Aims. The incidence of thigh pain with the short stem varies widely across different studies. We aimed to evaluate the incidence and characteristics of post-operative thigh pain after using a particular bladed short stem and its potential risk factors. Patients and Methods. We respectively reviewed 199 consecutive patients who underwent unilateral total hip replacement using the Tri-lock stem from 2013–2016, of which 168 patients were successfully followed up with minimum two year clinical follow-up. All information about thigh pain and pre- and postoperative HHS score were gathered and all preoperative and immediate postoperative radiographs were available for review. Any complications were recorded. Results. Of the 168 patients, 34 (20.2%) patients reported thigh pain at a mean 3.1 years after surgery. Of these, 2 (5.9%) reported severe pain (NRS 5 or more). The pain was persistent (from surgery to final follow-up) in 13 patients (38.2%) and subsided within 2 years in 10 cases (29.4%). The most common site of pain was the lateral thigh (70.6%). The HHS improved from a mean 54.2 points preoperatively to 79.8 postoperatively. In 123 cases with radiographs at more than 2 years follow-up, all femoral stems were well-fixed and no revision surgery was needed at the latest. BMI and CFI were found to be independent risk factors for thigh pain after using this particular stem component. Conclusions. The incidence of thigh pain in Chinese THA patients with a bladed short stem component design is as high as 20%. Among them, nearly 40% will have some disruption in sleep or daily life. More than one-third of the cases of thigh pain were persistent. A larger BMI and patients with a funnel-type morphology of the femoral canal are independent risk factors for thigh pain in the setting of this particular stem component

Background. Thigh pain following a well-fixed total hip arthroplasty (THA) remains problematic and a source of patient dissatisfaction. The purpose of this study is to evaluate if the development of distal femoral cortical hypertrophy (DFCH) is associated with chronic postoperative thigh pain after THA with a short stem implant. Methods. All patients who underwent an uncomplicated primary THA via a direct anterior approach with the short stem Taperloc Microplasty® (Zimmer Biomet, Warsaw, IN) implant between 2011 and 2015 were mailed a pain drawing questionnaire. Radiographs were reviewed at 1-year minimum to determine cortical thickness change from immediate post-op. Thigh pain was compared to DFCH as well as patient demographics and femoral stem size. 293 patients were included in the study. Results. Mean follow-up was 3.2 years. A total of 218 hips (74%) had cortical hypertrophy in Gruen zone 3 and 165 hips (56%) had cortical hypertrophy in Gruen zone 5. Fifty-two hips (18%) had ≥25% cortical hypertrophy in zone 3 and 91 hips (31%) had ≥25% cortical hypertrophy in zone 5. A total of 44 patients (15%) reported anterior thigh pain and 43 patients (15%) reported lateral thigh pain. Development of DFCH in either Gruen zone 3 or 5 was not associated with anterior or lateral thigh pain. Stem size was positively correlated with zone 3 hypertrophy and inversely related to zone 5 hypertrophy. Thigh pain was not associated with patient age, gender, activity level or stem size. Conclusion. The development of distal femoral cortical hypertrophy after THA with a short stem implant was high, but not associated with patient reported anterior or lateral thigh pain. For any tables or figures, please contact the authors directly

Background. Although thigh pain is an annoying problem after total hip arthroplasty (THA), little information has been known about its natural course. Methods. To determine the frequency, time of onset, and duration of thigh pain after cementless THA, we evaluated 240 patients (240 hips) who underwent primary THA because of femoral head osteonecrosis with the use of a single tapered stem. Results. Twenty-seven patients (11.3%) experienced thigh pain during the follow-up of 3–11 years(mean, 84 months). The pain developed 2–78 months (median, 25 months) after THA. The 75% of pain developed within 36 months. In 25 patients, the pain disappeared postoperatively 1 month-64 months (mean, 17.4 months), and 2 patients (7.4%, 2/27) had persistent thigh pain. There were no differences in the latest Harris Hip Score between the thigh pain group and no thigh pain group. Conclusion. Our results provided basic information about the natural history of thigh pain after cementless THA with a tapered stem design

One of major problems in Total Hip Arthroplasty is thigh pain. We have examined the effect of femoral canal injection of Calcium Phosphate Paste (CPP) for cementless THA. CPP is a mixture of alpha Tri-Calcium Phosphate, Tetra-Calcium Phosphate, Calcium Hydrogen Phosphate and Hydroxyapatite. This paste harden in 10 minutes and its stiffness increases to 80Mpa in 3days. Cementless THA were performed in 45 osteoarthritic hips from 1999 to 2002. Eight of 40 patients were male and 32 were female, average age were 62.4 years old ranged 43 to 81. In 11 hips, CPP (10–12g) were filled as a femoral canal filler around the distal end of stem. In 34 hips, as a control, no CPP were filled in the canal. Proximal part of the stem was HA coated on rough metal surface. No thigh pain were observed in CPP group patients. In control group, five hips (14.7%) showed thigh pain (p< 0.05), but walking disability and pain were mild in the first year and improved by the next year. CPP filled in the canal were absorbed slowly on X-ray film, but prevention of thigh pain lasts for long time maximum 3 years. No infections and pulmonary embolism were observed in both series. Filling CPP into the gap between stem tip and femoral canal is useful technique to prevent thigh pain after cementless THA

Conventional wisdom holds that aseptic failure of proximal ingrowth femoral stems should be addressed by revision to a longer femoral stem dependent upon more distal fixation. This is a reliable and time-honoured strategy with a high likelihood of success provided secure initial fixation of the revision stem is obtained. Yet, stems reliant upon more distal diaphyseal fixation are accompanied by a greater risk of physiologic thigh pain attributable to the differential in flexural stiffness of the femoral shaft compared with the prosthetic stem. Contemporary proximal ingrowth femoral stems have become the most popular device used in total hip arthroplasty and are traditionally reserved for primary procedures. Nevertheless, the flat tapered design offers a tight fit between the medial and lateral endosteal cortices of the femur, unimpeded by an increasing anteroposterior dimension of the stem, and provides a secure geometrical block to rotational movement of the stem. In instances when the primary stem is not fit to the endosteal cortex on the anteroposterior radiograph, such as with the Corail or SROM devices, the opportunity may exist for revision with a flat tapered proximal ingrowth stem that is upsized to abut the endosteal femoral cortex. Such a strategy preserves the diaphyseal femur for subsequent revision in these typically young patients and avoids the issue of thigh pain in this active population. Likewise, revision of a well-fixed long stem that is associated with unrelenting thigh pain may be similarly accomplished by revision to a flat proximal ingrowth stem provided the integrity of the upper femur can be maintained during the revision. A prophylactic cerclage wire around the proximal femur is a helpful adjunct when using flat tapered proximal ingrowth stems in the revision setting

Six porous-coated, uncemented femoral components were revised at a mean of 34.5 months for persistent thigh pain. At operation the stems were rigidly stable, difficult to extract, and showed good bony ingrowth. The four men and two women, with an average age of 59 years, all had thigh pain starting within the first year, progressive over time and unresponsive to conservative measures. These cases show that rigid fixation with good bony ingrowth does not guarantee the clinical success of a porous-coated uncemented femoral stem

INTRODUCTION:. Short femoral stems are receiving increasing attention for less invasive total hip replacement (THR). The purpose of this study is to report our initial experience with a short modular femoral (SMF) stem at a minimum two-year follow up. METHODS:. Twenty-six primary total hip arthroplasties (THAs) using the SMF stem were performed between August 2009 and January 2010. Patients were evaluated clinically with Harris Hip Score (HHS) and radiographically up to two years. Radiographs were analyzed to determine the degree of stem migration from its initial postoperative position. These parameters were compared to those of a cohort of 54 patients implanted with a monolithic tapered wedge stem from the same manufacturer over the same time period. RESULTS:. There were three early revisions of the femoral component for thigh pain in the SMF group, and one revision for CoCr allergy, with improvement in HHS from 60 to 89. Radiographically, 20 of 26 stems (76%) migrated into varus in the first six weeks. Of these, eight patients (29.6%) reported moderate to severe thigh pain. Radiographic evidence of isolated lateral cortical hypertrophy at the stem tip was seen in 46% of study patients, and evidence of osteointegration was seen in all cases by one year. Between one and two years post op the pain had resolved in four patients not revised. It was persistent in one patient. Comparative analysis with the control group demonstrated no significant difference in stem subsidence, but a significantly greater varus shift in coronal-plane angulation (Mean 4.3°, SD 3.8° vs. Mean 1.0°, SD 1.1°; p < 0.0001). Mean HHS was lower in the SMF group (85.2 vs. 91.4; p < 0.01) at last follow up. DISCUSSION AND CONCLUSION:. The SMF stem demonstrated a tendency towards migration into a varus position where the lateral stem touches the lateral cortex of the femur, with resulting relatively higher incidence of thigh pain and early aseptic revision

A retrospective review of 148 consecutive porous-coated hip arthroplasties (PCA) showed an incidence of thigh pain of 13% one year after surgery, and 22% at two years. Positive correlations were made with femoral stem subsidence (greater than 2 mm) and with distal periosteal and endosteal bone formation. No positive correlations were made with parameters of bone quality or component fit. Resolution of pain occurred in one-third and an anti-inflammatory agent produced partial relief in two-thirds of the patients. We conclude that thigh pain is secondary to stem instability with distal stress transfer in the absence of stable proximal fixation

Thigh pain and periprosthetic osteolysis associated with the femoral stem, is a common complication of cementless total hip arthroplasty. Treatment of this disabling complication is difficult but usually requires revision of the femoral stem, which is a procedure not without further morbidity. We describe a solution which does not require revision and which brought about resolution of the thigh pain. The patient was a 79 year old male who had a primary Total hip replacement (year 1998),This was revised (early 2001) to an uncemented cup (ABG type) and uncemented femoral component (Link MP stem) . He continued to experience disabling thigh pain which limited walking to only a few yards.The pain was thought to be related to concomitant paget’s disease in the Right hemipelvis and proximal femur. Rheumatology assessment and treatment with IV Pamidronate (three courses of treatment) did not produce any relief of pain and indicated a mechanical prosthesis related cause of pain. Radiology assessment was also indicating the same with osteolysis at the tip of the prosthesis. The patient did not want a further revision procedure, but wanted relief of pain.Therfore sufgicsl intervention to treat the osteolysis with allograft ground bone introdued retrogradely via an anterior knee approach with an intercondylar pilot hole and initial supracondylar reaming. Allograft was introduced using a 5 ml syringe and impacted with a 1 cm diameter metal rod. 50 ml of ground bone was introduced and impacted forcibly with rod and hammer impaction. The knee wound was closed in layers over 2 drains and post-op management was same as for total knee replacement, CPM and active NWB mobilization for six weeks followed by PWB, progressing to full weight bearing mobilization. Walking was free of thigh pain and walking distance was improved

Thigh pain appears often after THA used of the cement-less femoral components, but the appearance mechanism of thigh pain does not have been elucidated. As one factor of manifestation of thigh pain, it has been guessed that the pressure from the inside of medullary cavity of bone by the stem. The purpose of this study is confirming whether the flexor reflex is caused, by using the femur of a rabbit that applied the pressure from the inside of medullary cavity of bone. Japanese white rabbits with weight of about 3kg were used. Evaluation of the appearance of the pain by the pressure was performed by measurement of the hind leg flexor activity produced by the flexor reflex. After confirming that appearance of the muscles activity by the pain reflex from adding the pain stimulus to the hind leg skin of rabbits, we loaded of the pressure into the inside of medullary cavity of bone and observed whether the muscles activity appears. As the laboratory animals model, we prepared two kinds of rabbits by the difference in the amount of reaming. And we tested how the differences show up between these two kinds of rabbits. In the rabbits with few amounts of reaming, the flexor reflex appeared in low pressure. But, in the rabbits with many amounts of reaming, the flexor reflex did not appear in high pressure, either. It is known that the somatic sensory nerves are distributed in the bone, and it is known that the sensory nerve ends exist in the medullary cavity of bone. It was suggested that the pain is induced, when the sensory nerve ends remained in the inside of medullary cavity of bone and the pressure in whicha reaction is possible was carried out there

Controversy continues to exist regarding the choice of a cementless femoral component in a primary total hip arthroplasty. Both proximally coated tapered stems and fully coated cylindrical stems have excellent clinical results. The incidence of both thigh pain and proximal femoral stress shielding and multiple validated outcome measures were evaluated in a prospective randomized clinical trial with a minimum of two year follow-up comparing a proximally coated tapered femoral stem to a fully coated cylindrical femoral stem. A prospective randomized clinical trial (RCT) was performed comparing a cylindrical cobalt chrome fully coated femoral stem (Prodigy, Depuy, Warsaw, IN) to a tapered, titanium, proximally porous coated stem (Synergy, Smith & Nephew,. Memphis, TN) with respect to thigh pain, femoral stress shielding and multiple outcome measures. One hundred and ninety-four patients were enrolled and evaluations were performed pre-operatively, three months, six months and annually. Multiple outcome measures (Harris Hip Score, SF12, WOMAC, Patient Satisfaction Questionnaire, Thigh Pain Questionnaire) were obtained. Sixty-one of these patients were randomized to receive a bone density scan pre-operatively, two weeks post-operatively, six months and annually. Twelve patients were unavailable for two-year follow-up, leaving one hundred and eighty-two patients evaluated. No significant differences were demonstrated in thigh pain incidence or the multiple outcome measures. Bone density scans demonstrated significantly greater bone density (p< 0.005) in the tapered stem versus the cylindrical stem patients at two-week evaluations from distal femoral reaming. Both stem designs demonstrated statistically significant bone loss in Gruen zones one, six, seven between the two-week and one and two-year evaluations. There were no differences between stem designs although the Prodigy stem demonstrated trends towards greater bone loss in Gruen zones six and seven. This prospective RCT demonstrated no difference in thigh pain incidence and multiple outcome measures between patients receiving a proximally coated tapered versus a fully coated cylindrical femoral component. Both stem designs demonstrated statistically significant proximal femoral bone loss between the post-operative and two-year evaluations; however, there were no differences between stem designs

Aims: To review the results and clinical performance of the Anthropometric Total Hip (ATH) with line to line broaching. Methods: 70 press þt titaniumalloy double-wedge taper (136 to 213 mm [mean, 187 mm]) extensively coated grit-blasted (RA=12.0μ) stem prostheses were implanted in 67 patients. There were 29 primary THA, 33 conversions of surface replacements, 6 revision THA and 2 conversions of Hemi-Surface Replacements. The mean age was 55.8 years (range, 20 to 77 years). There were 34 males and 33 females (3 bilateral). The initial etiology was OA (50%), ON (11%), DDH (23%), Post- Trauma (4%), SCFE (2%), Rheumatoid (2%), and Ç other È (8%).Results: The mean follow-up time was 4.7 years (Range: 2–8). UCLA hip scores improved for Pain, Walking, Function, and Activity from 4.8, 6.0, 5.5, and 4.5 pre-operatively to 9.2, 8.3, 7.9, and 5.9 post-operatively. ROM was also comparable to cemented THA results. There were no intra operative fractures. One patient had a bicycling accident, fractured his femoral shaft which healed without surgery. Solid biologic þxation (Ç osseointegration È) was achieved in 100% with the grit-blasted stem. Conclusions: This early investigation shows excellent clinical results, and none of the patients reported any thigh pain. Intra-operative fractures were eliminated with line to line broaching. Our results demonstrate that thigh pain with cementless THA can be essentially eliminated with a titanium-alloy stem and a gentle double-wedge taper geometry. Extensive Ç osseointegration È suggests potential for long term durability

Aims. The aim of this study was to reassess the rate of neurological, psoas-related, and abdominal complications associated with L4-L5 lateral lumbar interbody fusion (LLIF) undertaken using a standardized preoperative assessment and surgical technique. Methods. This was a multicentre retrospective study involving consecutively enrolled patients who underwent L4-L5 LLIF by seven surgeons at seven institutions in three countries over a five-year period. The demographic details of the patients and the details of the surgery, reoperations and complications, including femoral and non-femoral neuropraxia, thigh pain, weakness of hip flexion, and abdominal complications, were analyzed. Neurological and psoas-related complications attributed to LLIF or posterior instrumentation and persistent symptoms were recorded at one year postoperatively. Results. A total of 517 patients were included in the study. Their mean age was 65.0 years (SD 10.3) and their mean BMI was 29.2 kg/m. 2. (SD 5.5). A mean of 1.2 levels (SD 0.6) were fused with LLIF, and a mean of 1.6 (SD 0.9) posterior levels were fused. Femoral neuropraxia occurred in six patients (1.2%), of which four (0.8%) were LLIF-related and two (0.4%) had persistent symptoms one year postoperatively. Non-femoral neuropraxia occurred in nine patients (1.8%), one (0.2%) was LLIF-related and five (1.0%) were persistent at one year. All LLIF-related neuropraxias resolved by one year. A total of 32 patients (6.2%) had thigh pain, 31 (6.0%) were LLIF-related and three (0.6%) were persistent at one year. Weakness of hip flexion occurred in 14 patients (2.7%), of which eight (1.6%) were LLIF-related and three (0.6%) were persistent at one year. No patients had bowel injury, three (0.6%) had an intraoperative vascular injury (not LLIF-related), and five (1.0%) had ileus. Reoperations occurred in five patients (1.0%) within 30 days, 37 (7.2%) within 90 days, and 41 (7.9%) within one year postoperatively. Conclusion. LLIF involving the L4-L5 disc level has a low rate of persistent neurological, psoas-related, and abdominal complications in patients with the appropriate indications and using a standardized surgical technique. Cite this article: Bone Joint J 2024;106-B(1):53–61

OBJECTIVE OF THE STUDY. The objective of this study is to establish the medium-term clinical and radiological results with the cementless three-dimensional Vektor-Titan stem compared with conventional cementless stem, such as PerFix stem. The latter stem has a double-wedge design with a rounded distal portion for canal filling (Fig. 1). MATERIALS AND METHODS. From July, 2004, to May, 2010, fifty seven Vektor-Titan stems and 150 PerFix stems were implanted for the patients with osteoarthritis, avascular necrosis, femoral neck fracture, and rheumatoid arthritis in our hospital. The results were evaluated clinically using Japanese Orthopedic Association (JOA) scores and the Merle d’Aubigne and Postel (M&P) scores. Radiographs were analyzed retrospectively. The criteria used for determining loosening were migration or a total radiolucent zone between the prosthesis/bone cement and host bone, wherein the width increased progressively or change of position, i.e., migration or subsidence of the prosthesis. Migration of the socket seen on the radiograph was defined as either the presence of a ≥2-mm position change or rotation. Position changes of the stem seen on the radiograph were defined as the presence of a progressive subsidence of ≥2 mm or change of position, e.g., varus or valgus. The follow-up period was 9.2 ± 2.6 (range, 5.0–14.0) years. RESULTS. One patient had intraoperative femoral shaft fracture and healed by conservative treatment. The mean JOA and M&P scores improved from preoperative 39.3 and 6.8 points to postoperative 90.9 and 17.2 points, respectively. Thigh pain was less frequent for Vektor-Titan stems (Table 1). Radiolucent lines was far less likely to appear for Vektor-Titan stems evaluated by Gruen's zonal analyses (Table 2). On the other hand, there were radiolucent zones of more than 90% in zone 4 with cementless PerFix stems (Table 2). There was no cases of loosening or postoperative infection. Although signs of bone atrophy were found in the proximal femur and the trochanters in 66.7 % of all cases, bone structure was radiologically normal without stress shielding in most cases (Table 2). On the contrary, there was evidence of an even denser bone structure, such as trabeculae, at the tip of the stem and the lateral implant fixation within the greater trochanter in Vektor-Titan stem cases. These findings remained unchanged over observation periods. DISCUSSION AND CONCLUSIONS. The cementless Vektor-Titan stem is made of Ti6AI7Nb, has got the shape of a straight three-dimensional cone. It has a high proximal volume in the form of a three-dimensional taper with longitudinal ribs. This design achieves strong primary fixation in the proximal metaphysis. Radiologically, newly formed trabeculae toward to the stem were indicative of direct biological fixation at the bone-implant interface. Medium-term results with the cementless Vektor-Titan stem show no implant loosening with stable metaphyseal fixation and preservation of bone structure in the proximal femur and the absence of radiolucent zones around the stem compared with conventional cementless stem

We have reviewed retrospectively 80 patients who were treated for traumatic fractures of the femur with a Grosse-Kempf nail to assess the incidence and causes of persisting pain in the proximal thigh.

At a mean of 21 months after operation 33 patients had residual pain severe enough to interfere with their lifestyle or mobility. This was in the region of the scar on the greater trochanter in three-quarters of the patients. Only four showed no radiological abnormality. There was nonunion of the fracture in two, Paget’s disease in one, breakage of the nail in two and prominence of the proximal locking screw in five, although we found no correlation between prominence of the nail and pain.

There was a strong relationship between pain and heterotopic ossification at the proximal end of the implant; this was present in 64% of the patients with pain as compared with those without pain (p < 0.001, Mann-Whitney U test). Of the 80 patients, 27 had the implant removed after 18 months, 17 of them because of pain. In six of these 17, the pain was not relieved. Prominence of the nail proximally was not associated with pain, but protuberance of laterally-based proximal locking screws caused problems. We found a strong association between heterotopic bone formation and pain, but it is uncertain whether this is the true cause or merely an indication of some other factor such as traumatic damage to the glutei during insertion of the nail. Removal of the implant does not always cure such pain.

Glomus tumours are rare and benign, arising from a neuromyoarterial glomus body, most commonly in the hand. We report a patient with such a tumour in an atypical site, the right vastus lateralis. Pain was aggravated by muscle contraction, and ultrasonography and MRI were required to locate the lesion accurately. Surgical excision gave immediate pain relief.

Abstract. Background. The use of tourniquet in knee arthroplasty is common but in recent times, it has initiated a debate on its use. Complications from use of tourniquet are well documented in literature but there is less evidence on thigh pain, blood loss and length of stay post arthroplasty. Methods. We included 62 patients undergoing knee arthroplasty either Unicondylar knee arthroplasty or total knee arthroplasty. Patients were allocated randomly in tourniquet and without tourniquet groups. Half of the patients had UKA and other half TKA. Thigh pain was recorded using Visual analogue scale on day 1, 2 and on discharge. A drop in pre-operative and post operative haemoglobin level was recorded too. Independent sample t-test was done to compare the difference between the 2 groups mainly, drop in haemoglobin, thigh pain, knee pain and length of stay. Results. The mean drop in haemoglobin was comparable and was not statistically significant. Thigh pain on day 1 in no tourniquet group had a mean value of 0 and statistically significant difference in thigh pain at day 1,2 and discharge. In subgroup analysis between TKA and UKA the latter had improved results. Conclusions. Knee arthroplasty surgery without the use of tourniquet provides less thigh pain in the post-operative period and there isn't any significant difference in post op haemoglobin drop. None of the patient required any blood transfusion. A trend of early discharge was noted too but probably due to sample size, it wasn't statistically significant

Aims. There are concerns regarding initial stability and early periprosthetic fractures in cementless hip arthroplasty using short stems. This study aimed to investigate stress on the cortical bone around the stem and micromotions between the stem and cortical bone according to femoral stem length and positioning. Methods. In total, 12 femoral finite element models (FEMs) were constructed and tested in walking and stair-climbing. Femoral stems of three different lengths and two different positions were simulated, assuming press-fit fixation within each FEM. Stress on the cortical bone and micromotions between the stem and bone were measured in each condition. Results. Stress concentration was observed on the medial and lateral interfaces between the cortical bone and stem. With neutral stem insertion, mean stress over a region of interest was greater at the medial than lateral interface regardless of stem length, which increased as the stem shortened. Mean stress increased in the varus-inserted stems compared to the stems inserted neutrally, especially at the lateral interface in contact with the stem tip. The maximum stress was observed at the lateral interface in a varus-inserted short stem. All mean stresses were greater in stair-climbing condition than walking. Each micromotion was also greater in shorter stems and varus-inserted stems, and in stair-climbing condition. Conclusion. The stem should be inserted neutrally and stair-climbing movement should be avoided in the early postoperative period, in order to preserve early stability and reduce the possibility of thigh pain, especially when using a shorter stem. Cite this article: Bone Joint Res 2021;10(4):250–258

The Thompson hemiarthroplasty is a common treatment option for acute neck of femur fractures in the elderly population. Our department noted a significant number of patients returning with thigh pain, radiographic loosening and femoral osteolysis following cemented implantation of the titanium alloy version of the Thompson hemiarthroplasty. We are not aware of any previous reports documenting complications specific to the titanium Thompson implant and a retrospective cohort study was therefore initiated following clinical governance approval. 366 titanium alloy Thompson prostheses were implanted for hip fracture treatment between 2017 and 2020. As of February 2023, 6 of these have been revised at our hospital. 5 were revised for symptomatic femoral osteolysis and 1 presented with an acute periprosthetic fracture. All revised cases were determined to be aseptic. 32 living patients were excluded from recall on compassionate grounds due to permanent nursing home residence. 47 living patients were identified of which 33 attended for xray. 28 deceased and/or nursing home resident patients who had pelvis x-rays in the previous 12 months were also included in the analysis. Including the 6 index hips already revised, a total of 61 hip xrays were analysed, of which 19 hips (31.1%) showed radiographic evidence of femoral osteolysis or loosening. We conclude that there is a concerning incidence of femoral osteolysis and implant loosening associated with the titanium Thompson implant. We have discontinued use of the implant and reported our experience to the MHRA. We encourage other Scottish Health-Boards who use this implant to consider enhanced follow-up