1 . The results of compression arthrodesis of the hip have been studied in fifty-six patients. There was one post-operative death from pulmonary embolism on the tenth day. 2. Bony union for the whole series (fifty-five patients) was achieved in 76·4 per cent. Sound fibrous ankylosis, indistinguishable from bony union clinically and functionally, was achieved in 10·9 per cent. Residual movement occurred in 12·7 per cent. 3. Thirty-five patients were treated by the standard technique of eight weeks in plaster, followed by full weight bearing, irrespective of whether any movement was detected on clinical testing. 82·8 per cent achieved sound bony union; 5·7 per cent achieved sound fibrous ankylosis, and residual movement occurred in 11·4 per cent. 4. Ten patients were treated without plaster protection; six achieved bony union; three had sound fibrous ankylosis and one had residual movement. Healing was delayed in this group and there was more residual deformity. 5. 67·5 per cent of all patients recovered full knee range. Only one patient with reduced range had knee flexion of less than 90 degrees. Twenty-four of the thirty-five patients treated by the standard technique of eight weeks in plaster were examined. Fifteen had full knee movement; in only four was knee flexion less than 120 degrees and in no case was it less than 90 degrees. 6. Return to full activity was rapid. Sixty per cent of patients returned to work within six months and 80 per cent within nine months of surgery. Five of the six patients examined with residual movement in the hip joint were back at work within six months of surgery. 7. This study lends support to the view that arthrodesis of the hip, in the presence of normal function in the opposite hip, is compatible with vigorous and full activity

Discrepancy in leg length after total hip replacement has been associated with patient dissatisfaction. We prospectively studied 200 consecutive patients undergoing unilateral Charnley hip replacements to identify whether there is a demonstrable association between such disparity and postoperative function. Radiological measurements between defined points on the pelvis and femur of the operated hip were compared with the same points on the contralateral joint. A lengthening index was derived and statistical analysis used to compare this with validated functional outcome scores (Harris hip score and the SF36 Health Survey) and patient satisfaction. Our results showed no statistical association between leg-length discrepancy after hip arthroplasty and functional outcome or patient satisfaction

During hip resurfacing arthroplasty, excessive valgus positioning or surgical technique can result in notching of the femoral neck. Although mechanical weakening and subsequent fracture of the femoral neck are well described, the potential damage to the retinacular vessels leading to an ischaemic event is relatively unknown. Using laser Doppler flowmetry, we measured the blood flow in 14 osteoarthritic femoral heads during routine total hip replacement surgery, before and after notching of the femoral neck. In ten hips there was a reduction in blood flow of more than 50% from the baseline value after simulated notching of the femoral neck. Our results suggest that femoral head vascularity in the osteoarthritic state is similar to the non-arthritic state, where damage to the extraosseous vessels can predispose to avascular necrosis. Surgeons who perform resurfacing arthroplasty of the hip should pay careful attention to these vessels by avoiding excessive dissection around the femoral neck and/or notching

We performed a meta-analysis to evaluate the relative efficacy of regional and general anaesthesia in patients undergoing total hip or knee replacement. A comprehensive search for relevant studies was performed in PubMed (1966 to April 2008), EMBASE (1969 to April 2008) and the Cochrane Library. Only randomised studies comparing regional and general anaesthesia for total hip or knee replacement were included. We identified 21 independent, randomised clinical trials. A random-effects model was used to calculate all effect sizes. Pooled results from these trials showed that regional anaesthesia reduces the operating time (odds ratio (OR) −0.19; 95% confidence interval (CI) −0.33 to −0.05), the need for transfusion (OR 0.45; 95% CI 0.22 to 0.94) and the incidence of thromboembolic disease (deep-vein thrombosis OR 0.45, 95% CI 0.24 to 0.84; pulmonary embolism OR 0.46, 95% CI 0.29 to 0.80). Regional anaesthesia therefore seems to improve the outcome of patients undergoing total hip or knee replacement

General remarks–Comparison of the two reviews shows that patients with good results return more readily for a review than those with poor results. In middle-aged patients with some disability for walking an attendance of 80 per cent at least is necessary in order to obtain a representative follow-up five to ten years after operation. An outstanding feature of all the operations reviewed is the degree of lasting relief of pain. It is rare to find that a patient with severe hip pain before operation has pain of the same severity after any of these operations at least up to ten years afterwards, and probably for much longer. Generally speaking, although in advancing years stiffness of the hip is undoubtedly a handicap, it is preferable to instability, particularly if this is progressive. A patient can adapt himself to and accept a disability that is permanent and unaltering, but instability increasing in later years can be distressing mentally and incapacitating physically. Cup arthroplasty–There is an element of unpredictability in the results, especially the late results, of cup arthroplasty. Movement decreases and there is a tendency for pain and instability to increase after four or five years. There is little to indicate which case will be successful although the results vary according to the condition for which operation is performed. The operation gives good results, on the whole, for osteoarthritis, particularly when the operation is done on one hip only. Stability is much more important when both hips are involved, and, unless this is good in at least one hip, the results of bilateral operations are poor. "Excellent" results are not obtained in rheumatoid arthritis but few results are "poor." Operations for congenital dislocation of the hip give the most disappointing results. In operations for ankylosing spondylitis there is a high incidence of stiffening of the hip, but many patients are greatly improved in comparison to their state before operation. Displacement osteotomy–The hazard in displacement osteotomy is ankylosis, particularly when internal fixation is not used. Relief of pain and stability are well maintained. The results in general, and for pain in particular, are less good when internal fixation is used. Adduction of the upper fragment of the femur appears to be of value in the production of a good result. In the series examined it was less often achieved when internal fixation was the method of immobilisation. The best results were obtained in cases of congenital dislocation of the hip and there were few "poor" results in cases of congenital subluxation. Excision of the head and neck of the femur and Batchelor's operation–Rehabilitation may take a long time, but the late results are more predictable than in the other operations reviewed. A "fair" result is more likely than an "excellent" one, but late "poor" results are few. Relief of pain is better after excision of the head and neck than after any other operation reviewed

1. Two hundred and eleven cases of arthroplasty of the hip have been studied in an attempt to establish the causes of success and failure by comparing the excellent, good and bad results. 2. The findings suggest that the result of an arthroplasty depends largely upon four factors: the surgical approach to the hip joint, the acetabular roof, the interposition substance, and the early post-operative complications. 3. Some important points in the technique of operation and in the post-operative management are described

This review describes the development of arthroscopy of the hip over the past 15 years with reference to patient assessment and selection, the technique, the conditions for which it is likely to prove useful, the contraindications and complications related to the procedure and, finally, to discuss possible developments in the future

We investigated the relationship between a number of patient and management variables and mortality after surgery for fracture of the hip. Data relating to 18 817 patients were obtained from the Scottish Hip Fracture Audit database. We divided variables into two categories, depending on whether they were case-mix (age; gender; fracture type; pre-fracture residence; pre-fracture mobility and ASA scores) or management variables (time from fracture to surgery; time from admission to surgery; grade of surgical and anaesthetic staff undertaking the procedure and anaesthetic technique). Multivariate logistic regression analysis showed that all case-mix variables were strongly associated with post-operative mortality, even when controlling for the effects of the remaining variables. Inclusion of the management variables into the case-mix base regression model provided no significant improvement to the model. Patient case-mix variables have the most significant effect on post-operative mortality and unfortunately such variables cannot be modified by pre-operative medical interventions

Fifty-four adults with eighty hips affected by congenital disease which had not been treated have been reviewed. Fifty-nine per cent of forty-two dislocated hips had fair or poor grading scores. The incidence of osteoarthritis was markedly increased in the presence of a well-developed false acetabulum. Unilateral dislocation led to valgus deformity and degenerative changes in the ipsilateral knee in seven of twenty-two patients. Dislocation did not increase the incidence of symptomatic lumbar spondylosis. The height of the dislocated head on the ilium was not found to be related to the prognosis for the hip, the knee or the lumbar spine and did not correlate with the development of the false acetabulum. Frank congenital subluxation eventually led to osteoarthritis of the hip

We reviewed the results of anterior hip release for fixed flexion deformity in 57 hips in 38 children with spina bifida at an average follow-up of 8.9 years (2 to 22). The indication for this operation was a fixed flexion deformity of more than 30° which interfered with function. In 43 hips there was a good outcome in that the fixed flexion deformity remained less than 30° at follow-up. Four hips had a good initial result but deteriorated after an average of five years, and ten had a poor outcome with deformity of over 30°. Six hips required a repeated anterior hip release and two of these were successful. The success of anterior hip release could not be related to the neurological level or the age at operation. Successful surgery correlated with the walking ability of the child at the latest follow-up

Three cases are reported which presented as "irritable" or "observation" hips and failed to respond to rest at home and in hospital. In each case a campylobacter organism was grown from the faeces; none were found in a group of 20 patients in the paediatric ward for other reasons. The patients responded to a course of erythromycin. It is postulated that they may have had a reactive arthropathy of the hip and suggested that cultures for Campylobacter be made as part of the investigation of irritable hip

We have compared the energy expenditure during walking in three patients, aged between 51 and 55 years, with unilateral disarticulation of the hip when using the mechanical-controlled stance-phase control knee (Otto Bock 3R15) and the microprocessor-controlled pneumatic swing-phase control knee (Intelligent Prosthesis, IP). All had an endoskeletal hip disarticulation prosthesis with an Otto Bock 7E7 hip and a single-axis foot. The energy expenditure was measured when walking at speeds of 30, 50, and 70 m/min. Two patients showed a decreased uptake of oxygen (energy expenditure per unit time, ml/kg/min) of between 10.3% and 39.6% when using the IP compared with the Otto Bock 3R15 at the same speeds. One did not show any significant difference in the uptake of oxygen at 30 m/min, but at 50 and 70 m/min, a decrease in uptake of between 10.5% and 11.6% was found when using the IP. The use of the IP decreased the energy expenditure of walking in these patients

We present a case of late dislocation of the hip in a 30-month-old girl. Her hip was clinically stable at birth and an ultrasound scan at six weeks was normal. She had no additional risk factors for developmental dysplasia. She underwent anterior open reduction with a femoral osteotomy

This study evaluated the feasibility of using published data from more than one register to define the performance of different hip implants. In order to obtain estimates of performance for specific types of hip system from different register, we analysed data from the annual reports of five national and one Italian regional register. We extracted the number of implants and rates of implant survival at different periods of follow-up. Our aim was to assess whether estimates of cumulative survival rate were comparable with data from registers from different countries, and our conclusion was that such a comparison could only be performed incompletely

1. The literature of dislocation of the hip in childhood from 1922 to 1954 is reviewed. A total of eighty-eight cases have been recorded. 2. A further case, in a child of one year and eleven months, is described. 3. Nine of the children whose cases have been recorded developed Perthes' disease of the hip after the dislocation, an incidence of 10 per cent. A similar incidence of avascular necrosis of the femoral head has been reported after dislocation of the hip in adults

1. The condition of persistent foetal alignment is discussed both as an entity and in its relationship to the development of a normal hip, and also to the varying degrees of congenital dislocation of the hip. A possible connection with osteoarthritis is also mentioned. 2. The secondary deformities to which it may give rise are discussed, and the way in which both primary and secondary deformities may be corrected is described. 3. The importance of estimating rotation with the hip in full extension is emphasised. 4. The results in eight patients so treated are mentioned

Aims. The National Joint Registry for England, Wales and Northern Ireland (NJR) has extended its scope to report on hospital, surgeon and implant performance. Data linkage of the NJR to the London Implant Retrieval Centre (LIRC) has previously evaluated data quality for hip primary procedures, but did not assess revision records. . Methods. We analysed metal-on-metal hip revision procedures performed between 2003 and 2013. A total of 69 929 revision procedures from the NJR and 929 revised pairs of components from the LIRC were included. Results. We were able to link 716 (77.1%) revision procedures on the NJR to the LIRC. This meant that 213 (22.9%) revision procedures at the LIRC could not be identified on the NJR. We found that 349 (37.6%) explants at the LIRC completed the full linkage process to both NJR primary and revision databases. Data completion was excellent (> 99.9%) for revision procedures reported to the NJR. Discussion. This study has shown that only approximately one third of retrieved components at the LIRC, contributed to survival curves on the NJR. We recommend prospective registry-retrieval linkage as a tool to feedback missing and erroneous data to the NJR and improve data quality. Take home message: Prospective Registry – retrieval linkage is a simple tool to evaluate and improve data quality on the NJR. Cite this article: Bone Joint J 2016;98-B:33–9

We studied 1061 children with myelomeningocele, reviewing 3184 pelvic radiographs from 802 patients. Hip dislocation had occurred by the age of 11 years in 28% of children with a thoracic neurosegmental level, 30% of those with an L1/2 level, 36% of L3, 22% of L4, 7% of L5 and only 1% of those with sacral levels. Hip dislocation was not inevitable even when there was maximal muscle imbalance about the hip. The average hip flexion contracture in children aged 9 to 11 years was significantly greater in those with thoracic (22 degrees) and L1/2 (33 degrees) levels than in those with L4 (9 degrees), L5 (5 degrees) or sacral (4 degrees) levels. Our findings indicate that muscle imbalance is not a significant factor in the production of flexion deformity or dislocation of the hip; both are commonly seen in the absence of imbalance. The restoration of muscle balance should no longer be considered to be the principal aim of the management of the hip in children with myelomeningocele

Between January 1984 and January 1986, 131 porous-coated anatomic total hip replacements were performed in 119 consecutive patients. Of these, 100 patients (110 hips) who were alive at a minimum of 18 years after replacement were included in the study. The mean age of the patients at surgery was 48.4 years and that of surviving patients at the latest follow-up was 67.8 years. The mean duration of the clinical and radiological follow-up was 19.4 years (18 to 20). The mean Harris hip score initially improved from 55 points before to 95 points at two years after operation, but subsequently decreased to 91 points after six years, 87 points after 11.2 years, and 85 points after 19.4 years. At the final follow-up, 23 hips (18%) of the entire cohort and 21% of survivors had undergone revision because of loosening or osteolysis of the acetabular component and eight hips (6%) of the entire cohort and 7% of survivors for loosening or osteolysis of the femoral component. Only four femoral components (4%) were revised for isolated aseptic loosening without osteolysis and two (2%) for recurrent dislocation. On the basis of these long-term results, the porous-coated anatomic femoral component survived for a minimum of 18 years after operation while the acetabular component was less durable. The findings identify the principles of uncemented joint replacement which can be applied to current practice

The Norwich Health District (population 400,000) has been studied during a five-year period in an attempt to assess the value of examination of the hip in the newborn. It is confirmed that complicated deliveries produce higher rates of neonatal instability. But, in sixteen out of the seventeen cases with hip dislocations diagnosed late, delivery had been normal. It is estimated that after normal deliveries, hospital doctors detect only 50%, and family doctors only 28%, of cases of instability of the hip. It is concluded: 1) that the problem of congenital dislocation of the hip will not be eliminated by neonatal examination alone, even if skill in clinical examination could be improved and maintained; 2) that repeated examinations should be considered mandatory until the child is walking. In this regard, the value of the sign of limitation of abduction requires study; 3) that the public should be made aware by an appropriate health education programme that the problem of congenital dislocation of the hip has not yet been solved