Rapidly progressive osteoarthritis of the hip (RPOH) is an unusual subset of osteoarthritis. It is characterized by rapid joint space loss, chondroly­sis, and sometimes marked femoral head and acetabular destruction as a late finding. The exact pathogenetic mechanism is unknown. Potential causes of RPOH include subchondral insufficiency fracture resulting from osteoporosis, increasing posterior pelvic tilt as a mechanical factor, and high serum levels of matrix metalloproteinase (MMP)-3 as biological factors. This study was aimed to identify some markers that associate with the destructive process of RPOH by analyzing the proposed pathological factors of the disease, MMP-3, pelvic tilt, and osteoporosis. Of female patients who visited our hospital with hip pain from 2012 through 2018, this study enrolled female patients with sufficient clinical records including the onset of hip pain, age and body mass index (BMI) at the onset, a series of radiographs during the period of >12 months from the onset of hip pain, and hematological data of MMP-3 and C-reactive protein (CRP). We found the hip joints of 31 patients meet the diagnostic criteria of RPOH, chondrolysis >two mm in one year, or 50% joint space narrowing in one year. Those patients were classified into two groups, 17 and 14 patients with and without subsequent femoral head destruction in one year shown by computed tomography, respectively. Serum MMP-3 and CRP were measured with blood samples within one year after the hip pain onset. The cortical thickness index (CTI) as an indicator of osteoporosis and pelvic tilt parameters were evaluated on the initial anteroposterior radiograph of the hip. These factors were statistically compared between the two groups. This study excluded male patients because RPOH occurs mainly in elderly females and the reference intervals of MMP-3 are different between males and females. There was no difference in age at onset or bone mass index between the RPOH patients with and without subsequent femoral head destruction. Serum levels of MMP-3 were significantly higher in the RPOH patients with the destruction (152.1 ± 108.9 ng/ml) than those without the destruction (66.8 ± 27.9 ng/ml) (P = 0.005 by Mann-Whitney test). We also found increased CRP in the patients with femoral head destruction (0.725 ± 1.44 mg/dl) compared with those without the destruction (0.178 ± 0.187 mg/dl) (P = 0.032 by Mann-Whitney test). No difference in the duration between the hip pain onset and the blood examination was found between the two groups. There was no significant difference in CTI or pelvic tilt between the two groups. The pathological condition that may increase serum MMP-3 and CRP could be involved in femoral head destruction after chondrolysis of the hip in patients with RPOH

Metal-on-metal resurfacing offers an alternative strategy to hip replacement in the young active patient with severe osteoarthritis of the hip. The aim of this study was to compare functional outcomes, failure rates and impending revisions in hybrid total hip arthroplasties (THAs) and Birmingham Hip Resurfacings (BHRs) in young active patients. We compared the 5-7 year clinical and radiological results of the metal-on-metal BHR with hybrid THA in two groups of 54 hips each, matched for sex, age, body mass index and activity. Function was excellent in both groups as measured by the Oxford hip score (median 13 in the BHRs and 14 in the THAs, p=0.14), but the resurfacings had higher UCLA activity scores (median 9 v 7, p=0.001) and better EuroQol quality of life scores (0.90 v 0.78, p=0.003). The THAs had a revision or intention to revise rate of 8% and the BHRs 6%. Both groups demonstrated impending failure on surrogate end-points. 12% of THAs had polyethylene wear and osteolysis under observation, and there was femoral component migration in 8% of resurfacings. Polyethylene wear was present in 48% of hybrid hips without osteolysis. Of the femoral components in the resurfacing group which had not migrated, 66% had radiological changes of unknown significance (classification proposed). In conclusion, the early to mid-term results of resurfacing with the BHR appear at least as good as those of hybrid THA. Only by longer term follow-up will we establish whether the change of practice recorded here represents a true advance

Thrust plate prosthesis (TPP) is a bone conserving prosthesis in use for over thirty years. TPP is a stemless and uncemented femoral prosthesis fixed at the lateral femoral cortex with a bolt, plate and screw. This has a metal-on-metal articulation with a 28mm Metasul head and Allofit press fit acetabular cup. Our study aimed to assess the survival of this prosthesis. At Oswestry 234 TTP's were implanted between 1995 and 2005. All patients completed a self-assessed questionnaire of Harris Hip Score pre-operatively and post-operatively at 2 months, 1 year, and then yearly. Only those who had a follow up was within the last two years were included in the analysis. 76 patients who had failed to satisfy the criteria were excluded. Of the 158 hips in the study 75 hips were in male patients and 83 were in female patients. The median age of patients was 52 years (range 15 to 82). 75 hips were on the right side and 83 on the left. All patients were operated by the senior author or a senior trainee under his supervision (seven hips). Revision of the implant or decision to revise was taken as the end point of our study. The median time to follow up was 7 years (range 1 to 15). The median pre-operative hip score was 43 (range 3 to 77) which rose to 83 points (range 11 to 100) at the latest follow up. Median hip score in females improved from 39 to 82 points and in males from 52 to 85 points. Twelve patients (5.1%) underwent revision surgery either for infection or aseptic loosening. The Thrust Plate Prosthesis had a good outcome with an increase in hip score of 40 points and 94.9 % survival at a median of 7 years.

The prevalence of gluteal tendinopathy (GT) associated with osteoarthritis of the hip is difficult to determine as it is frequently undiagnosed or misdiagnosed as trochanteric bursitis. Its relationship to total hip arthroplasty (THA) outcomes is currently unknown. The aim of this study was to determine the incidence of GT at the time of hip arthroplasty and examine the relationship between GT and patient reported outcomes (PROMS) before and after THA. Patients undergoing THA for primary osteoarthritis between August 2017 and August 2020 were recruited. Tendinopathy was assessed and graded at time of surgery. PROMS included the Oxford Hip Score (OHS), HOOS JR, EQ-5D, and were collected preoperatively and at one year after THA. Satisfaction with surgery was also assessed at 1 year. 797 patients met eligibility criteria and were graded as Grade 1: normal tendons (n =496, 62%), Grade 2: gluteal tendinopathy but no tear (n=222, 28%), Grade 3: partial/full thickness tears or bare trochanter (n=79, 10%). Patients with abnormal gluteal tendons were older (p=0.001), had a higher mean BMI (p=0.01), and were predominately female (p=0.001). Patients with higher grade tendinopathy had statistically significant inferior PROMS at one year, OHS score (44.1 v 42.9 v 41.3, p 0.001) HOOS JR (89.3 V 86.3 V 85.6 p 0.005). Increasing gluteal tendon grade was associated with a greater incidence of problems with mobility (p=0.001), usual activities (p=0.001) and pain (p=0.021) on EQ5D. There was a 3 times relative risk of overall dissatisfaction with THA in the presence of gluteal tears. This study demonstrated that gluteal tendinopathy was commonly observed and associated with inferior 1-year PROMS in patients undergoing THA for OA. Increasing degree of tendinopathy was a negative prognostic factor for worse functional outcomes and patient satisfaction

Introduction. Total hip arthroplasty (THA) is a highly successful procedure achieving excellent clinical outcomes beyond 10 years post-surgery. With exception of periprosthetic infection, dislocation is the most common cause of failure in THA. A novel reverse total hip (RTH) replacement has been developed to address dislocation through reversal of the typical THA articulation in which a femoral cup and acetabular ball interlock at the extremes of motion to enhance mechanical stability in all planes. The purpose of this study was to assess the safety and efficacy of this novel RTH in a series of 22 patients and to monitor implant fixation using radiostereometric analysis (RSA). Methods. Twenty two patients with end-stage osteoarthritis of the hip were enrolled between 2017 and 2019 at a single center. All surgeries were performed by a group of four high-volume fellowship-trained arthroplasty surgeons. All patients received at least 1 acetabular cup screw and RSA markers inserted into the acetabulum and proximal femur. Follow-up time points were 6 weeks, 6, 12 and 24 months and included patient reported outcome measures (HOOS, Oxford-12, Harris Hip Score, SF-36 and Satisfaction) as well as RSA assessment. Results. The patient cohort consisted of 11 females and 11 males with mean age of 70.8 years and body mass index 31.3 kg/m. 2. At the time of writing, 21, 15 and 3 patients had completed their 6-month, 1- and 2-year clinical follow-ups, respectively. There was a significant improvement in function and pain with the RTH between pre-operative and six and twelve month follow up as collected by the HOOS, Oxfrod-12, HHS, WOMAC, EQ-5D and SF-36 PCS with p<0.001 for all. The sole exception was the SF-36 MCS which had a non-statistical improvement. Eighteen of 20 patients were satisfied or very satisfied with the outcome of surgery. Average vertical migration of the acetabular cup at 6 and 12 months was 0.082 mm and 0.110 mm, respectively. Average distal migration of the femoral stem at 6 and 12 months was 0.015 mm and 0.035 mm, respectively. Conclusions. Early results indicate acceptable safety and efficacy of this novel RTH for treating osteoarthritis of the hip. The femoral and acetabular components both appear well fixed at near-term follow-up, as assessed with RSA. Further follow-up will determine if these results are maintained at 24 months post-surgery. Additional patient enrollment will assess acetabular cup fixation without the use of screws. For any figures or tables, please contact authors directly

Introduction. Recently, femoroacetabular impingement has been postulated as an important cause for the development of primary osteoarthritis of the hip. Various studies have shown that primary osteoarthritis of the hip is rare amongst Asians including Indians. We conducted an anthropometric study to evaluate prevalence of abnormal head-neck offset in Indian population and to correlate it with the low prevalence of primary osteoarthritis in Indian population. Material and Methods. We retrospectively evaluated three dimensional CT scans of hips conducted as a part of another project done over a period of two years at our institute. An axial image was created parallel to the central axis of the femoral neck and passing through the centre of the femoral head using coronal scout view. This image was then used to calculate Alpha and Beta angles and head-neck offset ratio. Results. The average alpha angle (45.6°) reported in our study is similar to that reported in a Western population. Similarly, the prevalence of abnormal offset ratio found in our study (11.8%) is similar to the estimated prevalence of 10-15% of FAI in a Western population. Conclusion. We conclude that differences in the prevalence of hip osteoarthritis in Indian and Western populations cannot be explained on the basis of variation in prevalence of FAI and other factors may be responsible

When patients present at an early age with osteoarthritis of the hip, there is usually an underlying predisposing cause. In men, a common cause is femoroacetabular impingement (FAI). This is evident as anterior neck osteophytes, with retroversion and varus alignment of the femoral head, most likely the result of subclinical slipped capital femoral epiphysis. The resulting femoroacetabular cam impingement causes degenerative osteoarthritis (OA) of the hip, at an earlier age than primary OA. Patients present in their 40s and 50s with advanced arthritis, and are faced with the prospect of a total hip arthroplasty. Women may experience this as well, but may present with early hip arthritis as a result of subclinical dysplasia or pincer FAI more often than their male counterparts. Hip resurfacing has several advantages over traditional total hip replacement for younger patients, especially men. These include bone preservation, less dislocation, thigh pain or leg length inequality, easier return to athletics, and easy revision on the femoral side. It is indicated in young, active patients. The resurfacing procedure realigns the femoral head on the native and resurfaces the arthritic joint. Anterior neck osteoplasty is performed. Head retroversion is corrected. This restores deep flexion, and eliminates forced external rotation in flexion. Hip resurfacing can be done through either an anterior or posterior approach, although the anterior approach gives easier access to the anterior femoral neck, and preserves the blood supply to the head. This may help prevent femoral neck fractures and late head collapse

Puropose. Three-dimensional (3D) templating based on computed tomography (CT) in total hip arthroplasty improves the accuracy of implant size. However, even when using 3D-CT preoperative planning, getting the concordance rate between planned and actual sizes to reach 100% is not easy. To increase the concordance rate, it is important to analyze the causes of mismatch; however, no such studies have been reported. This study had the following two purposes: to clarify the concordance rate in implant size between 3D-CT preoperative planning and actual size; and to analyze risk factors for mismatch. Materials and Methods. A single surgeon performed 149 THAs using Trident Cup and Centpillar Stem (Stryker) with CT-based navigation between September 2008 and August 2011. Minimal follow-up was 2 years. Patients with incomplete postoperative CT were excluded from this study. Based on these criteria, the study examined 124 hips in 111 patients (mean age, 60 years, mean BMI 23.2 kg/m2). The preoperative diagnosis was primary osteoarthritis in 8 hips, secondary osteoarthritis in 102 hips, osteonecrosis in 9 hips, rapidly destructive coxopathy in 4 hips and rheumatoid arthritis in 1 hip. We compared cup and stem sizes between preoperative planning and intraoperatively used components. Radiological evaluations were cortical index and canal flare index on preoperative X-rays. We evaluated preoperative planning and postoperative components for cup orientation, cup position, and stem alignment (anteversion, flexion and varus angle) on the CT-navigation system. Fixation of the stem was evaluated by X-ray radiography at 2 years postoperatively according to Engh's criteria. Statistical analysis was performed with the Mann-Whitney U test, and values of P<0.05 were considered statistically significant. Results and Discussion. The concordance rate in cup size between preoperative planning and used implants was 94.4% (117/124 hips) (CS group). A one-size larger cup was used in 4 hips (CO group), and a one-size smaller cup was implanted in 3 hips (CU group). No significant difference was seen between the CS group and the CO or CU groups in change of cup orientation and cup position from planning (P>0.05) (Table 1). The concordance rate of stem size between preoperative planning and used stem was 85.5% (106/124 hips) (SS group). A one-size larger stem than the plan was used in two hips (SO group), and a one-size smaller stem than the plan was implanted in 16 hips (SU group). Significant differences were seen between the SU and SS groups in flexion angle, varus angle, and canal flare index (P<0.05, Table 2). Extension or varus of the stem, or an increase in canal flare index, were risk factors for the used stem size being smaller than planned. On the latest follow-up X-rays, all 124 hips showed bone ingrown stability of the implants. Conclusion. The accuracy of implant size selection was 94.4% and 85.5% for the cup and stem, respectively. No factors associated with cup size mismatch were identified. Flexion angle, varus angle, and canal flare index were associated with stem size mismatch between preoperative planning and the actual used size

Introduction. Venous thromboembolism (VTE) is one of the common complications after total hip replacements (THRs). To reduce the risk of VTE, early rising, active movement of the foot, the use of a foot pump or graduated compression stockings and prophylactic administration of anticoagulant drugs are important. Further, intraoperative factors should be taken intoãζζconsideration. Objective. The objective of this study is to assess the influence of surgical approaches, which are a modified Watson-Jones approach and a posterolateral approach, on the frequency of VTE after primary THRs. Materials and Methods. One hundred seventy-five patients underwent 199 primary total hip replacements by a single surgeon using modified Watson-Jones approach between gluteus medius muscle and tensor fascia lata (AL Group). The average age at the operation was 63.4 ±12.5 years old. The average BMI was 23.6±3.6. The original diagnosis consisted of 151 cases of osteoarthritis of the hip, 34 cases of avascular necrosis of the femoral head, 7 cases of rheumatoid arthritis and two cases of rapidly destructive coxopathies. Control group was 159 primary total hip replacements by a single surgeon using posterolateral approach (PL Group). The average age at the operation was 63.0±11.3 years old. The average BMI was 22.8±3.6. The original diagnosis consisted of 130 cases of osteoarthritis of the hip, 17 cases of avascular necrosis of the femoral head, 7 cases of rheumatoid arthritis and four cases of rapidly destructive coxopathies. VTE was detected by contrast computed tomography or ultrasound, and soluble fibrin monomer complex (SF) was measured on the first day after surgery. Results. The frequency of VTE was thirty three of 199 cases (16.6%) in the AL Group. On the other hand, the frequency of VTE was sixty three of 159 cases (39.6%) in the PL Group. The average value of SF on the first day after surgery was 16.1±28.1 in the AL Group, 15.4±20.6 in the PL Group, respectively. In each group, the SF values showed a significant difference between VTE detected cases (41.7±55.3 in the AL Group; 24.2±26.4 in the PL Group) and VTE non-detected ones (10.9±13.6 in the AL Group; 9.4±12.4 in the PL Group) by Mann-Whitney U test. Conclusion. Modified Watson-Jones approach is useful to reduce the risk of VTE, compared with posterolateral approach. The foot position to obstruct blood flow during THRs using poterolateral approach may be the risk factor for VTE

The progressive painful and disabling predicament of patients with severe osteoarthritis awaiting a total hip or knee arthroplasty (THA/TKA) results in a decline in muscle mass, strength and function also known as Sarcopenia. We conducted a cross-sectional, prospective study of patients on the waiting-list for a THA/TKA in the South Australian public healthcare system and compared the findings to healthy participants and patients newly referred from their general practitioners. Participants with a history of joint replacements, pacemakers and cancers were excluded from this study. Outcomes of this study included (i) sarcopenia screening (SARC-F ≥4); (ii) sarcopenia, defined as low muscle strength (hand grip strength M<27kg; F<16kg), low muscle quality (skeletal muscle index M<27%, F<22.1%) and low physical performance (short physical performance battery ≤8). Additional outcomes include descriptions of the recruitment feasibility, randomisation and suitability of the assessment tools. 29 healthy controls were recruited; following screening, 83% (24/29) met the inclusion criteria and 75% (18/24) were assessed. 42 newly referred patients were recruited; following screening, 67% (30/45) met the inclusion criteria and 63% (19/30) were assessed. 68 waiting list patients were recruited; following recruitment, 24% (16/68) met the inclusion criteria and 75% (12/16) were assessed. Preliminary data shows increasing waiting time is associated with higher SARC-F scores, lower hand grip strength and lower muscle quality. As a pilot study, preliminary data demonstrate that: (1) study subjects’ willingness to participate will enable a larger study to be conducted to establish the prevalence of sarcopenia and the diagnostic cut-off points for this patient group. (2) SARC-F is a suitable tool to screen for sarcopenia. (3) There is a positive correlation between waiting time for a THA/TKA and sarcopenia

Introduction. Hip Arthrodesis had been considered as a useful surgical option in young adult patient with high activity demands suffering from osteoarthritis of the hip. Although the procedure surely eliminates pain of the hip joint, it can also cause disorders of the adjacent joints in addition to the complete loss of motion, might consequently deteriorate the activity of daily living. The purpose of this retrospective study was to investigate the efficacy and drawback of hip arthrodesis, focusing on the effect of this procedure on the adjacent joints. Materials and Methods. From 1976 to 1989, 29 hip arthrodesis were performed and 22 hips were followed up (1 died, 6 lost). Disorders led to arthrodesis were septic arthritis (1 hip), post-traumatic (1), osteonecrosis (1), primary osteoarthritis (3), and secondary osteoarthritis due to DDH (16). The average age at surgery was 38 years (range, 19–53 years, 6 men and 16 women). Hip arthrodesis was indicated for young active adults with end stage osteoarthritis, who had normal or mild osteoarthritis in contralateral hip and needed physical labor. The hip was positioned in 30 degrees of flexion, 0 to 5 degree of external rotation, and 0 to 5 degree of abduction. Clinical and radiographic assessment was done for these patients. The clinical follow-up consisted of questionnaire which assessed ability of typical Japanese daily living movement and patient's satisfaction. The condition of the adjacent joints was evaluated clinically and radiographically. Results. After an average follow-up of 22 years (range15-28), no patients complained of pain in the fused hip joint. On the other hand, pain in the adjacent joints was seen frequently. Seventeen (77%) of 22 patients had low back pain and one of these patients, who had severe low back pain, required conversion of arthrodesis to THA. Ten patients (45%) had contralateral hip pain and 8 (36%) of whom subsequently needed THA. All patients who required THA had early stage osteoarthritis when they underwent arthrodesis. Ten patients (45%) had knee pain (5 in the ipsilateral and 5 in the contralateral knee). Radiographic progression of osteoarthritis in adjacent joints was also seen frequently, namely, 9 in lumbar spine, 11 in contralateral hip, 6 in ipsilateral and 6 in contralateral knee. Although pain in the involved hip disappeared, activity of daily living was severely deteriorated (impossible to clip nail: 88%, ride a bicycle: 94%, use a Japanese toilet: 75%, sit in Japanese style: 50%). As a result, only 4 patients (18%) were satisfied with the hip arthrodesis. Discussion. The satisfaction of hip arthrodesis was unexpectedly poor despite of pain relief of involved hip joint. One of essential reasons was activity of daily living in Japanese style, which requires relatively deep flexion in hip and knee. Compensation of limited movement in hip might cause pain and progression of osteoarthritic change in adjacent joints. Another vital reason was that we indicated this procedure for bilateral DDH case whose contralateral hip had early stage osteoarthritis, ended up with THA in most cases

Femoroacetabular impingement (FAI) is a condition of the hip where there is a mismatch of the femoral head and hip acetabulum. This mismatch creates abnormal contact between the bones and causes hip pain which can lead to damage, and eventually osteoarthritis of the hip. The diagnosis and treatment of FAI has become one of the most popular clinical scenarios in orthopaedic surgery, with hip arthroscopy procedures increasing exponentially over the past five years. Surgical intervention usually involves correcting the existing deformities by reshaping the ball and socket (“osteoplasty” or “rim trimming”) so that they fit together more easily while repairing any other existing soft tissue damage in the hip joint (e.g. labral repair). Although correction of the misshaped bony anatomy and associated intra-articular soft tissue damage of the hip is thought to appease impingement and improve pain and function, the current evidence is based on small, observational, and low quality studies. A lack of definitive evidence regarding the efficacy of osteochondroplasty in treating FAI fueled the design and execution of the FIRST randomized controlled trial (RCT). FIRST evaluated the impact of surgical correction of the hip impingement morphology with arthroscopic osteochondroplasty versus arthroscopic lavage on pain, function, and quality of life in adults aged 18–50 years diagnosed with non-arthritic FAI at one year. FIRST was a large definitive RCT (NCT01623843) enrolling patients with FAI requiring surgical intervention across 11 international clinical sites. Participants were randomized to either arthroscopic osteochondroplasty (shaving of bone) or lavage (washing the joint of painful inflammation debris). The primary outcome was patient-reported pain within one year of the initial surgery measured using the Visual Analogue Scale (VAS). Secondary outcomes included function, health utility, and health-related quality of life using several general and hip-centric health questionnaires. An independent, blinded adjudication committee evaluated the quality of surgery, re-operations, and other patient complications. Patients and data analysts were blinded to the treatment groups. Two-hundred and twenty participants were enrolled into the FIRST trial over a six-year period (pilot phase: N=50, from 2012–2013 and definitive phase: N=170, from 2015–2018) at 11 clinical sites in Canada, Finland, and Denmark. The FIRST results will be released at the ISAKOS annual meeting as follows. The absolute difference in rate of pain reduction between groups was XX (95% CI: YY-YY, p=X). The mean differences of the Short-Form 12 (SF-12, MCS and PCS), Hip Outcome Score (HOS), International Hip Outcome Tool (iHOT-12), and EuroQol 5-Dimensions (EQ-5D) between groups are XX (95% CI: YY-YY, p=X)…, respectively. Reoperations occurred in XX of 220 (X%) patients over the one-year follow up period (OR:XX, 95% CI: YY-YY, p=X) and the patients treated with arthroscopic osteochondroplasty conferred the following risk of reoperation within one-year compared to arthroscopic lavage (RR:XX, 95% CI: YY-YY, p=X). This RCT represents major international efforts to definitively identify the optimal treatment strategy for FAI. The results of this trial will change practice, being used to prevent chronic hip pain and loss of function caused by hip osteoarthritis

Introduction. In our institution, we started to perform THA with SuperPATH approach, including preservation of soft tissue around the hip (James Chow et al. Musculoskelet Med 2011) since July 2014, aiming for fast recovery and prevention of hip dislocation. For minimally-invasive approaches, however, there have been a few reports on malalignment of the implants related to shortage of operative field. The purpose of this study is to examine the short-term results of THA using SuperPATH, especially implant alignment. Materials and methods. We performed a study of 45 patients (45 hips) with osteoarthritis of the hip joint who had a THA with SuperPATH approach. There were 8 men and 37 women with an average age of 73 years, which were minimally 24 months followed. Dynasty Bioform cup and Profemur Z stem (Microport Orthopaedics) were used for all cases. Patients were clinically assessed with Merle d'Aubigne score and complications. Implant alignment and stability were radiologically evaluated by annual X-ray and CT acquired two months after surgery. Results. Merle d'Aubigne score was 10.2 (pain:2.8, mobility:4.4 walking ability:3.0) preoperatively and 16.6(pain:5.8, mobility:5.8, walking ability:5.0) at the latest follow-up. There were no dislocation and infection, but intraoperative proximal femoral fracture was found for two cases, which was managed to treat with additional circulating wire intraoperatively. Latest follow-up X-ray image showed 95% of the stem A-P alignment to be within 2 degrees and 5% to be more than 2 degrees and less than 5 degrees, while 44% of the stem lateral alignment to be within 2 degrees, 47% to be more than 2 degrees and less than 5 degrees, and 8% to be more than 5 degrees. From CT images averaged cup position found to be 40±5 degrees for inclination, and 19±5 degrees for anatomic anteversion, averaged stem anteversion to be 33±9 degrees. Annual X-ray evaluation showed no radiolucent line and less than Grade 2 stress-shielding (Engh classification) around the implants for all cases. One case had more than 5mm subsidence of the stem in early postoperative period, but not progressively subsided. No loosening of components was evident. Discussion and Conclusion. Many minimally-invasive approaches have developed, there have been many reports on fast recovery and low incidence of postoperative hip dislocation, however, the risk of complications or malalignment related to shortage of operative field has been pointed out. In this study, intraoperative proximal femoral fracture occurred for two cases. Also, though there were no loosening and the components position seemed excellent but lateral view of the X-ray showed 8% to be more than 5 degrees tilting alignment, resulting from femoral broaching required before femoral neck resection. SuperPATH approach, including pass way from between the Gluteus Medius and the piriformis tendon, can preserve the whole short external rotators and capsule of the hip joint, leading to fast recovery and low incidence of postoperative dislocation. Moreover, this approach may be friendly to the surgeons familiar with the posterior approach because of easily conversion to the conventional posterior approach

Introduction. Many minimally-invasive approaches have been described in an effort to improve short-term results of total hip arthroplasty (THA), aiming for fast recovery and prevention of dislocation. In our institution, we started to perform THA with SuperPATH approach, including preservation of soft tissue around the hip (James Chow et al. Musculoskelet Med 2011) since July 2014. The purpose of this study is to examine the short-term results of THA using SuperPATH, especially treatment progress of rehabilitation. Materials and methods. We performed a study of 30 patients (30 hips) with osteoarthritis of the hip joint who had a THA with SuperPATH approach. There were 4 men and 26 women with an average age of 71 years, which were followed up for 24 months. Patients were clinically assessed with Merle d'Aubigne score, postoperative hip pain during walking by Numerical Rating Scale (NRS:0–10), complications and treatment progress of rehabilitation in regard to moving and activities of daily living. Implant alignment and stability were radiologically evaluated by annual X-ray and CT acquired two months after surgery. Results. Merle d'Aubigne score was 10.4 (pain:2.9, mobility:4.5 walking ability:3.0) preoperatively and 16.8(pain:5.9, mobility:5.9, walking ability:5.0) at the latest follow-up. NRS showed less than 3 points for more than 50% of the THA patients next day postoperatively. For more than 80%, NRS showed less than 1 point at 7 days after surgery, and most patients acquired the ability of level ground walking for 100 meters independently by 4 days postoperatively, climbing up and down stairs independently by 5 days and wearing/taking off their socks independently by 7 days. There were no dislocation and infection, but intraoperative proximal femoral fracture was found for two cases, which was managed to treat with additional circulating wire intraoperatively. From CT images averaged cup position found to be 39±5 degrees for inclination, and 21±6 degrees for anatomic anteversion, averaged stem anteversion to be 33±9 degrees. No loosening of components was evident. Discussion and Conclusion. Many minimally-invasive approaches have developed, there have been many reports on fast recovery and low incidence of postoperative hip dislocation, however, the risk of complications related to shortage of operative field has been pointed out. In this study, intraoperative proximal femoral fracture occurred for two cases, but the components position seemed excellent and NRS showed less pain postoperatively and most of the patients acquired walking ability in a few days. SuperPATH approach, including pass way from between the Gluteus Medius and the piriformis tendon, can preserve the whole short external rotators and capsule of the hip joint, leading to fast rehabilitation progress. Moreover, this approach may be friendly to the surgeons familiar with the posterior approach because of easily conversion to the conventional posterior approach

Although many distal fit and fill design cementless stems have shown a very good long term stable fixation, short proximal coated stems are recently increasing in their use with an expectation of less stress shielding and an ease of removal at revision surgery. We introduced an anatomic short stem made from titanium alloy with proximal plasma-spray titanium and hydroxyapatite coating (CentPillar, Stryker, Mahwah) in 2002. To evaluate a minimum 10-year outcome of the system in terms of fixation and stress shielding, we reviewed initial 100 consecutive cases operated by a single surgeon. There were 91 hips with osteoarthritis and 9 hips with osteonecrosis. There were 94 females and 6 males. Average age at operation was 58 years. The patients were followed up for an average of 11 years. Average JOA hip score improved significantly from 46.9 preoperatively to 96.7 at the final examination. There were no dislocation, or revision, or radiographic loosening. When we looked at the level of bone atrophy, 80% of cases showed no stress shielding below the lessor trochanter. We conclude that the CentPillar stem showed mild stress shielding due to short proximal bone ongrowth coating while keeping a long term good clinical score and radiographic stability

It is estimated that approximately 3.1 – 7.7% of the general population suffers from primary osteoarthritis of the hip, with up to 42% of these cases being bilateral. The odds of undergoing a contralateral THA after index unilateral THA range from 16–85%. Up to 20% of these patients have the contralateral THA within 5 years. For this patient population, simultaneous bilateral THA may be an appealing option but it remains controversial. Proponents of bilateral simultaneous THA cite advantages such as a single anesthetic exposure, overall shorter length of hospital stay, quicker recovery, earlier return to function, less time off of work, and potential economic advantages. Only recently has there been more data emerging on patients undergoing simultaneous bilateral THA through the direct anterior approach (DAA). The DAA has the distinct advantage of supine positioning that facilitates easy exposure to both hips without the need to reposition the patient onto a fresh surgical incision while performing the second operation. Recent publications suggest that bilateral simultaneous DAA is a safe procedure and may have economic benefits as well. At our institution between 2010 and 2016, a consecutive series of 105 patients (210 hips) undergoing simultaneous bilateral DAA THA and a matched group of 217 patients undergoing unilateral DAA THA by the same surgeon at a single institution were reviewed. The two groups were matched by gender, age, body mass index and date of surgery. There were no significant differences between the two groups in terms of early complications. There were 2 complications in the unilateral group that were intraoperative nondisplaced calcar fractures that were treated with a single cerclage cable and 50% weight bearing for four weeks. There were 6 in-hospital systemic complications in the unilateral group compared to 7 in the bilateral group (p = 0.129). In-hospital systemic complications were similar between the two groups and included urinary retention, cardiopulmonary abnormalities, alcohol withdrawal, and nausea / vomiting. There were a total of 14 30-day follow-up hip-related complications in the unilateral group compared to 5 in the bilateral group (p = 0.06) These complications were similar between the two groups and included wound healing issues, tendinitis / bursitis, deep infection, nerve palsy, stem subsidence, and instability. Intraoperative estimated blood loss (EBL) was 360cc in the unilateral group compared to 555cc in the bilateral group (p < 0.001). The bilateral group had lower postoperative day one (POD1) hemoglobin (9.5 g/dl vs. 10.2 g/dl; p < 0.001). Four percent of unilateral patients required blood transfusion compared to 11% in the bilateral group. There were significant differences between the two groups in terms of distance ambulated on POD1 and length of stay (LOS). On average, the unilateral patients walked 235 feet on POD1 compared to 182 feet for the bilateral patients (p < 0.001). Length of stay was significantly longer in the bilateral group (1.95 days vs. 1.12 days; p < 0.001). All 322 patients involved in the study were discharged to home except for a single patient in the bilateral group who was discharged to a skilled nursing facility. In conclusion, we found no difference in in-hospital or 30-day complication rates when comparing the simultaneous bilateral group to the unilateral group. The main difference when compared to unilateral surgery is increased blood loss yet this did not directly result in specific complications. Simultaneous bilateral DAA THA can be performed safely and without an unacceptably high perioperative complication rate

Introduction. Total hip replacement (THR) is a very common procedure performed for the treatment of osteoarthritis of the hip. The aim of THR is to restore function and quality of life of the patients, by restoring femoral offset, leg length, centre of rotation, and achieving stability, to avoid dislocation postoperatively. Method. We aimed to perform preoperative assessment of femoral offset on anteroposterior (AP) radiographs of the hip, and on corresponding CT scans, for patients undergoing primary THR. Patients were positioned according to a standardised protocol prior to obtaining radiographs of the hip and CT scan. Inter- and intra-observer reliability was evaluated between 3 observers of differing levels of seniority – an orthopaedic trainee, a fellow, and a consultant. CT scan measurements of offset were performed by one consultant radiologist. The researchers measuring radiographic offset were blinded to the results of the CT measurements. Results. In the entire cohort of 50 patients, the mean femoral offset was 44 mm on AP radiographs of the hip and 45 mm on CT scans. No significant difference in mean femoral offset was seen between AP radiographs of the hip and CT. There was good inter and intra-observer reliability in the measurement of femoral offset on AP radiographs of the hip. There was no difference in the radiographic measurements between observers of differing levels of seniority. Conclusions. Accurate restoration of femoral offset is very important in the good functioning of THR. AP radiographs of the hip are accurate, and should be routinely obtained preoperatively for templating, prior to THR

The number of Americans over the age of 80 is increasing at a faster rate than that of the 65–80 population. The cohort age 85–94 years had the fastest rate of growth from 2000–2010. The number of Americans older than 95 years grew at approximately 26% during the same period. This rapid growth has been associated with an increasing incidence of osteoarthritis of the hip and knee in this population. This surge in the growth rate of the elderly population has coincided with an increasing demand for primary and revision total joint arthroplasty. Surgeons need to be prepared to perform safely and appropriately these procedures in this rapidly growing segment of the population. Surgeons need to be aware of the 1) clinical outcomes that can be expected when total joint procedures are performed in this group of patients; 2) the morbidity and mortality associated with the performance of these procedures; and 3) the relative cost effectiveness of these interventions. Clinical outcomes of TJA in this population are generally good. Pain and satisfaction scores are similar to those of younger patients. Although pre-operative pain and functional impairment scores are higher pre-operatively in elderly patients, these improve significantly following TJA. However, functional outcome scores decline noticeably after 5 years, reflecting the impact of coexistent comorbidities. The continued need for assistive devices is greater in this age group than in younger total joint patients. The risk of falls, a particular issue of concern in this age group, is reduced after total hip and knee surgery. The rate of complications, including mortality, following TJA in this age group is greater than in the 65–79-year-old group. The use of hospitalists to co-manage peri-operative care is particularly important in this age group. The increased rate of complications is associated with longer lengths of stay. However, the length of stay for this age group after primary total joint replacement is decreasing significantly; reflecting the widespread streamlining of peri-operative care that is being incentivised and implemented nationwide. The use of extended care facilities is also greater in this age group. The performance of revision TJA in this age group is particularly challenging. The rates of revision in elderly patients are anticipated to rise significantly in coming years. Although revision TJA is associated with significant pain relief and patient satisfaction, it is accompanied by mortality and complication rates that are substantially greater than those in younger age groups

Introduction. Total hip arthroplasty (THA) is the most effective treatment modality for severe arthritis of the hip. Patients report excellent clinical and functional outcomes following THA, including subjective improvement in gait mechanics. However, few studies in the literature have outlined the impact of THA, as well as surgical approach, on gait kinetics and kinematics. Purpose. The purpose of this study was to determine the impact of surgical approach for THA on quantitative gait analysis. Methods. Thirty patients undergoing THA for primary osteoarthritis of the hip were assigned to one of three surgical approaches (10 anterior, 10 posterior, and 10 lateral). A single surgeon performed each individual approach. Each patient received standardized implants at the time of surgery (cementless stem and acetabular component, cobalt chrome femoral head, highly cross-linked liner). Patients underwent 3D gait analysis pre-operatively, and at 6- and 12-weeks following the procedure. At each time point, temporal gait parameters, kinetics, and kinematics were compared. Statistical analysis was performed using one-way analysis of variance. Results. All three groups were similar with respect to age (p=0.27), body mass index (p=0.16), and the Charlson Comorbidity Index (p=0.66). Temporal parameters including step length, stride length, gait velocity, and percent stance and swing phase were similar between the groups at all time points. The lateral cohort had higher pelvic tilt during stance on the affected leg than the anterior cohort at 6-weeks (p=0.033). Affected leg ipsilateral trunk lean during stance was higher in the lateral group at 6-weeks (p=0.006) and 12-weeks (p=0.037) compared to the other cohorts. The anterior and posterior groups demonstrated an increased external rotation moment at 6-weeks (p=0.001) and 12-weeks (p=0.005) compared to the lateral group. Discussion. Although temporal parameters were similar across all groups, some differences in gait kinematics and kinetics exist following THA using different surgical approaches. However, the clinical relevance based on the small magnitude of the differences remains in question

Total hip arthroplasty (THA) is the most effective treatment modality for severe arthritis of the hip. Patients report excellent clinical and functional outcomes following THA, including subjective improvement in gait mechanics. However, few studies in the literature have outlined the impact of surgical approach on gait kinetics and kinematics. The purpose of this study was to determine the impact of surgical approach for THA on quantitative gait analysis. Thirty patients undergoing THA for primary osteoarthritis of the hip were assigned to one of three surgical approaches (10 anterior, 10 posterior, and 10 lateral). A single surgeon performed each individual approach. Each patient received standardised implants at the time of surgery (cementless stem and acetabular component, cobalt chrome femoral head, highly cross-linked liner). Patients underwent 3D gait analysis pre-operatively, and at 6- and 12-weeks following the procedure. At each time point, temporal gait parameters, kinetics, and kinematics were compared. Statistical analysis was performed using one-way analysis of variance. All three groups were similar with respect to age (p=0.27), body mass index (p=0.16), and the Charlson Comorbidity Index (p=0.66). Temporal parameters including step length, stride length, gait velocity, and percent stance and swing phase were similar between the groups at all time points. The lateral cohort had higher pelvic tilt during stance on the affected leg than the anterior cohort at 6-weeks (p=0.033). Affected leg ipsilateral trunk lean during stance was higher in the lateral group at 6-weeks (p=0.006) and 12-weeks (p=0.037) compared to the other cohorts. The anterior and posterior groups demonstrated an increased external rotation moment at 6-weeks (p=0.001) and 12-weeks (p=0.005) compared to the lateral group. Although temporal parameters were similar across all groups, some differences in gait kinematics and kinetics exist following THA using different surgical approaches. However, the clinical relevance based on the small magnitude of the differences remains in question