Cause Of Total Hip Arthroplasty Research Articles

Animal Models of Femur Head Necrosis for Tissue Engineering and Biomaterials Research.

Femur head necrosis, also known as osteonecrosis of the femoral head (ONFH), is a widespread disabling pathology mostly affecting young and middle-aged population and one of the major causes of total hip arthroplasty in the elderly. Currently, there are limited number of different clinical or medication options for the treatment or the reversal of progressive ONFH, but their clinical outcomes are neither satisfactory nor consistent. In pursuit of more reliable therapeutic strategies for ONFH, including recently emerged tissue engineering and biomaterials approaches, in vivo animal models are extremely important for therapeutic efficacy evaluation and mechanistic exploration. Based on the better understanding of pathogenesis of ONFH, animal modeling method has evolved into three major routes, including steroid-, alcohol-, and injury/trauma-induced osteonecrosis, respectively. There is no consensus yet on a standardized ONFH animal model for tissue engineering and biomaterial research; therefore, appropriate animal modeling method should be carefully selected depending on research purposes and scientific hypotheses. In this work, mainstream types of ONFH animal model and their modeling techniques are summarized, showing both merits and demerits for each. In addition, current studies and experimental techniques of evaluating therapeutic efficacy on the treatment of ONFH using animal models are also summarized, along with discussions on future directions related to tissue engineering and biomaterial research. Impact statement Exploration of tissue engineering and biomaterial-based therapeutic strategy for the treatment of femur head necrosis is important since there are limited options available with satisfactory clinical outcomes. To promote the translation of these technologies from benchwork to bedside, animal model should be carefully selected to provide reliable results and clinical outcome prediction. Therefore, osteonecrosis of the femoral head animal modeling methods as well as associated tissue engineering and biomaterial research are overviewed and discussed in this work, as an attempt to provide guidance for model selection and optimization in tissue engineering and biomaterial translational studies.

Efficacy of total hip arthroplasty after operatively treated acetabular fracture.

We evaluated the clinical and radiological outcomes of patients following total hip arthroplasty (THA) for acetabular fracture. This was a retrospective cohort study in a single center. The medical records of patients who underwent THA from March 2002 to March 2017 were reviewed. Inclusion criteria were THA and a history of open reduction and internal fixation of acetabular fractures. Thirty-seven patients with a mean age of 56.2years were enrolled. The Harris hip score (HHS), acetabular fracture classification, time interval between acetabular fracture and THA, cause of THA, surgical approach, implant type, complications, radiographic results, and Kaplan-Meier survival curves were analyzed. All patients were followed up for an average of 6.6years. The mean preoperative HHS of 42.5 had improved to 83.5 at the final follow-up (p < 0.05). There were 29 cases of post-traumatic arthritis, 6 cases of avascular necrosis, and 4 cases of non-union. The average interval from injury to THA was 58months (range 4-336months). The re-admission rate was 18.9%. Patients who underwent conversion to THA due to post-traumatic arthritis combined with non-union acetabular fracture developed clinical failure more frequently than patients with post-traumatic arthritis (p = 0.037). At 12years, 83.4% of patients were free from revision of femoral and acetabular components. THA secondary to an operatively treated acetabular fracture provides good symptomatic relief, but shows relatively inferior survival rates, and clinical failure was related to post-traumatic arthritis with acetabular non-union.

Mid- and long-term effectiveness of total hip arthroplasty with Ribbed femoral stem prosthesis in 354 cases

To evaluate the mid- and long-term effectiveness of total hip arthroplasty (THA) with Ribbed femoral stem prosthesis. A clinical data of 354 patients (384 hips) with hip disease who underwent THA with Ribbed femoral stem prostheses between October 2006 and May 2016 was retrospectively analyzed. There were 171 males and 183 females, with an average age of 53.4 years (range, 20-82 years). There were 324 cases of single hip and 30 cases of bilateral hips. The cause of THA included the avascular necrosis of the femoral head in 151 cases (159 hips), hip osteoarthritis in 134 cases (136 hips), rheumatoid arthritis in 43 cases (43 hips), ankylosing spondylitis in 20 cases (40 hips), and trauma in 6 cases (6 hips). The Harris score of total 354 patients before operation was 42.34±8.89. Harris scores were used to evaluate hip function after operation. X-ray films were used to determine the length of the lower limb, the radiolucent line on the femur side, the stability of the prosthesis, and the occurrence of stress shielding. The incisions healed by first intention. All patients were followed up 2-11 years with an average of 7.4 years. The Harris score at last follow-up was 80.52±7.61, which significantly increased when compared with preoperative score ( t=134.804, P=0.000). Two cases (2 hips) of prosthetic infections, 3 cases (3 hips) of prothesis loosening, and 4 cases (4 hips) of periprosthetic fractures, and 48 cases (48 hips) of mild to moderate thigh pain occurred after operation. X-ray films showed 76 cases (78 hips) with radiolucent lines on the femur side and stress shielding. According to the Engh's method, there were 364 hips of bone ingrowth, 15 hips of fibrosis ingrowth, and 5 hips of prosthesis instability. The femoral stem subsidence occurred in 25 cases (25 hips), and the difference in leg length discrepancy was more than 10 mm in 5 patients. THA with Ribbed femoral stem prosthesis can achieve satisfactory effectiveness with good initial stability and rapid bone growth. The incidence of stress shielding is relatively high, but the stress shielding has no significant impact on the mid- and long-term survival rate and effectiveness of femoral prosthesis.

Natural History of Slipped Capital Femoral Epiphysis.

Slipped capital femoral epiphysis (SCFE) occurs at a rate of 1 in 10,000 to 20,000 children. A PubMed search was undertaken to evaluate recent SCFE literature. A convenience sample of articles were selected and summarized. Most slips appear well tolerated long-term with ∼5% resulting in total hip arthroplasty (THA) at 20-year follow-up. Classic data reveals poor outcomes following closed reduction for treatment of SCFE. Improvements in intraoperative fluoroscopy and avoidance of pin penetration have reduced the rates of chondrolysis. Unfortunately, avascular necrosis remains a known risk in patients, occurring in 15% to 50% of patients following acute, unstable slips. This is the most common cause of THA in patients with SCFE. Rate of THA due to degenerative arthritis secondary to SCFE is more difficult to determine and occurs at a later age. Although realignment procedures to address anatomic abnormalities from SCFE have increased in popularity, it is unclear if this prevents degenerative arthritis and subsequently reduces the rate of THA. SCFE patients face an increased risk of disability and death due to their underlying medical comorbidities. Interventions for weight loss, blood pressure management, and lifestyle adjustments should be considered at the time of SCFE diagnosis. SCFE remains a challenging and common condition for pediatric orthopedists. Although innovative techniques have been proposed, long-term outcome data still supports in situ pinning for stable slips, and in situ pinning with capsular decompression for unstable slips to minimize the risk of avascular necrosis.

Osteonecrosis of the femoral head: pathophysiology and current concepts of treatment.

Osteonecrosis of the femoral head is a disabling pathology affecting a young population (average age at treatment, 33 to 38 years) and is the most important cause of total hip arthroplasty in this population. It reflects the endpoint of various disease processes that result in a decrease of the femoral head blood flow.The physiopathology reflects an alteration of the vascularization of the fine blood vessels irrigating the anterior and superior part of the femoral head. This zone of necrosis is the source of the loss of joint congruence that leads to premature wear of the hip.Several different types of medication have been developed to reverse the process of ischemia and/or restore the vascularization of the femoral head. There is no consensus yet on a particular treatment.The surgical treatments aim to preserve the joint as far as the diagnosis could be made before the appearance of a zone of necrosis and the loss of joint congruence. They consist of bone marrow decompressions, osteotomies around the hip, vascular or non-vascular grafts.Future therapies include the use of biologically active molecules as well as implants impregnated with biologically active tissue.Cite this article: EFORT Open Rev 2019;4:85-97. DOI: 10.1302/2058-5241.4.180036

The metal nanoparticle-induced inflammatory response is regulated by SIRT1 through NF-κB deacetylation in aseptic loosening.

Aseptic loosening is the most common cause of total hip arthroplasty (THA) failure, and osteolysis induced by wear particles plays a major role in aseptic loosening. Various pathways in multiple cell types contribute to the pathogenesis of osteolysis, but the role of Sirtuin 1 (SIRT1), which can regulate inflammatory responses through its deacetylation, has never been investigated. We hypothesized that the downregulation of SIRT1 in macrophages induced by metal nanoparticles was one of the reasons for osteolysis in THA failure. In this study, the expression of SIRT1 was examined in macrophages stimulated with metal nanoparticles from materials used in prosthetics and in specimens from patients suffering from aseptic loosening. To address whether SIRT1 downregulation triggers these inflammatory responses, the effects of the SIRT1 activator resveratrol on the expression of inflammatory cytokines in metal nanoparticle-stimulated macrophages were tested. The results demonstrated that SIRT1 expression was significantly downregulated in metal nanoparticle-stimulated macrophages and clinical specimens of prosthesis loosening. Pharmacological activation of SIRT1 dramatically reduced the particle-induced expression of inflammatory cytokines in vitro and osteolysis in vivo. Furthermore, SIRT1 regulated particle-induced inflammatory responses through nuclear factor kappa B (NF-κB) acetylation. Thus, the results of this study suggest that SIRT1 plays a key role in metal nanoparticle-induced inflammatory responses and that targeting the SIRT1 pathway may lead to novel therapeutic approaches for the treatment of aseptic prosthesis loosening.

SIRT1 protects osteoblasts against particle-induced inflammatory responses and apoptosis in aseptic prosthesis loosening.

Aseptic loosening is the most common cause of total hip arthroplasty (THA) and total knee arthroplasty (TKA) failure and revision surgery. However, there is still no effective therapeutic target in the clinical treatment. Besides, the underlying mechanism of aseptic loosening is largely unknown. The result of our study indicated that SIRT1 has the ability to effectively regulate the wear particle-induced inflammatory responses, apoptosis, osteolysis in particle-stimulated osteoblasts and particle-induced osteolysis animal models. Our study provides a potential target for the prevention and treatment of aseptic loosening and further investigated the underlying mechanism of aseptic loosening, which may make contribution to decrease the incidence of THA and TKA failure in the clinical practice.

Cost-effectiveness model comparing dual-mobility to fixed-bearing designs for total hip replacement in France

BackgroundInstability is among the main causes of total hip arthroplasty (THA) failure. In clinical studies, THA with a dual-mobility cup (THA-DM) decreased the risk of instability after primary THA compared to THA with a fixed-bearing design (THA-FB). However, whether THA-DM is more cost-effective than THA-FB has not been established using Markov modelling with determination of the incremental cost-effectiveness ratio (ICER). The objectives of this work were to: (1) measure the efficiency of these two options, (2) use the nationwide hospital electronic database (PMSI) to estimate direct costs of dislocations and revisions for instability, and (3) conduct deterministic and probabilistic sensitivity analyses to estimate potential mean annual cost-savings in France. HypothesisWe hypothesised that primary THA-DM was cost-saving compared to primary THA-FB. Material and methodsIn the database, we identified 80,405 patients who had THA in 2009 and we collected their outcomes over 4 years (2009–2012). Cost-effectiveness was assessed based on the costs of resources used for all consequences of prosthetic dislocation and paid for by the statutory health insurance system or other sources. ResultsTHA-DM was associated with a relative risk of dislocation of 0.4 versus THA-FB. This risk difference translated into 3283 fewer dislocations per 100,000 patients with THA-DM. The corresponding cost-savings for the 140,000 primary THA procedures done in France annually was 39.62 million Euros. A relative risk of 0.2 would yield annual cost-savings of 56.28 million Euros. In the probabilistic sensitivity analysis, THA-DM was the less costly option under all hypotheses, with potential maximum cost-savings of more than 100 million Euros per year in France. DiscussionThis comparative cost-effectiveness analysis suggests that THA-DM may induce substantial cost-savings compared to THA-FB. This possibility should be assessed by long-term clinical studies of new-generation DM prostheses.

Genetic variation in inflammatory and bone turnover pathways and risk of osteolytic responses to prosthetic materials.

Wear particle-induced inflammatory bone loss (osteolysis) is the leading cause of total hip arthroplasty (THA) failure. Individual susceptibility to osteolysis is modulated by genetic variation. In this 2-stage case-control association study we examined whether variation within candidate genes in inflammatory and bone turnover signaling pathways associates with susceptibility to osteolysis and time to prosthesis failure. We examined two cohorts, comprising 758 (347 male) Caucasian subjects who had undergone THA with a metal on polyethylene bearing couple; 315 of whom had developed osteolysis. Key genes within inflammatory, bone resorption, and bone formation pathways were screened for common variants by pairwise-SNP tagging using a 2-stage association analysis approach. In the discovery cohort four SNPs within RANK, and one each within KREMEN2, OPG, SFRP1, and TIRAP (p < 0.05) were associated with osteolysis susceptibility. Two SNPs within LRP6, and one each within LRP5, NOD2, SOST, SQSTM1, TIRAP, and TRAM associated with time to implant failure (p < 0.05). Meta-analysis of the two cohorts identified four SNPs within RANK, and one each within KREMEN2, OPG, SFRP1, and TIRAP associated with osteolysis susceptibility (p < 0.05). Genetic variation within inflammatory signaling and bone turnover pathways may play a role in susceptibility to osteolysis.

Antibiotic-loaded cement spacer for treatment of Klebsiella infected total hip and knee arthroplasty

Infection following total hip arthroplasty (THA) or total knee arthoplasty (TKA) may have devastating consequences. Some bacterial strains are often encountered as agents of these infections, others occur less frequently but are sometimes burdened with more severe complications. Kebsiella spp. are uncommon causes of THA or TKA infection. The aim of this study was to identify an effective treatment algorithm for multidrug resistant Kebsiella spp. caused THA or TKA infections. During the 3-year period, from January 1 2009 to December 31 2011, we registered and treated 5 patients with THA or TKA multidrug resistant Klebsiella spp. caused infection. All the patients were primarily operated in other institutions, and were admitted in our clinic after the onset of infection symptoms. In three of the cases Klebsiella infection was complicated by additional infection (Staphyloccocus aureus, Pseudomonas aeruginosa and Serratia marscescens). In 3 of the cases we performed revision arthroplasty after double exchange of antibiotic-loaded articulating cement spacer, and in 2 of the cases the standard two-stage revision approach with one antibiotic cement spacer exchange was applied. The mean length of follow-up after reimplantation surgery was 17.1 months (range 2-31 months). One patient died 2 months after the final reimplantation procedure. The initial Klebsiella infection was eradicated in all the patients. At the end follow-up after definitive reimplantation, the patients had no clinical, laboratory or microbiological parameters positive for active infection. According to our experience with multidrug-resistant Klebsiella TKA/THA infections, two-stage approach, in some cases with double articulating cement spacer exchange prior to definitive reimplantation, is the most effective treatment option.

Minimum 5-year Follow-up for Primary THA Using a Tapered, Proximally Coated Cementless Stem

The purpose of this study was to assess the survivorship of a proximally coated, cementless femoral stem used for total hip arthroplasty at a minimum 5-year follow-up by assessing clinical outcomes and implant survival. A total of 936 primary total hip arthroplasties were performed in 854 patients by 3 high-volume surgeons between 2001 and 2007. Patients included 385 men and 469 women with a mean age of 56 years (range, 20-88 years) and a mean follow-up of 7 years (range, 5-11 years). The aseptic revision rate related to the femoral component was 0.3%. Three patients underwent revision of the femoral component. Mean postoperative Harris Hip Score improved to 91 points (range, 70-100 points). When stratified by primary cause of total hip arthroplasty, no differences were found in implant survivorship or postoperative Harris Hip Scores. With the exception of the 3 patients who underwent revision surgery, postoperative radiographic evaluation of the stems demonstrated no progressive radiolucencies, component malalignment, change in component position, or implant subsidence at most recent follow-up.These results are encouraging and indicate a 0.3% revision rate for the femoral component. The cause of primary total hip arthroplasty did not affect the clinical outcomes. These types of prostheses will provide patients with a stable implant that is expected to have excellent durability and longevity.

New method for measuring acetabular component positioning with EOS imaging: feasibility study on dry bone

Malposition of the acetabular cup is the most common cause of total hip arthroplasty (THA) dislocation. The position of a total hip implant is usually analysed on computed tomography (CT) scan. We aim to prove it is possible to measure, with good accuracy, the position of an acetabular cup using the low-dose irradiation (EOS) imaging. We implanted an acetabular cup in a pelvic dry bone and measured cup anteversion and inclination with scanography. We performed 14 series of EOS acquisitions with different inclination, rotation and pelvic tilt, which were analysed by five observers. Two observers repeated angle measurements. We then calculated measurement inter- and intrareproducibility and accuracy. Using a confidence interval (CI) of 95 %, inter- and intra-observer reproducibility were ±1.6, and ±1.4°, respectively, for cup inclination; accuracy in comparison with CT was ±2.6°. Using a 95 % CI, inter- and intra-observer reproducibility for cup anteversion were ±2.5° and ±2.3°, respectively. Measurement accuracy compared with CT was ±3.9°. EOS imaging system is superior to standard radiography in terms of measuring acetabular anteversion and inclination.

Revision total hip arthroplasty using a reconstruction cage device and a cemented dual mobility cup

The main causes of total hip arthroplasty (THA) revisions are loosening and instability. Dual mobility cups were introduced to prevent instability, but their behavior during revisions with acetabular reconstruction has not been assessed. Use of a dual mobility cup cemented in a acetabular reconstruction cage device limits the risk of instability and does not hinder the acetabular fixation during THA revisions. The objective of this study was to test this hypothesis on a retrospective series of 96 revisions. At a mean follow-up of 41 months (range, 1-101 months), we analyzed a continuous series of 96 revisions using a reconstruction device (70 Kerboull™ cross-plates, six Burch-Schneider™ antiprotrusio cages, 20 custom-fit Novae ARM™ cages associated in all cases with a Novae Stick dual mobility cup cemented into the cage). Fifteen patients died at a mean follow-up of 22 months (range, 1-66 months) and four patients were lost to follow-up at a mean follow-up of 16 months (range, 9-27 months). These were acetabular revisons involving major bone loss, with 62 stage III and 26 stage IV cases on the SOFCOT classification. Eighty-seven patients (87.5%) underwent structural bone allografting. The mean Merle d'Aubigné score increased from 9.6 ± 3.06 (range, 2-16) preoperatively to 15.5 ± 2.32 (range, 7-18) at the follow-up. Ten dislocations (10.4%) occurred, five of which were delayed over three months after the index procedure (5.2%), but there were no intraprosthetic dislocations. At the follow-up, the X-rays showed eight hardware failures, including one cross-plate fracture, one hook fracture, and one flange fracture. Analysis of the radiological position of the cup showed a mean lowering of 15.6mm and a 9.4mm lateralization compared to the preoperative position. One revision for aseptic loosening and another for septic loosening were performed. Taking all-cause acetabular component exchange as a criterion, the survival rate at 8 years was 95.6% (95% CI, 93.3-97.7%) and 99.3% (95% CI, 98.9-99.6%) if the endpoint was aseptic acetabular exchange. This study confirms the advantage of dual mobility cups during acetabular reconstruction cemented in antiprotrusio cages as a way to limit, without eliminating, the risk of dislocation. Therefore cemented fixation of dual mobility cups in cages appears to be a reliable short-term option.

Total hip arthroplasty in young adults, with focus on Perthes' disease and slipped capital femoral epiphysis

Background and purpose Pediatric hip diseases account for 9% of all primary hip arthroplasties in the Norwegian Arthroplasty Register. We wanted to validate the diagnosis as reported to the register and to assess the quality of life of these patients after hip replacement.Patients and methods 540 patients accepted to participate in this follow-up study (634 hips). All were less than 40 years of age and had been reported to the Norwegian Arthroplasty Register as having undergone a primary total hip arthroplasty (THA) between 1987 and 2007. The underlying diagnosis, age at diagnosis, and type of treatment given prior to the hip replacement were recorded from the original hospital notes.Results The diagnoses reported to the Norwegian Arthroplasty Register were confirmed to be correct in 91% of all cases (538/592). For the 94 hips that had been treated due to Perthes' disease or slipped capital femoral epiphysis (SCFE), the diagnosis was verified in 95% of cases (89/94). The corresponding proportion for inflammatory hip disease was 98% (137/140) and it was only 61% for primary osteoarthritis (19/31). The self reported quality of life (EQ-5D) was poorer for these young patients with THA than for persons in age-matched cohorts from Great Britain and Sweden, except for those with an underlying SCFE.Interpretation The diagnoses reported to the Norwegian Arthroplasty Register as the underlying cause of THA were correct in 91% of cases. Individuals who undergo THA before the age of 40 have a reduced quality of life, except for those requiring a hip replacement because of SCFE.

Modified Watson-Jones approach versus modified Hardinge approach for total hip arthroplasty

Objective To compare clinical results of modified Watson-Jones minimally invasive approach and modified Hardinge approach in total hip arthroplasty(THA).Methods This study reviewed 90 patients who had undergone THA from January 2005 through February 2008.The modified Watson-Jones approach was used in 44 patients(group A),20 men and 24 women,with an average age of 68.2 ±8.0 years; the modified Hardinge approach was used in 46 patients(group B),21 men and 25 women,with an average age of 69.1 ± 9.2 years.The causes of THA were mostly femoral neck fracture(23 cases in group A and 21 cases in group B)and femoral head necrosis(9 cases in group A and 6 cases in group B).All the operations were performed by the same group of surgeons.Clinical evaluation involved the Harris hip scores and Barthel indexes at 3 months and the final follow-up.Radiographs were evaluated to examine the acetabular abduction angle.Complications in both groups were recorded.Results The patients had an average follow-up of 50.9 ± 10.1 months.Group A were significantly superior to group B in incision length,blood loss and ambulant patients within 3 days postoperation(P ＜ 0.05).There was no significant difference between the 2 groups in the acetabular abduction angle.At 3 months postoperation,the mean Harris hip score(82.4 ±3.3)and Barthel index(85.4±3.8)were significantly higher in group A than in group B(72.3 ±3.7 &77.2 ± 5.4)(P ＜ 0.05),but such significant differences between the 2 groups were not observed at the final follow-up(P ＞ 0.05).Complications,such as wound infection,hip dislocation,vascular and neural lesions,and deep vein thrombosis,did not occur in either group.Conclusion Both modified Watson-Jones minimally invasive approach and modified Hardinge approach can be successfully used for total hip replacement,but the former can lead to better functional recovery at 3 months after operation. Key words: Arthroplasty, replacement, hip; Femoral neck fractures; Femur head necrosis; Surgical procedures, minimally invasive

Genetic susceptibility to aseptic loosening following total hip arthroplasty: a systematic review

Introduction Aseptic loosening is the most common cause of total hip arthroplasty (THA) failure and revision surgery. Genetic polymorphisms could be determinant factors for implant loosening. Source of data We performed a comprehensive search of Medline, CINAHL, Googlescholar, Embase and Cochrane databases, using various combinations of the keyword terms 'aseptic loosening', 'gene', 'hip arthoplasty', 'genetics', 'loosening'. Twelve studies detailing the genetic investigation of patients with aseptic loosening of a THA were identified. Areas of agreement SNPs of GNAS1, TNF-238 A allele, TNF-α promoter (-308G→A) transition, IL6-174 G allele, interleukin (IL)-6 (-597) and (-572), MMP-1-promoting gene, C/C genotype for the MMP1, MT1-MMP, MMP-2, transforming growth factor-beta1 signal sequence (29T→C) transitions, A/A genotype for the OPG-163, and MBL were overexpressed in patients with aseptic loosening and periprosthetic osteolysis. Areas of controversy Data from single centre studies do not allow one to compare the results of different studies. Conclusion Several gene pathways and genes contribute to the genetic susceptibility to aseptic loosening following THA. Further studies will enhance the understanding of prosthesis failure, and may inform and direct pharmaceutical interventions. Growing points Further multi-centre prospective studies are necessary to confirm the general validity of the findings reported. Single-centre findings should be replicated in other centres and populations to open new avenues for pre-surgical genetic testing and to investigate immune response modulation in THA. Areas timely for developing research Research in this field could lead to better understanding of mechanisms behind aseptic osteolysis, and improve the results of THA.

Total Hip Arthroplasty with Hydroxyapatite-coated ABG® Hip Prosthesis: Minimum 5 Year Follow-up

Purpose: To evaluate the clinical and radiological results of total hip arthroplasty (THA) with a hydroxyapatite (HA)-coated (Anatomical Benoist Giraud, Howmedica, Europe) hip prosthesis. Materials and Methods: From March 1992 to December 1996, we performed 204 total hip arthroplasty with HA-coated hip prosthesis. This study included 142 hips. The causes of THA were osteonecrosis of the femoral head (122 hips), osteoarthritis (16 hips) and infection sequalae (4 hips). Clinical results were evaluated using Harris hip score. We observed osteointegration, cortical hypertrophy, reactive line around femoral stem, subsidence, polyethylene wear, osteolysis and radiolucent line around acetabular cup on the follow-up radiographs. Results: Harris hip score was an average of 84.5 points at last follow-up. Only one femoral stem was revised for loosening. Reactive lines around uncoated portion of femoral stem was observed in 70 hips. The cortical hypertrophy was observed at zone 2, 3, 5 and 6 in 46 hips. Forty-five acetabular cups (31.7%) were revised. The causes of cup revision wereolyethylene liner wear and osteolysis (24 hips), loosening (19 hips) and recurrent dislocation (2 hips). Conclusion: We found that the HA-coated femoral stem had high survival rate at minimum 5 years follow-up after THA, but acetabular cup had high revision rate for loosening and osteolysis.