Aims. We present the clinical and radiological results at a minimum follow-up of 20 years using a second-generation uncemented total hip arthroplasty (THA). These results are compared to our previously published results using a first-generation hip arthroplasty followed for 20 years. Methods. A total of 62 uncemented THAs in 60 patients were performed between 1993 and 1994. The titanium femoral component used in all cases was a Taperloc with a reduced distal stem. The acetabular component was a fully porous coated threaded hemispheric titanium shell (T-Tap ST). The outcome of every femoral and acetabular component with regard to retention or revision was determined for all 62 THAs. Complete clinical follow-up at a minimum of 20 years was obtained on every living patient. Radiological follow-up was obtained on all but one. Results. Two femoral components (3.2%) required revision. One stem was revised secondary to a periprosthetic fracture one year postoperatively and one was revised for late sepsis. No femoral component was revised for aseptic loosening. Six acetabular components had required revision, five for aseptic loosening. One additional acetabular component was revised for sepsis. Radiologically, all femoral components remained well fixed. One acetabular was judged loose by radiological criteria. The mean Harris Hip Score improved from 46 points (30 to 67) preoperatively to 89 points (78 to 100) at final follow-up. With revision for aseptic loosening as the endpoint, survival of the acetabular component was 95% (95% confidence interval (CI) 90 to 98) at 25 years. Femoral component survival was 100%. Conclusion. The most significant finding of this report was the low prevalence of aseptic loosening and revision of the femoral component at a mean follow-up of 22 years. A second important finding was the survival of over 90% of the hemispheric threaded ring acetabular components. While these shells remain controversial, in this series they performed well. Cite this article: Bone Jt Open 2021;2(1):33–39

Since 1977 we did implant ceramic on ceramic THR in younger and active population. In 1991 we published (JBJS B N°4) data's in a consecutive group of patients under 50 years of age. What about the same patients for more than 30 years? Eighty-six hips in 75 patients, 41 males 34 females, mean age 43 (18 to 50), mean weight 68 kg (36 to 100), Charnley class: 38 A, 28 (38 hips) B, 9 patients (10 hips) C. Sixty-six primary procedures, 20 revisions (18 failed arthroplasties: 6 THR, 5 resurfacing, four single cup, two hemiarthroplasty, one bipolar), one after acetabular fractures. Four hips previously infected. Eight Patients deceased (8 hips) prosthesis still in place, ten lost to follow-up before 2 years, eight hips in 8 patients were revised before the review, partially followed: from 2 to 20 years: 35, completely followed: 25 hips in 23 patients resuming in: No pain in 20, slight pain in 2, severe disability in 3 not related to the hip, no radiolucent lines in 22, radiolucent lines in 3, no osteolysis in 25. Revision for: early sepsis in one, socket loosening in 8 (3 revisions cases), femoral head fractures in 2: one extra small head (22mm) for Crowe 3 DDH, one fractured at 24 years. Inertness, stability related to fibrous tissue generation, no noise

We aimed to use data from a randomized controlled trial (RCT) comparing the sliding hip screw vs. intramedullary nailing (IMN) for trochanteric fractures to examine complication rates between those managed with a short vs. long IMN. This is a secondary analysis using one arm of an RCT of patients ≥18 years with trochanteric fractures. We examined differences in fracture-related (femoral shaft fracture, implant failure, surgical site infection (SSI), nonunion, limb shortening, and pain) and medical (organ failure, respiratory distress, stroke, deep vein thrombosis [DVT] gastrointestinal upset, pneumonia, myocardial infarction, sepsis, or urinary tract infection) adverse events (AE), and readmission between short vs. long IMNs. We included 412 trochanteric fracture patients, 339 (82.2%) of whom received a short (170mm–200mm) nail, while 73 (17.7%) received a long (260mm–460 mm) nail. Patients in the long group were more likely to be admitted from home (vs. an institution), and have comorbidities, or more complex fracture types. Patients in the long group had higher rates of fracture-related AE (12.3%) vs. the short group (3.5%). Specifically, SSI (5.5% vs. 0.3%) and pain (2.7% vs. 0.0%) were significantly higher in the long group. Patients in the long group were also more likely to develop DVT (2.7% vs. 0.3%), and be readmitted to the hospital (28.8% vs. 20.7%). Following covariable adjustment, long nails remained associated with a higher odds of fracture-related AE (5.11, 1.96–13.33) compared to short nails. We found no association between the adjusted odds of readmission and nail length (1.00, 0.52–1.94). Our analyses revealed that trochanteric fracture patients managed with long IMN nails may have a higher odds of fracture-related AE compared to short nails. Future research is required to validate these findings with larger event rates, and further optimize IMN for trochanteric fracture patients

After a hip fracture, infections are common, but signs of infection resemble those of systemic inflammatory response to trauma and surgery, and conventional infection markers lack specificity. Plasma-calprotectin, a novel marker of neutrophil activation, has shown potential as an infection marker in ER and ICU settings. To investigate if plasma-calprotectin is superior compared to conventional infection biomarkers after hip fracture. Prospective cohort study of hip fracture patients admitted to our department. Calprotectin, procalcitonin (PCT), C-reactive protein (CRP), and white blood cell (WBC) count were measured in blood plasma upon admission and on day 3 post-surgery. Patients with infection (pneumonia, UTI, sepsis, SSI, other soft tissue infections) pre- or post-surgery were compared to a control group without infection within 30 days. Statistics: Wilcoxon rank-sum test, medians with interquartile range, and area under the curve (AUC) with 95% confidence intervals. Pilot study comprises calprotectin obtained at least once for 60 patients at admission and 48 on day 3. Mean age 84 years (SD 8.4), 65% women. 9/60 patients (23%) were admitted with infections. They had higher levels of CRP (median 111 [73-149]) and PCT (0.35 [0.18–0.86]) compared to the control group (29 [16-64], p=0.037; 0.10 [0.07–0.17], p=0.007). Calprotectin (2.67 vs 2.51) and WBC (12.2 vs 9.3) did not differ significantly. AUC was highest for PCT (0.79 [CI 0.60–0.97]), followed by CRP (0.71 [0.46–0.96]), WBC (0.60 [0.35–0.84]), and calprotectin (0.58, [0.33–0.83]). Day 3, 6/48 (13%) had infections, without significant differences between groups in any marker. The median levels were: calprotectin 3.5 vs 3.1, CRP 172 vs 104, WBC 12 vs 9, PCT 0.16 vs 0.17. Calprotectin had highest AUC 0.68 (0.41–0.93, n.s.). AUC for WBC was 0.67 (0.31–1.00), CRP 0.66 (0.38–0.94), PCT 0.56 (0.29–0.82). Preliminary data show no significant associations with postoperative infection for any of the studied biomarkers. However, plasma-calprotectin might perform slightly better compared to conventional markers

Objectives. The diagnosis of periprosthetic joint infection (PJI) is difficult and requires a battery of tests and clinical findings. The purpose of this review is to summarize all current evidence for common and new serum biomarkers utilized in the diagnosis of PJI. Methods. We searched two literature databases, using terms that encompass all hip and knee arthroplasty procedures, as well as PJI and statistical terms reflecting diagnostic parameters. The findings are summarized as a narrative review. Results. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were the two most commonly published serum biomarkers. Most evidence did not identify other serum biomarkers that are clearly superior to ESR and CRP. Other serum biomarkers have not demonstrated superior sensitivity and have failed to replace CRP and ESR as first-line screening tests. D-dimer appears to be a promising biomarker, but more research is necessary. Factors that influence serum biomarkers include temporal trends, stage of revision, and implant-related factors (metallosis). Conclusion. Our review helped to identify factors that can influence serum biomarkers’ level changes; the recognition of such factors can help improve their diagnostic utility. As such, we cannot rely on ESR and CRP alone for the diagnosis of PJI prior to second-stage reimplantation, or in metal-on-metal or corrosion cases. The future of serum biomarkers will likely shift towards using genomics and proteomics to identify proteins transcribed via messenger RNA in response to infection and sepsis. Cite this article: A. Saleh, J. George, M. Faour, A. K. Klika, C. A. Higuera. Serum biomarkers in periprosthetic joint infections. Bone Joint Res 2018;7:85–93. DOI: 10.1302/2046-3758.71.BJR-2017-0323

Introduction. Previous studies have indicated that prolonged surgical time may lead to higher rates of infection following total hip arthroplasty (THA). The purpose of this study was to evaluate the influence of surgical time on 30-day complications following THA and to determine if there was a time interval associated with worse outcomes. Methods. Patients ≥18 years who underwent THA between 2005 and 2016 were identified from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database using procedural codes. Patients with surgical durations >240 minutes were excluded. Patient demographics, operation length, and 30-day major and minor complications were ascertained. Multivariable regression was used to determine if the rate of complications differed depending on length of operation, while adjusting for relevant covariables, and to identify independent predictors of operation length. Covariables of interest included age, sex, American Society of Anaesthesiologists (ASA) class, smoking status, functional status, comorbidities, anesthesia type, and Body Mass Index (BMI). Results. A total of 132,043 THA patients (average age 65 ±12 years) were identified from the database. Of these, 2,177 (1.64%) experienced a major complication, and 3,504 (2.64%) experienced a minor complication within 30-days of the initial procedure. Average operation length was 92.0 minutes (range 20 – 240 minutes). Independent predictors of prolonged operation length included overweight/obese BMI, male sex, cancer, dependent functional status, epidural anaesthetic, and ASA class II, III or IV vs. I Alternatively, older age, current smoking, and spinal anaesthetic were associated with shorter surgical durations. Unadjusted rates of both major and minor complications were significantly higher for patients whose operation lengths were ≥ 120 minutes (P>0.001). Specifically, patients whose operations lasted ≥ 120 minutes had higher rates of septic shock, sepsis, pulmonary embolism (PE), deep vein thrombosis (DVT), urinary tract infection (UTI), renal insufficiency, surgical site infection(SSI) and wound disruption. After covariable adjustment, surgical durations of 90–119 minutes increased the risk of minor complications by 1.2 (95%Confidence interval [95%CI] 1.1–1.3), while surgical durations of 120–180 minutes increased the risk of major complications by 1.4 (95%CI 1.3 – 1.6), and minor complications by 1.4 (95%CI 1.2 – 1.5), and surgical durations ≥180 minutes increased the risk of major complications by 2.1 (95%CI 1.8 – 2.6), and minor complications by 1.9 (95%CI 1.6 – 2.3). There was no difference in the overall risk of complications for operation times lasting 20 – 39, 40 – 59, or 60 – 89 minutes (P>0.05). In terms of specific complications, operation length ≥90 minutes was determined to be an independent risk factor for deep and superficial incisional SSI, as well as wound disruption, while operation length ≥ 120 minutes was an independent risk factor for sepsis, UTI, and deep, non-incisional SSI and operation length ≥ 180 minutes was an independent risk factor for PE, DVT, and cardiac arrest (p<0.05). Conclusion. These data indicate that prolonged surgical durations may be an independent predictor of major and minor complications following THA. This suggests that quality improvements could be made to improve operating room efficiency and surgical times and therefore postoperative outcomes

Introduction. Total hip arthroplasty (THA) is gaining popularity as a treatment for displaced femoral neck fractures (FNF), especially in physiologically younger patients. While elective THA for primary osteoarthritis (OA) has demonstrated low rates of complications and readmissions, the outcomes of THA for FNF are less predictable. Additionally, these THA procedures are equally included in various alternative payment bundles. Therefore, the aim of this study is to assess postoperative complication rates after THA for primary OA compared with FNF. Methods. The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2008 to 2016 was queried. Patients were identified using the Current Procedural Terminology (CPT) code for THA (27130) and divided into groups by diagnosis; OA in one group and FNF in another. Univariate statistics were performed. T-test compared continuous variables between groups, and Chi-square test compared categorical variables. Multivariate and propensity matched logistic regression analyses were performed to control for risk factors of interest. The primary outcomes for this study were death or serious morbidity (surgical site infection (SSI), infection, respiratory complication, cardiac complication, sepsis, or blood loss anemia requiring postoperative transfusion). Additional secondary outcomes included the incidence of specific complications, total operative time (time from incision to closure), length of hospital stay and proportion of patients that were discharged home. Results. Analyses included 139,635 patients undergoing THA. OA was the indication in 135,013 cases and FNF in 4,622 cases. Unadjusted analysis showed a significantly higher rate of mortality when THA was done for hip fracture (2.1% vs. 0.1%; p<0.001). There was also a significantly increased rate of serious morbidity for hip fracture patients; including cardiac complications (3.5% vs 0.96%; p<0.001), respiratory complications (1.3% vs 0.2%; p<0.001), postop transfusion (23.1% vs 9.36%; p<0.001), sepsis (0.95% vs 0.3%; p<0.001). There was a significantly higher percentage of patients requiring reoperation (4.5% vs 2.0%; p<0.001) and readmission (8.0% vs 3.5%; p<0.001) in the hip fracture group. There was a significantly higher percentage of patients in the hip fracture groups having operative time >90min (16.4% vs 10.1%; p<0.001), length of stay longer than 5 days (53.8% vs 7.5%; p<0.001), and a significantly lower percentage of patients who were discharged home (39.0% vs 78.0%; p<0.001). Propensity score matching resulted in a cohort of 6,968 patients; 3,484 in both the hip fracture and osteoarthritis groups. Mortality within 30 days was 530% higher, and major morbidity was 36% higher among FNF patients. Reoperation was 40% higher, readmission was 36% higher, operative length at the 90th percentile was 74% higher, prolonged length of stay was 838% higher, and discharge to home was 62% lower for the FNF group compared with OA patients. Logistic, reverse stepwise regression model () results were consistent with the propensity-matched analysis. Discussion and Conclusion. This large database study showed a higher risk of postoperative complications including mortality, major morbidity, reoperation, readmission, prolonged operative time, increased length of stay, and decreased likelihood of discharge home in patients undergoing THA for FNF compared with OA. Without risk adjustment, the bundled payment methods that are applied to THA procedures including those performed for FNF are at a disadvantage and likely inadequate to cover the more costly episode of care related to treating hip fracture patients

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).

Introduction. Native hip joint infection can result in hip arthrosis as a complication requiring the need for subsequent arthroplasty. There is little evidence to support single or staged THA. We present the results of patients who have undergone total hip arthroplasty (THA) following hip joint sepsis in our institution. Methods. Patients receiving a THA following previous hip joint sepsis between 2003 and 2015 were identified from the operative records database. Further clinical information was collected from the medical records, including timing of infection and surgery, as well as culture results. Functional outcome (Oxford Hip Score, OHS) and patient satisfaction scores (PSS) were recorded. Results. There were 21 males and 12 females with a mean age of 54 (21–82) at a mean follow up of 6.4 years (2–12) following definitive implantation. Thirteen patients underwent a single stage THA and 20 patients had a 2 stage procedure, two of whom required a repeat 1. st. stage prior to implantation. The mean time from native hip infection to operation was 17.2 years (3–59). At implantation, positive cultures were present in 19 cases, 13 of which were S. aureus. Two patients required revision due to a periprosthetic fracture and one patient required debridement, antibiotics and implant retention (DAIR). Therefore, the implant survivorship was 94% and infection rate was 3% at 6.4 years. Discussion. Both single and staged arthroplasty provide good results in patients who have developed septic arthritis. THA as a single stage was performed predominately in patients with a long remission between their initial infection and presentation. Positive culture at implantation does not confer a bad outcome as long as a thorough debridement is performed as routine in this patient group. Patient comorbidities are an important factor as both cases requiring reoperation were in IV drug users with Hepatitis C

Aims

The aim of this study was to compare open reduction and internal fixation (ORIF) with revision surgery for the surgical management of Unified Classification System (UCS) type B periprosthetic femoral fractures around cemented polished taper-slip femoral components following primary total hip arthroplasty (THA).

Background. Hip resurfacing arthoplasty (HRA) showed promising early and mid-terms results at the beginning of the new millennium. Adverse local tissue reactions associated with metal debris considerably slowed down the implantation of HRA which use is now limited to a few specialized centers. The long term success of this procedure, however, is still largely unknown. This study aimed to provide the clinical results of a series of 400 consecutive HRA with a minimum follow-up of 20 years. Methods. All patients treated with Conserve. ®. Plus HRA between November 1996 and November 2000 were retrospectively selected and 355 patients (400 hips) were included. The clinical results of this series was previously reported in 2004 at a follow up of 2 to 6 years[1]. There were 96 women (27%) and 259 men (73%). Mean age at surgery was 48.2 ± 10.9 years. Long-term survivorship was assessed with Kaplan-Meier survival estimates. UCLA hip scores and SF-12 quality of life scores were collected at follow-up visits. Radiographic positioning of the acetabular component was assessed with the computation of the contact patch to rim (CPR) distance. Radiolucencies about the metaphyseal stem and around the acetabular component were recorded to assess the quality of the component fixation. Results. The mean time of follow up was 16.3 ± 5.5 years including 183 hips beyond 20 yrs. Nine hips were lost to follow up (2.2%) Thirty-three patients (35 hips,8.8%) died of causes unrelated to the surgery at a mean 11.9 ± 5.3 years after surgery The mean UCLA hip scores at last follow-up were 9.3 ± 1.0, 9.1 ± 1.4, 9.0 ± 1.8, and 6.9 ± 1.7 for pain, walking, function, and activity, respectively. Post-operative SF-12 scores were 48.4 ± 10.3 for the physical component and 48.5 ± 15.5 for the mental component and did not differ from those of the general US population. Fifty-five patients (60 hips) underwent revision surgery at a mean time of 9.3 ± 5.8 years. Indications for revision surgery included acetabular component loosening (12 hips), femoral component loosening (31 hips), femoral neck fracture (6 hips), wear (6 hips), sepsis (2 hips), recurrent dislocations (1 hip), acetabular component protrusion after over-reaming (1 hip) and unknown (1 hip which was revised in another center). Using any revision as an endpoint, the Kaplan-Meier survivorship was 95.2% at 5 years, 91.2% at 10 years, 87.3% at 15 years, and 83.2% at 20 years. A multivariate model for risk factor analysis showed a diagnosis of developmental dysplasia (p=0.020) and a low body mass index (typically associated with higher levels of activity) (p=0.032), to be significantly related to revision for any reason. Female sex was not a risk factor after adjustment for hip dysplasia and component size was made (Table 1). There was only 1 femoral failure (a late neck fracture 19 years after surgery) among the hips reconstructed with a cemented metaphyseal stem (n=59). Five of the 6 hips (1.5%) with wear-related failures all had mal-positioned sockets (CPR distance <10mm) and were therefore preventable. There were no cases with a high score of aseptic lymphocytic vasculitis-associated lesions (ALVAL)[2], suggesting metal sensitivity. X-ray analysis showed excellent persisting fixation in all but one hip. Conclusions. In this group of patients operated over 20 years ago, HRA keeps providing excellent pain relief and quality of life to the patients. Subsequent progress in the preparation of the femoral head has considerably reduced the failure rate on the femoral side which was the main mode of failure in this initial series[3, 4]. The 83.1% 20 year survivorship of this initial series surpasses that of total hip arthroplasties in use 20 years ago in this young patient population[5]. Life-long durability of the device is anticipated for most of the remaining patients. The established benefits of this procedure, such as a low dislocation rate, an anatomic reconstruction with physiologic loading of the proximal femur, the absence of taper corrosion, and an easy conversion if ever necessary, make HRA a preferable alternative to THA in young and active patients. For any figures, tables, or references, please contact the authors directly

Aims. To investigate the longevity of uncemented fixation of a femoral component in total hip arthroplasty (THA) in patients with Dorr type C proximal femoral morphology. Patients and Methods. A total of 350 consecutive uncemented THA in 320 patients were performed between 1983 and 1987, by a single surgeon using the Taperloc femoral component. The 63 patients (68 hips) with Dorr type C proximal femoral morphology were the focus of this review. The mean age of the patients was 69 years (24 to 88) and mean follow-up was 16.6 years (ten to 29). Survival analysis included eight patients (eight hips) who died without undergoing revision surgery prior to obtaining ten years follow-up. All 55 surviving patients (60 hips) were available for clinical assessment and radiographic review. As a comparator group, the survival and implant fixation in the remaining 282 THAs (257 patients) with Dorr type A and B morphology were evaluated. The mean age of these patients was 52 years (20 to 82). Results. In the Dorr C patient group the mean Harris hip score improved from 51 points (21 to 69 points) pre-operatively to 89 (74 to 100) at final follow-up. No femoral component was loose by radiological criteria and osteolysis was only identified around two stems (3.3%). There was one revision (1.6%) of a well-fixed femoral component for sepsis at 11 years. The survival of the Taperloc femoral component at 20 years with revision for any reason as the endpoint was 98% (95% confidence interval; 87 to 99). A total of ten (3.5%) of the Dorr A and B patient group of 282 THAs required revision surgery. Only one (0.4%) for aseptic loosening. A total of two hips (1%) were loose by radiographic criteria and osteolysis occurred around 12 hips (4%). Conclusion. This study demonstrates that excellent fixation can be achieved using the Taperloc stem in patients with Dorr type A and B, and Dorr type C bone. Take home message: The Taperloc stem demonstrated equivalent results in Dorr type A and B and Dorr type C bone. Cite this article: Bone Joint J 2016;98-B:595–600

Abnormal wear of cobalt-containing metal-on-metal joints is associated with inflammatory pseudotumours. Cobalt ions activate human toll-like receptor 4 (TLR4), which normally responds to bacterial lipopolysaccharide (LPS) in sepsis. Activation of TLR4 by LPS increases the expression of chemokines IL-8 and CXCL10, which recruit leukocytes and activated T-cells, respectively. This study was designed to determine whether cobalt induces a similar inflammatory response to LPS by promoting the expression of IL-8 and CXCL10. A human monocytic cell line, derived from acute monocytic leukaemia, was treated with cobalt ions and expression of IL-8 and CXCL10 measured at mRNA and protein levels. Cobalt-treated macrophages showed a 60-fold increase in IL-8 mRNA, and an eightfold increase in production of the mature chemokine (both p < 0.001); expression of the CXCL10 gene and protein was also significantly increased by cobalt (both p < 0.001). Experiments were also performed in the presence of CLI-095, a TLR4-specific antagonist which abrogated the cobalt-mediated increase in IL-8 and CXCL10 expression. . These findings suggest that cobalt ions induce inflammation similar to that observed during sepsis by the simultaneous activation of two TLR4-mediated signalling pathways. These pathways result in increased production of IL-8 and CXCL10, and may be implicated in pseudotumour formation following metal-on-metal replacement. Cite this article: Bone Joint J 2014; 96-B:1172–7

Aims

Post-traumatic periprosthetic acetabular fractures are rare but serious. Few studies carried out on small cohorts have reported them in the literature. The aim of this work is to describe the specific characteristics of post-traumatic periprosthetic acetabular fractures, and the outcome of their surgical treatment in terms of function and complications.

Aims

United Classification System (UCS) B2 and B3 periprosthetic fractures in total hip arthroplasties (THAs) have been commonly managed with modular tapered stems. No study has evaluated the use of monoblock fluted tapered titanium stems for this indication. This study aimed to evaluate the effects of a monoblock stems on implant survivorship, postoperative outcomes, radiological outcomes, and osseointegration following treatment of THA UCS B2 and B3 periprosthetic fractures.

Aims

Revision total hip arthroplasty in patients with Vancouver type B3 fractures with Paprosky type IIIA, IIIB, and IV femoral defects are difficult to treat. One option for Paprovsky type IIIB and IV defects involves modular cementless, tapered, revision femoral components in conjunction with distal interlocking screws. The aim of this study was to analyze the rate of reoperations and complications and union of the fracture, subsidence of the stem, mortality, and the clinical outcomes in these patients.

Aims

It is important to analyze objectively the hammering sound in cup press-fit technique in total hip arthroplasty (THA) in order to better understand the change of the sound during impaction. We hypothesized that a specific characteristic would present in a hammering sound with successful fixation. We designed the study to quantitatively investigate the acoustic characteristics during cementless cup impaction in THA.

Aims

It is important to analyze objectively the hammering sound in cup press-fit technique in total hip arthroplasty (THA) in order to better understand the change of the sound during impaction. We hypothesized that a specific characteristic would present in a hammering sound with successful fixation. We designed the study to quantitatively investigate the acoustic characteristics during cementless cup impaction in THA.

Introduction. Hip resurfacing arthroplasty (HRA) lost its popularity because of excessive wear of the ASR M/M design. Now that causes of wear have been identified, it remains an attractive treatment option for young patients because of its bone-conserving nature, the preservation of bone mineral density, a low dislocation rate, and its biomechanical precision. Methods. We assessed the long-term clinical outcomes of 1074 patients (1321 hips) who were implanted with hybrid Conserve. ®. Plus HRA, with 556 surgeries performed in patients younger than 50 years of age (average, 41.6 years) compared to 765 surgeries performed in patients 50 years or older (average, 58.1 years). 74% of the patients were male. There were no exclusion criteria. The <50 group had a larger proportion of dysplasia and hips operated during the first generation of surgical technique. Results. The mean elapse time after surgery was 15.6 years (range 7.4 to 22.5 years). We found no difference in UCLA pain, walking and function scores between the two groups except for a slightly higher activity level in the younger group (7.4 vs. 7.2, p=0.0172). Quality of life SF-12 scores were also comparable. Although we found better survivorship rates for the group of older patients (Log-rank test p=0.0107 – Figure 1) between the younger and older patients (Table 1), this difference was largely explained by the greater proportion of dysplasia (p=0.0001) and 1. st. generation hips (p=0.044) in the <50 group. The rate of post-operative complications (dislocations, sepsis, neve palsies, blood-related and others) was not significantly different between groups (p=0.3738). However, the complication rate dropped significantly (p=0.0390) in both groups from 6.4% for the first and 2. nd. generations of surgical technique (n=670) to 3.8% with the 3. rd. generation of surgical technique (n=651). Conclusions. The long-term results of metal-on-metal HRA meet and even surpass the original expectations in young and active adults, with survivorship rates far superior to those reported in registries for conventional total hip arthroplasty. However, the etiologic characteristics (particulartly hip dysplasia in women of small size, but not osteonecrosis) of this demanding population also affect the results of HRA with a lower survivorship compared with that of older patients. For any tables or figures, please contact the authors directly

Aims

This study aimed to investigate the incidence of ≥ 5 mm asymmetry in lower and whole leg lengths (LLs) in patients with unilateral osteoarthritis (OA) secondary to developmental dysplasia of the hip (DDH-OA) and primary hip osteoarthritis (PHOA), and the relationship between lower and whole LL asymmetries and femoral length asymmetry.