Dislocation remains a leading cause of failure following revision total hip arthroplasty (THA). While dual-mobility (DM) bearings have been shown to mitigate this risk, options are limited when retaining or implanting an uncemented shell without modular DM options. In these circumstances, a monoblock DM cup, designed for cementing, can be cemented into an uncemented acetabular shell. The goal of this study was to describe the implant survival, complications, and radiological outcomes of this construct. We identified 64 patients (65 hips) who had a single-design cemented DM cup cemented into an uncemented acetabular shell during revision THA between 2018 and 2020 at our institution. Cups were cemented into either uncemented cups designed for liner cementing (n = 48; 74%) or retained (n = 17; 26%) acetabular components. Median outer head diameter was 42 mm. Mean age was 69 years (SD 11), mean BMI was 32 kg/m2 (SD 8), and 52% (n = 34) were female. Survival was assessed using Kaplan-Meier methods. Mean follow-up was two years (SD 0.97).Aims
Methods
The aim of this study was to evaluate the incidence of liner malseating in two commonly used dual-mobility (DM) designs. Secondary aims included determining the risk of dislocation, survival, and clinical outcomes. We retrospectively identified 256 primary total hip arthroplasties (THAs) that included a DM component (144 Stryker MDM and 112 Zimmer-Biomet G7) in 233 patients, performed between January 2012 and December 2019. Postoperative radiographs were reviewed independently for malseating of the liner by five reviewers. The mean age of the patients at the time of THA was 66 years (18 to 93), 166 (65%) were female, and the mean BMI was 30 kg/m2 (17 to 57). The mean follow-up was 3.5 years (2.0 to 9.2).Aims
Methods
Modular dual-mobility constructs reduce the risk of dislocation after revision total hip arthroplasty (THA). However, questions about metal ions from the cobalt-chromium (CoCr) liner persist, and are particularly germane to patients being revised for adverse local tissue reactions (ALTR) to metal. We determined the early- to mid-term serum Co and Cr levels after modular dual-mobility components were used in revision and complex primary THAs, and specifically included patients revised for ALTR. Serum Co and Cr levels were measured prospectively in 24 patients with a modular dual-mobility construct and a ceramic femoral head. Patients with CoCr heads or contralateral THAs with CoCr heads were excluded. The mean age was 63 years (35 to 83), with 13 patients (54%) being female. The mean follow-up was four years (2 to 7). Indications for modular dual-mobility were prosthetic joint infection treated with two-stage exchange and subsequent reimplantation (n = 8), ALTR revision (n = 7), complex primary THA (n = 7), recurrent instability (n = 1), and periprosthetic femoral fracture (n = 1). The mean preoperative Co and Cr in patients revised for an ALTR were 29.7 μg/l (2 to 146) and 21.5 μg/l (1 to 113), respectively.Aims
Patients and Methods
When fracture of an extensively porous-coated
femoral component occurs, its removal at revision total hip arthroplasty
(THA) may require a femoral osteotomy and the use of a trephine.
The remaining cortical bone after using the trephine may develop
thermally induced necrosis. A retrospective review identified 11
fractured, well-fixed, uncemented, extensively porous-coated femoral
components requiring removal using a trephine with a minimum of
two years of follow-up. The mean time to failure was 4.6 years (1.7 to 9.1, standard
deviation ( A total of four patients (36.4%) required further revision: three
for instability and one for fracture of the revision component.
There was no statistically significant difference in the mean Harris
hip score before implant fracture (82.4; These findings suggest that removal of a fractured, well-fixed,
uncemented, extensively porous-coated femoral component using a
trephine does not compromise subsequent fixation at revision THA
and the patient’s pre-operative level of function can be restored.
However, the loss of proximal bone stock before revision may be associated
with a high rate of dislocation post-operatively. Cite this article:
Revision total hip arthroplasty (THA) is challenging
when there is severe loss of bone in the proximal femur. The purpose
of this study was to evaluate the clinical and radiographic outcomes
of revision THA in patients with severe proximal femoral bone loss
treated with a fluted, tapered, modular femoral component. Between
January 1998 and December 2004, 92 revision THAs were performed
in 92 patients using a single fluted, tapered, modular femoral stem
design. Pre-operative diagnoses included aseptic loosening, infection
and peri-prosthetic fracture. Bone loss was categorised pre-operatively
as Paprosky types III-IV, or Vancouver B3 in patients with a peri-prosthetic
fracture. The mean clinical follow-up was 6.4 years (2 to 12). A
total of 47 patients had peri-operative complications, 27 of whom
required further surgery. However, most of these further operations
involved retention of a well-fixed femoral stem, and 88/92 femoral
components (97%) remained Revision THA in patients with extensive proximal femoral bone
loss using the Link MP fluted, tapered, modular stem led to a high
rate of osseointegration of the stem at mid-term follow-up. Cite this article:
Obesity is a risk factor for complications following
many orthopaedic procedures. The purpose of this study was to investigate
whether obesity was an independent risk factor increasing the rate
of complications following periacetabular osteotomy (PAO) and to
determine whether radiographic correction after PAO was affected
by obesity. We retrospectively collected demographic, clinical and radiographic
data on 280 patients (231 women; 82.5% and 49 men; 17.5%) who were
followed for a mean of 48 months (12 to 60) after PAO. A total of
65 patients (23.2%) were obese (body mass index (BMI) >
30 kg/m2).
Univariate and multivariate analysis demonstrated that BMI was an independent
risk factor associated with the severity of the complications. The
average probability of a patient developing a major complication
was 22% (95% confidence interval (CI) 11.78 to 38.21) for an obese
patient compared with 3% (95% CI 1.39 to 6.58) for a non-obese patient
The odds of a patient developing a major complication were 11 times
higher (95% CI 4.71 to 17.60, p <
0.0001) for an obese compared
with a non-obese patient. Following PAO surgery, there was no difference in radiographic
correction between obese and non-obese patients. PAO procedures
in obese patients correct the deformity effectively but are associated
with an increased rate of complications. Cite this article:
Dysplasia of the hip, hypotonia, osteopenia,
ligamentous laxity, and mental retardation increase the complexity
of performing and managing patients with Down syndrome who require
total hip replacement (THR). We identified 14 patients (six males,
eight females, 21 hips) with Down syndrome and degenerative disease
of the hip who underwent THR, with a minimum follow-up of two years
from 1969 to 2009. In seven patients, bilateral THRs were performed
while the rest had unilateral THRs. The mean clinical follow-up
was 5.8 years (standard deviation ( Cite this article:
The treatment of hip dysplasia should be customised
for patients individually based on radiographic findings, patient
age, and the patient’s overall articular cartilage status. In many
patients, restoration of hip anatomy as close to normal as possible
with a PAO is the treatment of choice. Cite this article:
We surveyed 343 young women with 420 total hip arthroplasties (THAs) regarding pregnancy and childbirth after THA. The mean age at surgery was 35 years (18 to 45). The mean length of follow-up after the initial arthroplasty was 16 years (6 to 27). Of these 343 women, 47 (13.7%) had a successful pregnancy after their primary THA. The first baby after a THA was delivered vaginally in 30 patients and by Caesarean section in 17. Of the 343 patients, 138 underwent a revision. For the entire series, the risk of revision at five years was 5%, at ten years 24%, and at 20 years 50%. After adjusting for age at surgical intervention, the risk of revision was not significantly associated with childbirth. Of the 47 patients who had a successful pregnancy, 28 (60%) noted an increase in pain in the hip during pregnancy and ten of these patients had persistent pain after their pregnancy. Seven patients complained of pain in the groin in the replaced hip after childbirth. At the time of this survey, five of these patients (70%) had had revision THA. Childbirth is not affected by the presence of a THA. Pregnancy after THA is not associated with decreased survival of the prosthesis. Pain in the hip is common during pregnancy in these patients. Pain in the groin which persists after delivery commonly leads to revision of the THA.
The anterior centre-edge (VCA) angle quantifies the anterior cover of the femoral head, and angles of less than 20° are considered abnormal. We have measured the VCA angles in hips without osteoarthritic changes. We took bilateral false-profile radiographs of nine female and 30 male cadavers without signs of osteoarthritis. The mean age at the time of death was 72 years (46 to 92). The mean VCA angle was 32.8° (17.7 to 53.6). The SD was 7.9°. Our findings suggest that the threshold of abnormality of the VCA angle may be slightly lower than previously thought. This information may be useful in counselling patients with asymptomatic acetabular dysplasia.