Aims: Review short to medium term results of a metal-on-metal (M/M) hybrid surface arthroplasty (SA) for a young and active patient population. Methods: The þrst 400 hips (of 533) in 355 patients underwent M/M hybrid surface arthroplasty. Mean age 48.2; 73% males, 27% females; 198 Charnley Class A; 139 Class B and 18 Class C. Diagnosis at surgery: OA 64%, DDH 11%, ON 9%, Post-traumatic 8%, Inßammatory arthritis 3%, SCFE and LCP 4%, Melorheostosis 0.3%. Results: Mean follow-up 3.9 years (2.6–6.5). Average UCLA hip scores post-op: pain 9.4, walking 9.5, function 9.4, and activity 7.7. The SF-12 physical and mental components were respectively, 31.2 and 46.8 pre-op and 50.1 and 53.0 post-op. 12 hips were converted to THA (8 in the þrst 102): 2 neck fractures, 7 femoral loosenings, 1 socket protrusio due to over-reaming, 1 subluxation due to impingement and 1 sepsis. Conclusions: Clinical results are excellent despite very high activity levels. The experience with SA of all cemented metal/UHMWPE bearing demonstrated failure rates of 15%–33% at 3 years. At longer follow-up, the preliminary experience is encouraging (3% failure rate). Dislocation is rare, and acetab-ular þxation secure. Initial femoral þxation is critical as the þxation area is small, especially with osteopenia and cystic degeneration. The percent of complications and potentially adverse radiographic changes was much greater in the þrst 100 cases, during the time of development of instrumentation, technique, and bearing optimization.

Aims: To review the medium term clinical and X-Ray results of DDH in SA, using the Conserve Plusª. Methods: 28 hips (26 patients, avg. age 43.2 years) with DDH were treated with hybrid MMSA. 81% were female. 42% had prior osteotomies. 25% had acetabular cysts that were grafted and 64% had femoral cysts (> 1cm in size) & 1 was grafted. A posterior approach was used in all but one case. Results: Mean F/U was 4.1 years (3.3– 6.5). UCLA hip scores were 3.3, 6.0, 5.7 and 4.5 pre-op and 9.2, 9.3, 9.3 and 7.1 at last F/U for pain, walking, function and activity. SF-12 scores normalized. Range of motion was 121.3û, 73.7û and 83.7û at last F/U for Flexion, abductionadduction, and rotation arcs. 2 hips were converted to THA: 1 for femoral neck fracture at 2 months (neck osteopenia and cystic degeneration) and 1 for recurrent subluxations due to poor offset and impingement due to prior multiple osteotomies. 4 technical complications successfully resolved: 1 trochanteric non-union, 1 post-op dislocation (closed reduction), 1 component mismatch (acetabular component exchange) and 1 femoral nerve palsy. X-ray analysis: 2 pts. presented complete radiolucencies around the metaphyseal stem and 1 patient was symptomatic and will require revision). Conclusions: SA is stable, except for 1 subluxation due to impingement with poor off-set compared to 7–10% with THA. The socket þxation is secure with grafts incorporating whereas prior SA with PE were poor due primarily to socket loosening. Femoral bone preparation is critical to avoid fractures and loosening.

Aims: The purpose of this study was to determine the success of retaining a well-þxed acetabular component at the time of isolated femoral revision and identify variables that may inßuence clinical decision making and outcome. Methods: 83 consecutive patients (90 hips) with a retained cementless socket during revision of a femoral component were reviewed. Eighty-þve percent of the hips were initially reconstructed as metal on polyethylene surface arthroplasty (SA) and 15% as a standard stem type total hip replacement (THR). Average age at the time of revision was 54. 33% of the patients had acetabular osteolysis of which 52% were grafted. Results: Mean follow up 9.6 years (5.5 to 15.9). Average time in situ of socket 14.8 years (7.1 to 20.2). 5 sockets were revised at a mean of 6.8 (2.5–10.4) years post revision and 13.1 years in situ. Reasons for socket revision were: 1 socket loosening, 1 dissociation of the liner cemented into the original socket, 1 instability, 1 conversion to a Metal/Metal bearing and 1 because it was the surgeonñs preference to remove the well-þxed socket. Dislocation rate was 15% with 50% occurring in the þrst 6 months post revision. Nine had more than one episode of dislocation. No recurrence or expansion of pelvic osteolysis was observed at last follow-up. Discussion: Revision of a cementless socket on the basis of the duration in vivo and/or presence of osteolysis does not appear to be warranted. Because of the high risk of dislocation off set liners/stems and larger femoral head sizes should be considered, especially in revision of SA.