Acetabular Side Research Articles

Acetabular and Femoral Component Positioning Using Direct Anterior Approach Versus Posterior Approach in Total Hip Arthroplasty.

Direct anterior approach (DAA) has recently become popular in total hip arthroplasty (THA). However, irrespective of the surgical approach used, component malposition is an important factor affecting function and complications after THA. This study aims to compare component positioning on the femoral and acetabular side between DAA and posterior approach (PA) to the hip joint. We hypothesized that the two approaches are similar in terms of component positioning. We prospectively studied 50 patients, matched according to age, sex, and body mass index, undergoing THA, divided non-randomly into 2 groups. Group 1 comprised 25 patients (35 hips) undergoing THA using DAA and group 2 comprised 25 patients (25 hips) undergoing THA using PA. Ten patients from group 1 had simultaneous bilateral THA. Radiological parameters studied were acetabular inclination (AI), coronal femoral stem alignment (CFA), leg length difference (LLD), acetabular cup version (AV), and femoral stem version (FV). There was no significant difference in AI, CFA, LLD, AV, and FV between the two groups. Excellent to good inter and intra-observer reliability expressed in terms of intraclass correlation coefficient (ICC) was noted for all the radiographic measurements. Both DAA and PA for THA achieve comparable radiological component positioning. DAA may not provide any advantage over PA in terms of positioning of the prosthesis. Level II, non-randomized comparative study.

Neglected Total Hip Dislocation

Background: Dislocation of total hip arthroplasty (THA) needs prompt intervention and reduction either closed or open. It is unusual to left THA dislocated. Hence in this study, the outcomes of neglected prosthesis after THA were determined. Methods: In this case series study, 15 neglected cases of total hips which had been left unreduced for long time (more than 3 months) were assessed. Cause of postponing reduction, femoral side and acetabular side defects, approach and type of revised prosthesis, Harris hip score (HHS), and other complications were studied. Results: The results in this study demonstrated that financial issues were the cause of delayed attempt for treatment in 5 cases and the other 10 cases had delay for treatment, because they searched for a specialist to accept performing an operating on them. There were some acetabular side and femoral side defects. By Paprosky classification, in femoral side, there were 6 defects: four type 2, one type 3A, and one 3B. In acetabular side, there were 10 defects (three type 1, one type 2a, three type 2b, one type 3a, and two type 3b). In one developmental dysplasia of the hip (DDH) case, previous osteotomy site was revised (distal segment rotated and then refixed) Conclusion: Totally, according to the obtained results, it may be concluded that outcomes were relatively good in neglected prosthesis cases after THA. However, recognition of high-risk cases and reduction of delay time may improve the outcomes.

The 3D animation shows the surgical procedure on the acetabular side of total hip arthroplasty for Crowe IV adult developmental hip dysplasia using patient-specific instrument

The 3D animation shows the surgical procedure on the acetabular side of total hip arthroplasty for Crowe IV adult developmental hip dysplasia using patient-specific instrument

The 3D animation shows the surgical procedure on the acetabular side of total hip arthroplasty for Crowe I or II adult developmental hip dysplasia using patient-specific instrument

The 3D animation shows the surgical procedure on the acetabular side of total hip arthroplasty for Crowe I or II adult developmental hip dysplasia using patient-specific instrument

The 3D animation shows the surgical procedure on the acetabular side of total hip arthroplasty for Crowe III adult developmental hip dysplasia using patient-specific instrument

The 3D animation shows the surgical procedure on the acetabular side of total hip arthroplasty for Crowe III adult developmental hip dysplasia using patient-specific instrument

Mid-term results after in situ pinning and hip arthroscopy for mild slipped capital femoral epiphysis: a minimum five-year follow-up.

Purpose In situ pinning of mild slipped capital femoral epiphysis (SCFE) results in an aspherical head–neck junction and arthroscopic osteochondroplasty can successfully correct the head–neck junction. However, whether the correction stays stable over at least five years remains unknown.MethodsIn a retrospective and consecutive series, 11 patients with a mean age of 12 years (range, 10 years to 15 years) were included. All patients were treated for mild SCFE with in situ pinning and staged hip arthroscopy correcting the head–neck junction. All patients were assessed clinically and radiographically (radiograph and magnetic resonance imaging (MRI)) pre-operatively, 12 weeks and at least five years’ post-operatively.ResultsThe mean range of motion (ROM) for flexion and internal rotation was stable over time with 100° (sd 4) and 21° (sd 6), respectively at the last follow-up. The mean alpha angle decreased from pre-operative 64° (range 61° to 68°) to 12 weeks post-operative 49° (range 46° to 52°; p = 0.001) and stayed stable over time. New superficial cartilage damage on either the acetabular or femoral side was seen in each three patients. Progressive labral degeneration was present in two patients.Conclusion In situ pinning and staged hip arthroscopy for the correction of mild SCFE is safe, restores normal alpha angles and reveals stable morphological correction at mid-term follow-up. Furthermore, the clinical results were excellent with almost normalized internal hip rotation at mid-term follow-up in patients who had reached adulthood. However, there was some joint deterioration, but without negative impact on subjective and clinical outcome after at least five years.Level of evidenceIV

A conservative approach to dislocation following total hip arthroplasty: a review of 8606 hips

We present the data on 8606 total hip arthroplasty (THA) procedures carried out in 7818 patients through a posterior approach between 1998 and 2017. 218 hips (2.5%) suffered at least 1 dislocation with dislocation rates declining from 6.2% from 1998 to 2002 to 1.5% from 2003 to 2017. Overall, 92 hips (1.06%) required revision surgery but of these, only 5 (0.06%) had a full revision of both components with the remaining 87 requiring intervention only on the acetabular side. None have had a pseudo-arthrosis; none were left dislocated and all remain stable to date. In patients who have a second dislocation within 3 months of their primary surgery we recommend a spica or long leg cylinder cast to reduce the need for revision surgery. We propose an algorithm to manage instability with less aggressive operative treatment in this often-elderly patient population with the potential for less physiological insult and significant cost savings.

What Are the Long-term Results of Cemented Revision THA with Use of Both Acetabular and Femoral Impaction Bone Grafting in Patients Younger Than 55 Years?

The increasing number of THAs in younger patients will inevitably result in an increase of revision procedures. However, there is little evidence about the outcome of revision procedures in this patient group. Therefore, we updated a previous study conducted 5 years ago about the outcome of revision procedures in patients younger than 55 years. We sought to provide a concise update on the previously reported (1) long-term failure rate as defined by repeat revision, (2) clinical outcome as defined by the Oxford Hip score and the Harris Hip score, and (3) radiographic outcome of cemented revision THA performed with impaction bone grafting on both the acetabular and femoral sides in one surgery in patients younger than 55 years old. Between 1991 and 2007, we performed 86 complete THA revisions in patients younger than 55 years. In 38% (33 of 86) of revisions, bone impaction grafting was used on both the acetabular and femoral side because of acetabular and femoral bone stock loss. Mean age at time of revision was 46 ± 8 years. No patient was lost to follow-up, but six patients died during follow-up, including three since 2015. Still, the hips of all 33 patients were included in analysis at a mean of 17 ± 5 years. Failure was calculated using competing risk analysis. For clinical outcome, we assessed the Harris Hip score and the Oxford Hip score from our longitudinally maintained institutional database. Radiographic analysis was performed to evaluate radiographic loosening, defined as radiolucencies ≥ 2 mm in all zones or ≥ 5 mm migration for both components. The acetabular component was also considered loose with tilting ≥ 5°. The 15-year failure rate of revision THA was 27% (95% CI 13 to 44) for re-revision of any component for any reason and 10% (95% CI 3 to 25) for re-revision of any component for aseptic loosening. The mean Harris Hip score increased from 55 ± 18 preoperatively to 74 ± 22 at latest follow-up. Eight cups were considered radiographically loose, seven of which were re-revised. No stems were considered radiographically loose. Failure rate with endpoint radiographic loosening at 15 years was 23% (95% CI 10 to 39). We found that impaction bone grafting with a cemented cup and a cemented stem is a valuable biological revision technique that results in a stable and durable solution, after one or even multiple previous revision THAs. Although current implants may prove sufficient in most cases, they do not promote bone stock preservation. We believe that in young patients with bone stock loss, impaction bone grafting can be used as long as the defect can be contained adequately with a metal mesh and viable bone bed is available for revascularization. Level IV, therapeutic study.

Characterizing Femoral and Acetabular Bone Loss in Two-Stage Revision Total Hip Arthroplasty for Infection

BackgroundThe process of infection and multiple procedure-related factors in 2-stage exchange arthroplasty may lead to severe bone loss that can complicate subsequent reimplantation. The primary purpose of this study is to quantitatively characterize the extent of bone loss on the femoral and acetabular side prior to reimplantation during 2-stage revision hip arthroplasty for infection. MethodsThis retrospective case series includes 47 patients with planned 2-stage exchange arthroplasty for treatment of infected total hip replacement. Demographic, clinical, and surgical information, and complications during the 2-stage process were collected on all patients. The radiographs of all patients were reviewed prior to first-stage explantation and post-reimplantation or latest follow-up to characterize bone loss using the Paprosky classification systems. ResultsOf the 47 patients with planned 2-stage exchange, 10 patients (21%) were not reimplanted. Following explant and spacer placement, 32 patients (68%) experienced progressive femoral bone loss, and 20 (43%) experienced progressive acetabular bone loss. Patients who experienced progression of both femoral and acetabular bone (14, 30%) had a longer time between resection and reimplantation (164 ± 128 vs 88 ± 26 days, P = .03). A reimplantation time of greater than 90 days was associated with an increased risk of combined bone loss progression (15% vs 53%, P = .01). For patients who underwent reimplantation (79%), increased bone loss led to high rates of diaphyseal femoral fixation (97%) and revision acetabular components (38%). ConclusionIncreased time to reimplantation in 2-stage exchange arthroplasty for prosthetic hip infections is associated with a high rate of acetabular and femoral bone loss, and increased complexity of reimplantation.

Three-dimensional-printed customized prosthesis for pubic defect: prosthesis design and surgical techniques

BackgroundThis study is to describe the detailed design and surgical techniques of three-dimensional (3D)-printed customized prosthesis for pubic bone defect.Patients and methodsFive patients under type III resections were included in this study. Based on radiography data, 3D pelvic model was established and virtual surgery was simulated. Detailed anatomy data were measured including the size and arc of normal pubis, the size of residual bone in acetabular side. Different fixation ways were considered according to shape of defect. After features modification and porous structure design, prostheses were fabricated. The osteotomy guides and plastic models were used during surgery.ResultOf 5 cases, the prostheses consist of the type with stem (3, 60%) and the type without stem (2, 40%). Mean follow-up period was 13.6 months (range, 8-24 months). For partial pubis removed cases, the mean length and width of narrowest part of normal superior pubis were 13.19 mm (range, 12.51-14.12 mm) and 7.80 mm (range, 7.18-8.26 mm) respectively. Mean arc of normal pubis was 2.71 rad (range, 2.66-2.73 rad). For the entire pubis resection cases, the mean diameter of narrowest parts and length of normal superior pubis were 11.52 mm (range, 11.13-11.91 mm) and 64.78 mm (range, 63.46-66.09 mm), while the diameter of narrowest part and length of normal inferior pubis were 7.37 mm (range, 7.20-7.54 mm) and 86.43 mm (range, 84.28-88.57 mm). Mean length and arc of intramedullary stem was 20 mm (range, 18-21 mm) and 2.7 rad. Mean screw holes number was 6.3 (range, 6-7) while ultimate screws number in surgeries was 4.3 (range, 4-5). Porous structure with 600-μm-pore size and 70% porosity was applied in parts of contact with residual bone.Conclusion3D-printed customized prostheses could be a feasible option to reconstruct bone defect after type III resection. The design of 3D-printed customized prostheses is a multi-step process which is based on strict anatomic measurement.

Discrimination of Low-Energy Acetabular Fractures from Controls Using Computed Tomography-Based Bone Characteristics

The incidence of low-energy acetabular fractures has increased. However, the structural factors for these fractures remain unclear. The objective of this study was to extract trabecular bone architecture and proximal femur geometry (PFG) measures from clinical computed tomography (CT) images to (1) identify possible structural risk factors of acetabular fractures, and (2) to discriminate fracture cases from controls using machine learning methods. CT images of 107 acetabular fracture subjects (25 females, 82 males) and 107 age-gender matched controls were examined. Three volumes of interest, one at the acetabulum and two at the femoral head, were extracted to calculate bone volume fraction (BV/TV), gray-level co-occurrence matrix and histogram of the gray values (GV). The PFG was defined by neck shaft angle and femoral neck axis length. Relationships between the variables were assessed by statistical mean comparisons and correlation analyses. Bayesian logistic regression and Elastic net machine learning models were implemented for classification. We found lower BV/TV at the femoral head (0.51 vs. 0.55, p = 0.012) and lower mean GV at both the acetabulum (98.81 vs. 115.33, p < 0.001) and femoral head (150.63 vs. 163.47, p = 0.005) of fracture subjects when compared to their matched controls. The trabeculae within the femoral heads of the acetabular fracture sides differed in structure, density and texture from the corresponding control sides of the fracture subjects. Moreover, the PFG and trabecular architectural variables, alone and in combination, were able to discriminate fracture cases from controls (area under the receiver operating characteristics curve 0.70 to 0.79). In conclusion, lower density in the acetabulum and femoral head with abnormal trabecular structure and texture at the femoral head, appear to be risk factors for low-energy acetabular fractures.

Evaluation of anterior inferior iliac spine impingement after hip arthroscopic osteochondroplasty using computer simulation analysis.

Anterior inferior iliac spine (AIIS) impingement is an important risk factor for revision hip arthroscopy. Although a morphological classification system is available, evaluating AIIS impingement with respect to joint kinematics remains a challenge. To use computer simulation analysis to ascertain the prevalence of AIIS impingement before and after osteochondroplasty. A total of 35 joints from 30 cases (20 males and 10 females; average age: 43.3 ± 13.7 years) were analyzed. All joints had cam morphology and underwent hip arthroscopic osteochondroplasty. A three-dimensional model of each joint was constructed pre- and postoperatively. Joint kinematic simulation software (ZedHip®, Lexi, Tokyo) was used to identify the impingement point on the acetabular side and the incidence (expressed as a percentage) of AIIS impingement calculated. Radiographic and clinical evaluation was performed pre- and postoperatively. AIIS impingement was observed postoperatively in six joints but preoperatively in only one joint. The rate of AIIS postoperative impingement was significantly higher than that of preoperative impingement. All impingement points were located on the inferior aspect of the AIIS apex. However, there were no significant differences between the AIIS impingement and non-impingement groups in terms of clinical outcome. The incidence of AIIS impingement after osteochondroplasty was 17% by computer simulation analysis. Osteochondroplasty may result in subsequent AIIS impingement.

Radiological subsidence and acetabular erosion after tapered uncemented hemiarthroplasty in femoral neck fractures a 10- to 13- year follow-up study

BackgroundContemporary uncemented hemiarthroplasties are being used after displaced femoral neck fractures, however, their functional and radiological results remain controversial.The aim of this study was to evaluate the clinical and radiological results of a tapered uncemented stem combined with a uni- or bipolar hemiarthroplasty after a minimum follow-up of ten years. Patients and Methods135 patients underwent uncemented hip hemiarthroplasty after a displaced femoral neck fracture between 2004 and 2007. Their mean age was 81.5 years old (range, 70 to 90). 38 patients were evaluated with a minimum follow-up of ten years. We analysed the complications and the postoperative clinical result according to the Merle D´Aubigné and Postel scale. Radiological femoral type according to Dorr et al., femoral canal filling and the appearance of stem loosening, subsidence and acetabular erosion according to Baker et al., were also assessed. ResultsThere were two early periprosthetic femoral fractures. The mean clinical score was 15.8 (range, 9 to 17). Six hips were converted to a total hip arthroplasty due to acetabular erosion, and three stems were revised due to an infection, a late periprosthetic fracture and one aseptic loosening. The survival rate for any cause was 85.4% (Confidence interval (CI) 76 – 92.4%). The survival rate for revision surgery on the acetabular side at 10 years was 92.6% (CI 85 – 100%) and on the femoral side was 97.6% (CI 94.4 – 100%). 14 hips showed non-progressive radiological subsidence and 9 acetabular erosion. Stem subsidence was related to a femoral canal filling < 80% (p = 0.035) and acetabular erosion to a cylindrical femur (p = 0.024). ConclusionBone fixation can be obtained with a contemporary uncemented stem in hemiarthroplasty for patients over 70 years old with a femoral neck fracture. Acetabular erosion was frequent after ten years, however, the rate of revision surgery was low.

Research progress of total hip arthroplasty for patients with sequelae of suppurative hip arthritis

To summarize the research progress of total hip arthroplasty (THA) in treatment of sequelae of suppurative hip arthritis. The relevant literature was systematically searched and the operation timing, treatments of acetabular and femoral sides, and prosthesis selection in THA for sequelae of suppurative hip arthritis were summarized. THA is an effective way to treat the sequelae of suppurative hip arthritis. In order to avoid the recurrence of infection, THA is recommended to be performed after 10 years of resting period of hip septic infection. These patients may have acetabulum dysplasia and poor coverage of acetabulum. When performing THA, high position acetabulum, osteotomy of the medial acetabular wall, structural bone graft, Cage, tantalum augment, or three-dimensional printing prosthesis can be chosen. The femoral side may has small medullary cavity, increased femoral neck anteversion, increased femoral neck-stem angle, extend trochanter, and poor bone mass. When performing THA, the femoral osteotomy and appropriate prosthesis can be selected for treatment. The patients with sequelae of suppurative hip arthritis are mostly young, cementless THA is preferred for a better long-term survivorship. THA is an effective method for the sequelae of suppurative hip arthritis, but the operation is difficult and has relative high complication rate. Surgeons should have full understanding.

The accuracy of pre-operative digital templating in total hip arthroplasty performed in a low-volume, resource-constrained orthopaedic unit

Aims: Total hip arthroplasty (THA) is considered one of the most successful surgical procedures in modern medicine. The success of THA is well documented, and includes high patient satisfaction rates, low morbidity rates and cost-effective surgery. Most publications come from THA performed in high-volume arthroplasty units, done in high-income countries. Limited data is available on THA performed in low-volume, low-income countries. The aim of this study was to evaluate the accuracy of digital templating in a low-volume, resource constrained orthopaedic unit from 2016 to 2017. We introduced a standardised hip radiography programme, followed by a stepwise pre-operative templating method. We compared the implant sizes inserted during THA with the templated sizes determined pre-operatively. This was to deduct whether digital templating in a low volume arthroplasty unit is accurate and of the same value as digital templating done in a high-volume unit. Methods: A descriptive retrospective study was conducted on all patients who received elective primary uncemented THA in a low-volume, resource-constrained orthopaedic unit. Pre-operative radiographs were done according to guidelines published by Scheerlinck followed by pre-operative templating using the Impax Orthopaedic tools® software and a stepwise technique described by Bono. Implanted prosthesis sizes, as recorded in operation notes, were retrospectively compared to pre-operative templating. Results: A total of 56 participants were included (30 females, 26 males), with a mean age of 55.5 (32–78) years. On the acetabular side, in 71% (n=40; p<0.001) there was a cumulative difference of one implant size between the templated cup size and the actual cup size used. On the femoral side, in 79% (n=44; p<0.001) there was a cumulative difference of one implant size between the templated stem size and the actual stem size used. Oversizing of the implants was more prevalent, with 20% (n=11) of the acetabular components oversized by two or more sizes and 13% (n=7) of the femoral components oversized by two or more sizes. Conclusion: With the introduction of a standardised radiology programme and a stepwise templating technique, the benefits and accuracy of pre-operative templating done in a low-volume, resource-constrained orthopaedic unit is comparable to published data done in high-volume arthroplasty units. Level of evidence: Level 4

Primary total hip arthroplasty: mid-term outcomes of dual-mobility cups in patients at high risk of dislocation.

Dual-mobility cups (DMC) are currently used in patients having risk factors of instability. Most of the studies report the use of DMC in patients having a single high-risk variable. The aim of the study was to analyse a continuous series of patients treated with primary total hip arthroplasty (THA) and DMC with different high risk for dislocation. This is a retrospective study analysing the outcomes of primary THA with DMC in patients at high-risk of dislocation. The sample consisted of 215 patients having 1 of 3 aetiologies or risk factors: (1) young subjects (<55 years); (2) osteonecrosis of the femoral head (ONFH); and (3) femoral neck fracture (FNF). With a mean follow-up duration of 70 ± 24.7 months, the findings showed the following: 2 patients had dislocated their hip following motor vehicle accidents; 1 patient had a traumatic femoral peri-prosthetic fracture; and 1 patient had an acute infection. No intra-prosthetic dislocation or aseptic loosening were encountered. No radiolucent lines were observed on the acetabular side. The mean modified Hip Harris Score was 96.6 ± 7.4%. Out of 186 patients, 170 (90.1%) would label their operated hip as a "forgotten hip". 78 out of the 84 patients (92.8%) who used to practice oriental sitting and/or ablution for prayers were able to return to their usual daily activities of extreme hip position and 74 out of the 84 patients (88%) described their operated hip as "a forgotten hip". No correlation was found between any of the studied variables. The findings of this series of patients at high risk of dislocation showed excellent clinical and radiological results with very few complications. The use of DMC seems to counteract the impact of some aetiologies/risk factors that could lead to higher instability. Most patients practising extreme hip positions resumed their usual practices.

Functional and radiological outcome of uncemented total hip arthroplasty in young adults - 5 year follow-upollow-up

BackgroundEnd stage arthritis in young patients requires surgical intervention. THA remains the treatment of choice for restoring function and activity in end stage hip arthritis. The medium term outcome of uncemented THA in Indian population is less studied. Hence this study was taken up with aim to study clinical and radiological outcome of uncemented THA in patients with age less than 40 years. MethodsThis study was conducted during January 2013 to December 2013. Overall 66 patients with 74 arthritic hips were operated by single surgeon (1st Author) with Uncemented THA. All patients were either unilateral or bilateral arthritis of hip less than 40 years of age. Patients were evaluated preoperatively and postoperatively. After discharge patients were followed up at regular intervals. Activity level and Harris Hip score was calculated. Radiological evaluation was done with anteroposterior and lateral X-rays. ResultsTotal 50 patients (56 hips) followed up at five year follow-up. Clinical and radiological evaluation was done during follow-up. Most common etiology was avascular necrosis of hip (56.6%). None of the patients had any major complications. Mean Harris Hip score improved from 36 to 92. The activity level was assessed at five year follow-up with maximum patients in moderate manual labor category. Bony ingrowth with no evidence of loosening was seen consistently both on femoral and acetabular side in all patients on X-ray. No statistically significant association was found between initial alignment of the femoral component and clinical outcome ConclusionUncemented THA can be used in young patients with excellent to good functional and radiological outcome at midterm follow-up, high satisfaction rate and lower rate of complications.

Arthroplasty for Congenital Hip Deformity

Development dysplasia of the hip is complex problem encompassing a spectrum of anatomical abnormalities. Total hip arthroplasty (THA) has emerged as the gold standard for management of secondary osteoarthritis due to hip dysplasia. Unique acetabular and femoral anatomy presents many challenges to reconstructive surgeons. However, the goals of THA for these patients mirror the goals of THA for nondysplastic patients. Classification systems, such as the Crowe and Hartofilakidis systems, have been created to facilitate discussion and management of these unique challenges, and numerous techniques have been described to meet these demands, with the goal of recreating normal anatomy for these patients. On the acetabular side, surgeons aim to restore the native hip center will ensuring adequate acetabular implant coverage, while on the femoral side, they seek to restore normal femoral anteversion and provide equal leg lengths. This article details the various challenges reconstructive surgeons face, and the tools at their disposal to achieve the stated goals. When properly executed, THA for development dysplasia of the hip has shown excellent results, with no difference in outcomes for mildly dysplastic hips, though higher rates of mechanical failure for severely dysplastic hips.

Avaliação dos resultados clínicos e radiográficos da artroplastia total cimentada do quadril em 477 pacientes

Objective The purpose of the present study was to evaluate retrospectively the clinical and radiographic results of total hip arthroplasty (THA) performed with the Exeter technique and using the Exeter prosthesis. Methods Between March 2000 and December 2006, 504 THAs were performed in 477 patients, with several etiological diagnoses. A total of 260 surgeries were performed on the right side, 244 on the left side, and 27 were performed bilaterally. The mean age of the patients was 58.9 (17.7–86.8) years old, with a median of 69.0 years old. The preoperative planning was performed with appropriate templates. All of the surgeries were performed through the posterolateral approach with the patient placed on lateral decubitus. The clinical evaluation was performed according to the Harris hip score (HHS). In the radiographic evaluation, the bone cement interface in the three zones of DeLee and Charnley on the acetabular side and in the seven zones of Gruen on the femoral side were studied. Subsidence of the femoral component, presence of diaphyseal hyperthrophy, and heterotopic ossification were also observed. Results The mean follow-up of 441 surgeries (87.5%) was of 7.2 (1.0-16.6) years, with a median of 7.1 years. The incidence of complications was: dislocation, 3.2%; infection, 2.2%; peripheral nerve disorders 2.0%; thromboembolism 2.7%, acetabular cup loosing 2.0%; diaphyseal hypertrophy, 1.26%; distal migration of the femoral component between 2,0 mm and 2.9 mm, 0.5%; 1 case of aseptic loosing of the femoral component and 9 (1.8%) of the acetabular component. The mean HHS was mean 92.3 (50–100) points. Conclusion Cemented THA, with the methodology applied, proved to be an effective treatment for this group of patients. The results were satisfactory with acceptable complication rates.

Long-term results of cementless total hip arthroplasty for the treatment of ankylosed hip.

The purpose of this study was to report the long-term results of total hip arthroplasty (THA) for the treatment of ankylosed hip. Twenty-nine consecutive THAs were performed in 26 patients. The mean age of the patients at the time of the operation was 43.3 years (range, 19-69 years). We used cementless fixation in all hips and the mean duration of follow-up was 10.1 years (range, 4.5-20 years). Radiological evaluation of components, osteolysis, radiolucent lines and loosening were assessed. The Harris Hip Score (HHS), range of motion (ROM), limb-length discrepancy and walking capacity with or without any support were used preoperatively and at final follow-up for clinical evaluation. Survivorship analysis was conducted using the Kaplan-Meier method using second revision for any reason as the endpoint. The mean HHS was 85.6 (range, 55-98) points and mean ROM was 110.5° for flexion. The mean limb-length discrepancy improved from 4.1 cm to 1.1 cm. Positive Trendelenburg sign was recorded in 31% of the patients and 24% of patients needed any support for walking postoperatively. We observed surgical complications related to abductor arm in 25% of the patients. Radiolucency on the acetabular side was seen on one or more zones in 15 patients (16 hips). One aseptic acetabular component loosening was observed. On the femoral side, 11 patients demonstrated non-progressive radiolucent lines and osteolysis around the stem was seen in four hips but there was no aseptic stem loosening. The Kaplan-Meier survival rate considering revision for any reason as the endpoint was 81.5%, for aseptic loosening 91.3%, for a worst-case scenario of 66.4% at 10 years. Cementless fixation showed good to excellent results at 10 years. Preoperative and postoperative abductor status of the patient is critical for patient satisfaction.