 5 had abductor insufficiency, 4 had prior lumbar fusion, and 3 were conversions from fracture. The overall IPD incidence was 0.76%. Ten of the 11 DM IPD were missed at initial presentation or at the time of reduction, and all were discharged with presumed reduction. The mean time from IPD to surgical treatment was 3 weeks. One patient died with an IPD at 5 months. A DM head was reimplanted in six, two underwent revision of the acetabular component with exchange of DM head, and four were revised to a constrained liner. The re-revision rate was 55% at a mean 1.8 years. None of the patients who underwent cup revision required subsequent re-revision while half of the constrained liners and exchange of DM heads required re-revision. The overall rate of DM dislocation or IPD is low. It is critical to identify an IPD on radiographs as it was almost universally missed at presentation or when it occurred iatrogenically. For patients presenting with IPD, the surgeon should consider acetabular revision and conversion to a constrained liner or a larger DM, with special attention to removing impinging structures that could increase the risk of re-dislocation

In total hip arthroplasty (THA), cementless cup without screw holes has the putative benefits of maximizing host bone contact and reducing osteolysis by eliminating channels to backside wear particles. However, supplemental trans-acetabular screws cannot be used. 74 hips in 60 patients receiving same model of cementless cup without screw holes (Depuy Duraloc 100 HA cup) from 6/1999 to 3/2003 were prospectively followed up. All patients were allowed to have immediate full weight bearing. Age at THA was 53 ± 13 (range 24–74) years. Osteonecrosis was the leading hip disease (45% of hips). Survivorship was assessed using revision of the cup as the end point. Radiological parameters, including lateral opening angle, vertical and horizontal migration distances of the cups were measured. Paired t-test was used to compare between the measurements in early postoperative period and at final follow up. 51 hips were assessed at minimum 20 years follow-up. The mean follow-up was 22.6 (range 21 – 25) years. All the cups were well fixed. There were two cup revisions. Conventional polyethylene (PE) was used in both hips; osteolysis occurred 17 and 18 years later. Both cups were well fixed but were revised, one due to cup mal-positioning, one due to need in upsizing the articulation. 14 other hips were revised but these cups were well fixed and not revised; 9 loosened stems (most were cemented Elite plus stems), 5 PE wear and osteolysis (all were conventional PE). At 20 years, the survivorship of cups was 96.1%. Changes in lateral opening angle, vertical and horizontal migration distances were 0.44±1.59°, 0.01±1.52mm and -0.32±1.47mm respectively, without statistical significance. This study provided evidence of excellent long-term survivorship of cementless cup without screw holes. Immediate postoperative weight-bearing also did not lead to cup migration in the long-term

Dislocation post THA confers a higher risk of re-dislocation (Kotwal et al, 2009). The dual mobility (DM) cup design (1974) was aimed at improving the stability by increasing the femoral head to neck ratio (Cuthbert et al., 2019) combining the ideas of low friction arthroplasty with increased jump distance associated with a big head arthroplasty. Understand the dislocation rates, rates of aseptic loosening, infection rate and revision rates between the 2 types of constructs to provide current and up-to date evidence. Medline, pubmed, embase and Cochrane databases were used based on PRISMA guidelines. RevMan software was used for the meta-analysis. Studies (English literature) which used DM construct with atleast 6 months follow-up used as intervention and non DM construct as control were included. 2 independent reviewers conducted the review with a third reviewer in case of difference in opinion regarding eligibility. Primary outcome was dislocation rate and secondary outcome was rate of revision. 564 articles identified out of which 44 articles were screened for full texts and eventually 4 systematic review articles found eligible for the study. Thus, study became a review of systematic reviews. From the 4 systematic reviews, another 35 studies were identified for data extraction and 13 papers were used for meta-analysis. Systematic reviews evaluated, projected an average follow up of 6-8 years with significantly lower dislocation rates for DM cups. The total number of patients undergoing DM cup primary THA were 30,559 with an average age 71 years while the control group consisted of 218,834 patients with an average age of 69 years. DM group had lower rate of dislocation (p < 0.00001), total lower rate of cup revision (p < 0.00001, higher incidence of fracture (p>0.05). DM THA is a viable alternative for conventional THA. The long-term results of DM cups in primary THA need to be further evaluated using high quality prospective studies and RCTs

Abstract. Introduction. Dislocation post THA confers a higher risk of re-dislocation (Kotwal et al, 2009). The dual mobility (DM) cup design (1974) was aimed at improving the stability by increasing the femoral head to neck ratio (Cuthbert et al., 2019) combining the ideas of low friction arthroplasty with increased jump distance associated with a big head arthroplasty. Aims. Understand the dislocation rates, rates of aseptic loosening, infection rate and revision rates between the 2 types of constructs to provide current and up-to date evidence. Methods. Medline, pubmed, embase and Cochrane databases were used based on PRISMA guidelines. RevMan software was used for the meta-analysis. Studies (English literature) which used DM construct with atleast 6 months follow-up used as intervention and non DM construct as control were included. 2 independent reviewers conducted the review with a third reviewer in case of difference in opinion regarding eligibility. Primary outcome was dislocation rate and secondary outcome was rate of revision. Results. 564 articles identified out of which 44 articles were screened for full texts and eventually 4 systematic review articles found eligible for the study. Thus, study became a review of systematic reviews. From the 4 systematic reviews, another 35 studies were identified for data extraction and 13 papers were used for meta-analysis. Systematic reviews evaluated, projected an average follow up of 6–8 years with significantly lower dislocation rates for DM cups. The total number of patients undergoing DM cup primary THA were 30,559 with an average age 71 years while the control group consisted of 218,834 patients with an average age of 69 years. DM group had lower rate of dislocation (p < 0.00001), total lower rate of cup revision (p < 0.00001, higher incidence of fracture (p>0.05). Conclusion. DM THA is a viable alternative for conventional THA. The long-term results of DM cups in primary THA need to be further evaluated using high quality prospective studies and RCTs. Declaration of Interest. (b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project

Pelvic tilt can vary over time due to aging and the possible appearance of sagittal spine disorders. Cup position in total hip arthroplasty (THA) can be influenced due to these changes. We assessed the evolution of pelvic tilt and cup position after THA and the possible appearance of complications for a minimum follow-up of ten years. 343 patients received a THA between 2006 and 2009. All were diagnosed with primary osteoarthritis and their mean age was 63.3 years (range, 56 to 80). 168 were women and 175 men. 250 had no significant lumbar pathology, 76 had significant lumbar pathology and 16 had lumbar fusion. Radiological analysis included sacro-femoral-pubic (SFP), acetabular abduction (AA) and anteversion cup (AV) angles. Measurements were done pre-operatively and at 6 weeks, and at five and ten years post-operatively. Three measurements were recorded and the mean obtained at all intervals. All radiographs were evaluated by the same author, who was not involved in the surgery. There were nine dislocations: six were solved with closed reduction, and three required cup revision. All the mean angles changed over time; the SFP angle from 59.2º to 60º (p=0.249), the AA angle from 44.5º to 46.8º (p=0.218), and the AV angle from 14.7º to 16.2º (p=0.002). The SFP angle was lower in older patients at all intervals (p<0.001). The SFP angle changed from 63.8 to 60.4º in women and from 59.4º to 59.3º in men, from 58.6º to 59.6º (p=0.012). The SFP angle changed from 62.7º to 60.9º in patients without lumbar pathology, from 58.6º to 57.4º in patients with lumbar pathology, and from 57.0º to 56.4º in patients with a lumbar fusion (p=0.919). The SFP cup angle was higher in patients without lumbar pathology than in the other groups (p<0.001), however, it changed more than in patients with lumbar pathology or fusion at ten years after THA (p=0.04). Posterior pelvic tilt changed with aging, influencing the cup position in patients after a THA. Changes due to lumbar pathology could influence the appearance of complications long-term

In 2022, approximately 60% of inserted cups and stems in Sweden utilized cemented fixation. Two predominant brands, Refobacin Bone Cement R and Palacos R+G, both incorporating gentamicin, were employed in over 90% of primary cemented Total Hip Arthroplasties (THAs) between 2012 and 2022. This study investigates whether the choice between these cement types affects the risk of revision. The five most frequently used cemented cups and the three most common stems were studied. Inclusion criteria encompassed hips with non-tumour diagnoses, operated through a direct lateral or posterior incision, featuring a 28–36 mm metal or ceramic head. Outcomes were assessed for cup revisions (n=55,457 Refobacin, 37,210 Palacos), stem revisions (n=51,732 Refobacin, 30,018 Palacos), and all-cemented THAs with either brand (n=45,265 Refobacin, 26,347 Palacos). Kaplan-Meier life tables and hazard ratios (HR) utilizing Cox regression were computed, adjusting for age, sex, diagnosis, implant type, femoral head size, and material. Over a 10-year period, the cumulative percent revision with Refobacin was consistently higher than Palacos in all three analyses (cups: Refobacin 2.4 (2.3–2.5), Palacos 2.1 (2.0–2.2); stems: Refobacin 2.6 (2.5–2.7), Palacos 2.1 (2,0–2,2); all-cemented: Refobacin 3.2 (2.9–3.5), Palacos 2.9 (2.6–3.2)). Both unadjusted and adjusted HR were 13–25% lower with Palacos. In the analysis of all-cemented THAs, the adjusted HR for Palacos was 0.85 (0.76–0.95). Separating revisions into infectious and non-infectious reasons revealed a lower risk of infectious revisions with Palacos in all three analyses (all-cemented: adjusted HR infection 0.66 (0.56–0.78); non-infectious 1.10 (0.94–1.28)). Hips cemented with Refobacin may face an increased risk of infection, potentially due to a smaller release of antibiotics into surrounding tissues. Unaccounted factors like different mixing systems or unknown biases could also influence outcomes, emphasizing the need for further investigation

Background. Modular dual mobility (MDM) acetabular components are often used to prevent dislocation in revision total hip arthroplasty (THA). As there is insufficient data on these components, the outcomes were evaluated in a cohort with a mean follow-up time of greater than five years. Methods. Using the database of a single academic center, 126 revision THAs (117 patients) with one MDM were retrospectively reviewed. There were 94 hips in 88 patients with a mean follow-up time of 5.5 years. Survivorship analysis was performed with the endpoints of dislocation, reoperation for dislocation, cup revision for aseptic loosening, and cup revision for any reason. The secondary endpoints were perioperative complications and radiographic review. Results. The overall rate of dislocation was 11%, with a 6-year survival of 91%. Reoperation for dislocation was performed in 7 patients (7%), with a 6-year survival of 94%. The dislocations were early (mean 33 days) in 6 patients, and late (mean 4.3 years) in 4 patients. There were three intraprosthetic dissociations. An outer head diameter of 48 mm or greater was associated with a lower risk of dislocation (p=0.013). Four hips (4%) were revised for aseptic cup loosening, and 14 (15%) cups were revised for infection. Two hips had visible metallic changes of the backside of the cobalt chromium liner. Conclusion. Using this MDM component in revision THA, at mean follow-up time of 5.5 years, there was a higher rate of dislocation (11%) than previously reported. Outer bearing size was related to the risk of dislocation. There was a low rate of aseptic cup loosening. Longer follow-up of this MDM component and evaluation of other designs is warranted

Highly porous tantalum cups have been used in complex acetabular revisions for nearly 20 years but reports of long term results are limited. This study was designed to report ten year results of revision using a single porous tantalum cup design with special attention to re-operation for any reason, all-cause revision, and revision for aseptic loosening. Retrospective review of all revision THA cases performed from 1999–2006 using a highly porous tantalum acetabular component design with multiple screw holes and a cemented polyethylene liner (Zimmer Biomet, Warsaw, IN). Our institutional medical record and total joint registry were used to assess follow-up and xrays were reviewed. The Paprosky classification system was used to rate acetabular bone loss. Radiographic loosening was defined as new/progressive radiolucencies in all 3 acetabular zones, or cup migration (>2mm). Kaplan-Meier survivorship was used to assess survivorship free of cup revision/removal for any reason, and free of revision for aseptic loosening. Between 1999 and 2006 this tantalum cup was used in 916 revisions. Mean age: 66 (±6), BMI: 29 (±6), and male: 42%. Indications for revision: aseptic loosening 346 (38%), osteolysis 240 (26%), and infected arthroplasty 168 (18%). Large (3A or 3B) bone defects were present in 260, and pelvic discontinuity in 61. Reoperation for any reason: 133 (15%), but 84 of 133 cases did not require cup revision for instability (38) or femoral failure (24). Tantalum cup removal/revision was required in 49 (5.3%) for deep infection (39) and recurrent dislocation (6), and aseptic loosening (4). 10 year survivorship free of cup revision for any reason: 95% and for aseptic loosening: 99%. Radiographic review (mean 10 years): suspicious for aseptic loosening in another 4 cups. A highly porous tantalum acetabular component with multiple screws and a cemented polyethylene insert provided durable long term fixation for an array of acetabular revision problems. Long term aseptic loosening was very rare (<1%) and cup removal was mainly related to deep infection, and rarely dislocation