Total hip arthroplasty (THA) is increasingly used for active patients with displaced intracapsular hip fractures. Dislocation rates in this cohort remain high postoperatively compared to elective practice, yet it remains unclear which patients are most at risk. The aim of this study was to determine the dislocation rate for these patients and to evaluate the contributing patient and surgeon factors. A five-year retrospective analysis of all patients receiving THA for displaced intracapsular hip fractures from 2013–18 was performed. Data was collected from the institutions' hip fracture database, including data submitted to the National Hip Fracture Database (NHFD). Cox regression analysis and log-rank tests were implemented to evaluate factors associated with THA dislocation. Patient age, sex, ASA grade, surgeon seniority, surgical approach, femoral head diameter and acetabular cup type were all investigated as independent factors.Background
Methods
Metal-on-metal (MoM) hip resurfacing was developed in the 1990s by surgeons in Birmingham, UK, as a surgical solution to the problem of osteoarthritis in younger, more active patients. Early results were promising and the procedure gained in popularity. However, adverse reports of soft-tissue reaction and failure started to appear from 2008 onwards. Surgeons may be asked to write medico-legal reports on the surgical aspects of an individual case for claimant lawyers or in defence for the NHSLA or indemnity insurers. The purpose of this article is to cover some of the aspects of the operation that may be considered in such medico-legal reports.
Deficiency of the abductor mechanism is a well-recognised
cause of pain and limping after total hip replacement (THR). This
can be found incidentally at the time of surgery, or it may arise
as a result of damage to the superior gluteal nerve intra-operatively,
or after surgery owing to mechanical failure of the abductor muscle
repair or its detachment from the greater trochanter. The incidence
of abductor failure has been reported as high as 20% in some studies.
The management of this condition remains a dilemma for the treating
surgeon. We review the current state of knowledge concerning post-THR
abductor deficiency, including the aetiology, diagnosis and management,
and the outcomes of surgery for this condition. Cite this article:
