Femoral Stem In Patients Research Articles

Three-dimensional femur morphology analysis for the optimal location of subtrochanteric osteotomy with an implanted Wagner cone stem in total hip arthroplasty for Crowe type IV developmental dysplasia of the hip

BackgroundThis study aimed to accurately evaluate the matching of proximal and distal femoral segments and fitting of the femur–femoral stem in patients with Crowe type IV developmental dysplasia of the hip (DDH) who have undergone subtrochanteric osteotomy at different locations with an implanted Wagner cone stem to improve the rate of the bone union at the osteotomy site.MethodsThree-dimensional femur morphology of 40 patients with Crowe type IV DDH was evaluated at each cross-section to determine the femoral cortical bone area. This study focused on five osteotomy lengths (2.5, 3, 3.5, 4, and 4.5 cm). The overlapped area between the proximal and distal cortical bone segments was defined as the contact area (S, mm2), and the contact area to distal cortical bone area ratio was defined as the coincidence rate (R). Three indicators were used to evaluate the matching and fitting of the osteotomy sites with the implanted Wagner cone stems: (1) higher S and R between the proximal and distal segments; (2) the effective fixation length of the femoral stem at the distal segments being at least 1.5 cm; and (3) osteotomy did not involve the isthmus.ResultsIn all groups, S significantly decreased in the two proximal levels above the 0.5 cm level below the lesser trochanter (LT) compared with those below this level. In comparison, at osteotomy lengths from 2.5 to 4 cm, R significantly decreased in the three proximal levels. The optimal osteotomy levels ranged from 1.5 and 2.5 cm below the LT for an appropriately sized stem.ConclusionsSubtrochanteric osteotomy at the optimal level not only ensures fitting of the femur–femoral stem but also meets the requirements of a higher S and R to ensure adequate reduction and stabilization at the osteotomy site, which may contribute to the bone union. Although the optimal osteotomy level varies with the size of the femoral stem and the length of the subtrochanteric osteotomy, the optimal osteotomy levels for an appropriately sized Wagner cone femoral stem implantation range from 1.5 to 2.5 cm below the LT.

Total Hip Arthroplasty With the Wagner Cone Femoral Stem in Patients With Crowe IV Developmental Dysplasia of the Hip: ARetrospective Study.

The aim of this study is to assess treatment of Crowe type IV hip dysplasia with the Wagner cone femoral stem combined with transverse subtrochanteric shortening osteotomy and augmenting the osteotomy site using the intercalary segment as a strut autograft. One hundred twenty-seven hips of 91 patients diagnosed with Crowe type IV hip dysplasia and treated with total hip arthroplasty using the Wagner cone stem combined with transverse subtrochanteric shortening osteotomy were retrospectively evaluated by clinical and radiographic outcomes as well as complications. The mean follow-up was 8.4 years. The Harris Hip Score and the Western Ontario and McMaster University Osteoarthritis Index scores were significantly improved postoperatively (P= .000). Intraoperative femoral cracks were observed in 70 hips (55.1%) and all femurs healed smoothly. Femoral cracks did not have a significant effect on clinical outcomes, except for heterotopic ossifications (P= .032). The probability of 10-year survivorship of the components free of revision for any reasons as end point was 94.5%; when only the femoral components were considered the survivorship was of 96.9%. Transverse subtrochanteric shortening and augmenting the osteotomy site using the intercalary segment of bone resected from the shortened femur with the Wagner cone stem is an effective and reliable technique in the management of total hip arthroplasty in Crowe type IV hip dysplasia. Stable and firm placing of the femoral component which leads to an increased frequency of intraoperative femoral cracks does not have an unfavorable effect on clinical and radiological outcomes.

Initial femoral stem position in cementless bipolar hemiarthroplasty for femoral neck fracture in elderly patients is associated with early implant subsidence: A radiographic analysis

BackgroundBipolar hemiarthroplasty is a well-established treatment for displaced femoral neck fracture in elderly patients. Implant subsidence is a potential complication with cementless femoral stems, and smaller canal fill ratio has been reported as a radiographic risk factor. We aimed to determine the risk factors for subsidence, particularly the initial implant position relative to the resected medial calcar of proximal femur. MethodsWe retrospectively reviewed all cementless bipolar hemiarthroplasties performed using a single proximally hydroxyapatite-coated femoral stem in patients with a minimum radiographic follow-up of 12 weeks between January 2017 and December 2018. The amount of subsidence (significant subsidence defined as ≥ 5 mm), canal fill ratio, and implant position relative to the point of resected medial calcar (position A: medial and superior to calcar; position B: lateral and superior to calcar; position C: lateral and inferior to calcar) were measured and analyzed. ResultsOne-hundred eighty patients were identified (mean age: 80.9 years). Significant subsidence was observed in 52 patients (28.9%). On multivariate analysis, older age, lower canal fill ratio, implant position B, C, and less medial overhang of stem were independent risk factors for early implant subsidence. The risk ratio of position B and C to position A was 5.13 (95% confidence interval, 2.23-11.80). ConclusionIn our analysis, older age and lower canal fill ratio were associated with increased risk of subsidence, whereas implant with position A and more medial overhang were less prone to subsidence with the tapered proximally hydroxyapatite-coated implant.

Long-Term Clinical and Radiographic Results of an Ultra-Short Metaphyseal-Fitting Non-Anatomic Cementless Stem in Patients with Femoral Neck Fracture

BackgroundThe purpose of this study is to determine the clinical and radiographic outcomes, mortality rate, complication rate, and revision rate of this ultra-short non-anatomic cementless femoral stem in elderly patients with a femoral neck fracture. MethodsWe reviewed the results of 284 total hip arthroplasties performed with an ultra-short non-anatomic cementless stem in 280 previously active patients with a mean age of 72.8 ± 13 years (range 49-83). The mean follow-up was 9.3 years (range 7-13). ResultsThe mean Harris Hip Score was 86 ± 14 points at final follow-up. The mean Western Ontario and McMaster Universities Osteoarthritis Index score was 24 ± 6 points at the final follow-up. The mean University of California, Los Angeles activity score was 6 points at final follow-up. Osseointegration was seen in all acetabular (100%) and in 276 femoral components (97%). Kaplan-Meier survivorship analysis revealed that the survival rate of the femoral component at 8.3 years was 97% (95% confidence interval 91–100) and that of the acetabular component was 100% (95% confidence interval 94–100) with aseptic loosening or revision as the end point. ConclusionAn ultra-short non-anatomic cementless femoral stem in patients with good bone quality (Dorr A and some Dorr type B bone) is a safe treatment for femoral neck fracture. In patients with poor bone quality (Dorr C type), the results were very poor, and use of this stem should be avoided.

Long-Term Survival (up to 34 Years) of Retained Cementless Anatomic Femoral Stem in Patients

BackgroundThere is a paucity of studies longer than 30 years to determine clinical and radiographic results of retained cementless anatomic stem. The purpose of this study is to determine the long-term (up to 34 years) survival rate of the retained cementless anatomic femoral stem in patients <50 years of age. MethodsIsolated cup revision was performed with retaining primary cementless anatomic femoral stem in 206 patients (149 men and 57 women). Clinical and radiographic results were monitored at each follow-up. At the latest follow-up, computed tomography scans were carried out in all hips to determine the prevalence of osteolysis. The mean follow-up of the retained femoral stem was 30.3 years (range 27-34). The mean follow-up of the revised cup was 25.5 years (range 22-29). ResultsThe mean Harris Hip Score was 91 ± 7.8 points (range 71-100) and the mean Western Ontario and McMaster Universities Osteoarthritis score was 16 ± 7 points (range 7-34) at the final follow-up. The mean University of California, Los Angeles activity score was 7 ± 4 points (range 5-10) at the final follow-up. The overall survival rate of retained cementless femoral stems was 98.9% (95% confidence interval 91-100) at 30.3 years. The survival rate of the revised cup was 93% (95% confidence interval 89-98) at 25.5 years. ConclusionThe rate of aseptic loosening of already osseointegrated femoral stem remains low with ceramic-on-ceramic bearing in young active patients.

Raloxifene Prevents Early Periprosthetic Bone Loss for Postmenopausal Women after Uncemented Total Hip Arthroplasty: A Randomized Placebo-Controlled Clinical Trial.

ObjectiveTo examine the results of raloxifene for prevention of periprosthetic bone loss around the femoral stem in patients undergoing total hip arthroplasty (THA).MethodsBetween January 2015 and May 2017, 240 female patients between 55 and 80 years underwent primary THA and were randomly allocated to receive 60 mg raloxifene hydrochloride per day (treatment group, TG, n = 120) or placebo (control group, CG, n = 120) orally at bedtime using computer‐generated randomization sequence generation. Baseline data, the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC), women's quality of life (QoL) score, bone mineral density (BMD) around the prosthesis, and adverse events were compared between the two groups. The measuring range of BMD around the prosthesis was divided into seven regions of interest (ROI). The sample size was calculated to detect a mean difference in BMD of 0.15 g/cm2 with a standard deviation (SD) of 0.3. The error was set at 0.05 and the power level at 90% with additional compensation for a possible dropout rate of 20%.ResultsA total of 240 participants in the study up to 24 months after THA. There were no significant differences in the mean BMD of all the zones between groups before surgery (all P > 0.05). However, there were significant differences in the BMD of Gruen zones 4 and 7 between groups at 6 months postoperatively (both P < 0.05); there were significant differences in Gruen zones 1, 4, 6, and 7 at 12 months postoperatively (all P < 0.01); there were significant differences in Gruen zones 1, 2, 4, 6, and 7 at 24 months postoperatively (all P < 0.001). Patients taking raloxifene reported higher QoL scores, with better improvement in BMD in all areas except in zones 3 and 5 compared with the control group. There were no significant differences in WOMAC pain (P = 0.4045), WOMAC function (P = 0.4456) and women's QoL scores (P = 0.5983) between groups before surgery. However, WOMAC pain, WOMAC function and women's QoL score in the treatment group were significantly better at all time points (all P < 0.05). Patients in the treatment group showed no increased adverse events, including cardiac events, stroke, venous thromboembolism, and gynecological cancer (all P > 0.05), but did show decreased odds of breast cancer in comparison with those using a placebo (P = 0.0437).ConclusionRaloxifene can help inhibit bone loss around the prosthesis and improve the QoL of postmenopausal women after THA with no increased adverse events, and can even decrease the odds of breast cancer.

Ultra-Short Anatomic Uncemented Femoral Stem and Ceramic-on-Ceramic Bearing in Patients With Idiopathic or Ethanol-Induced Femoral Head Osteonecrosis

BackgroundLong-term result of the ultra-short anatomic cementless stem in the patients with idiopathic or ethanol-induced osteonecrosis of the femoral head has not been assessed. The aim of this study is to evaluate the long-term clinical, radiographic, computed tomography scan, and dual-energy X-ray absorptiometry scanning results, and survivorship of this specific femoral stem in patients with idiopathic or ethanol-induced femoral head osteonecrosis. MethodsTwo hundred fifty-six patients (335 hips) with an average age of 49.8 years (range 20-63) were enrolled in the current study. All patients underwent dual-energy X-ray absorptiometry scanning of the acetabulum and proximal femur preoperatively and at final follow-up. Computed tomography scan was obtained in all patients at final follow-up. The mean follow-up was 14.7 years (range 13-16). ResultsAt final follow-up, the average Harris hip score, Western Ontario and McMaster Universities Osteoarthritis Index score, and University of California, Los Angeles activity score were 94 points, 12 points, and 8 points, respectively. Four stems (1%) underwent revision for aseptic loosening. One acetabular component (0.3%) was revised for recurrent dislocation. No hip was revised for squeaking or clicking sound. Survivorship of the femoral stem was 99.0% (95% confidence interval 94-100) and that of the acetabular component was 99.4% (95% confidence interval 95-100) at 14.7 years. ConclusionUltra-short proximal loading anatomic uncemented femoral stems with ceramic-on-ceramic bearings have excellent survivorship free from aseptic loosening and good clinical results at long term. Level of EvidenceLevel IV

Primary stability of a short bone-conserving femoral stem: a two-year randomized controlled trial using radiostereometric analysis.

The aim of this study was to determine the stability of a new short femoral stem compared with a conventional femoral stem in patients undergoing cementless total hip arthroplasty (THA), in a prospective randomized controlled trial using radiostereometric analysis (RSA). A total of 53 patients were randomized to receive cementless THA with either a short femoral stem (MiniHip, 26 patients, mean age: 52 years, nine male) or a conventional length femoral stem (MetaFix, 23 patients, mean age: 53 years, 11 male). All patients received the same cementless acetabular component. Two-year follow-up was available on 38 patients. Stability was assessed through migration and dynamically inducible micromotion. Radiographs for RSA were taken postoperatively and at three, six, 12, 18, and 24 months. At two years, there was significantly less subsidence (inferior migration) of the short femoral stem (head, 0.26 mm, 95% confidence interval (CI) 0.08 to 0.43, sd 0.38; tip, 0.11 mm, 95% CI -0.08 to 0.31, sd 0.42) compared with the conventional stem (head, 0.62 mm, 95% CI 0.34 to 0.90, sd 0.56, p = 0.02; tip, 0.43 mm, 95% CI 0.21 to 0.65, sd 0.44, p = 0.03). There was no significant difference in dynamically inducible micromotion, rate of complications or functional outcome. This study demonstrates that the short femoral stem has a stable and predictable migration. However, longer-term survival analysis still needs to be determined. Cite this article: Bone Joint J 2018;100-B:1148-56.

Less periprosthetic bone loss following the anterolateral approach to the hip compared with the direct lateral approach

Background and purpose — The loss of bone mineral in the proximal femur following hip arthroplasty may increase the fracture risk around uncemented stems. We hypothesized that the surgical approach to the hip might influence bone mineral changes around the femoral stem in patients with a femoral neck fracture (FNF).Patients and methods — This was a pre-specified subgroup analysis (n = 51) of an ongoing randomized trial (n = 120) in patients with FNF. Participants were allocated to an uncemented hemiarthroplasty inserted through a direct lateral (Hardinge) approach or an anterolateral (modified Watson-Jones) approach. The 51 patients (mean age 83 (70–90) years, 33 women) were measured by dual-energy X-ray absorptiometry (DXA) to assess changes in periprosthetic bone mineral density (BMD).Results — The mean change in total BMD differed between groups at 12 months in favor of the anterolateral group (4.8%, 95% CI 0.0–9.6; p = 0.05). DXA at 3 months displayed BMD loss in the proximal Gruen zones in the lateral group compared with the anterolateral group. Zone 1 (–5.0% vs. 2.7%), zone 2 (–4.3% vs. 4.1%), zone 6 (–6.5% vs. 0.0%) and zone 7 (–11% vs. –2.4%, all p < 0.05).Interpretation — DXA measurements in this study indicate that surgical approach to the hip influences periprosthetic BMD. Clinical implications remain uncertain. Our conclusions should be interpreted with caution as we did not perform adjustments for multiple tests, possibly leading to inflation of false-positive findings.

How well do lower femoral neck-shaft angles match native anatomies in patients with deformed coxa vara hip? A retrospective chart review

Background and objectives: Patients undergoing total hip arthroplasty (THA) may have femoral deformities classified as either coxa vara, coxa valga, or physiologic. Understanding patients' anatomies is of importance for surgeons in an effort to tailor not only surgical approach, but also implant selection, and ultimately ensure optimal outcomes. The goal of the present study is to determine the efficacy of implanting a lower neck shaft angle (NSA) femoral stem in patients with coxa vara deformities and determine short-term clinical outcomes. Design: A retrospective chart review study. Methods: The study took place at The Texas Center for Joint Replacement in Plano, Texas. Two patient groups, clinical outcomes group and EOS group, were used for this study. The clinical outcomes group contained 55 patients who had undergone primary THA surgery from June 2013 to June 2015 by the senior author. The EOS group contained 36 patients who had undergone primary THA, and completed both preoperative and postoperative biplanar X-rays (low dose imaging device EOS) to obtain three-dimensional reconstructions of the skeletal system from October 2015 to November 2016. Operations were performed in all hips through the anterior supine intermuscular approach utilizing a 123° NSA femoral stem, which was lower than the NSA (133°) found in standard femoral stem implants. Outcome measures: Pre- and postoperative Harris hip scores used to assess clinical outcomes following surgery. Pre- and postoperative femoral offset, NSA, and femur length determined by EOS. Results: In the EOS group, mean femoral offset decreased by 3.5 mm, from 41.08 mm preoperatively to 37.6 mm postoperatively. Mean femoral NSAs decreased by 0.02°, from 123.02° preoperatively to 123.00° postoperatively. Mean femur length decreased by 2.4mm, from 404.2 mm preoperatively to 401.8 mm postoperatively. In the clinical outcomes group, mean Harris hip scores rose from 47 preoperatively to 93 postoperatively. Hip flexion range of motion improved from 87.5° preoperatively to 98° postoperatively. Conclusion: The lower NSA femoral stem examined in this study was proven to accurately restore NSA by 0.03°, femoral offset by 3.47 mm, and femur length by 2 mm, all within clinically documented satisfactory ranges without no revisions, suggesting excellent clinical outcomes in patients with coxa vara hip deformities. THA surgeons may consider utilizing femoral stems with a lower NSA in an effort to adequately restore hip function in patients with coxa vara hip deformities. Trial registration: This is a retrospective chart review study, therefore registration was not required.

More complications with uncemented than cemented femoral stems in total hip replacement for displaced femoral neck fractures in the elderly

Background and purpose — Total hip replacement (THR) is the preferred method for the active and lucid elderly patient with a displaced femoral neck fracture (FNF). Controversy still exists regarding the use of cemented or uncemented stems in these patients. We compared the effectiveness and safety between a modern cemented, and a modern uncemented hydroxyapatite-coated femoral stem in patients 65–79 years of age who were treated with THR for displaced FNF.Patients and methods — In a single-center, single-blinded randomized controlled trial, we included 69 patients, mean age 75 (65–79) and with a displaced FNF (Garden III–IV). 35 patients were randomized to a cemented THR and 34 to a reverse-hybrid THR with an uncemented stem. Primary endpoints were: prevalence of all hip-related complications and health-related quality of life, evaluated with EuroQol-5D (EQ-5D) index up to 2 years after surgery. Secondary outcomes included: overall mortality, general medical complications, and hip function. The patients were followed up at 3, 12, and 24 months.Results — According to the calculation of sample size, 140 patients would be required for the primary endpoints, but the study was stopped when only half of the sample size was included (n = 69). An interim analysis at that time showed that the total number of early hip-related complications was substantially higher in the uncemented group, 9 (among them, 3 dislocations and 4 periprosthetic fractures) as compared to 1 in the cemented group. The mortality and functional outcome scores were similar in the 2 groups.Interpretation — We do not recommend uncemented femoral stems for the treatment of elderly patients with displaced FNFs.

Total Hip Arthroplasty Using S-ROM Prosthesis for Dysplastic Hip

PurposeThe purpose of this study was to evaluate the clinical and radiological results of total hip arthroplasty using a proximal modular femoral stem in patients who had secondary coxarthrosis associated with a dysplastic hip.Materials and MethodsForty-two patients (45 hips) with secondary coxarthrosis were evaluated after undergoing primary total hip arthroplasty using an S-ROM proximal modular femoral stem. The average follow-up was 80 months (range: 60 to 96 months). Clinical and radiological assessments were performed based on the Harris hip score and the radiological changes around the prosthesis.ResultsThe average Harris hip score improved from 52.2 points to 88.5 points. All femoral stems showed stable fixation; there were 37 cases by bony ingrowth and 8 cases by stable fibrous ingrowth. Neither osteolysis nor progressive radiolucent lines around the femoral stem were found at the last follow-up. Forty-one hips (91.9%) revealed excellent or good clinical results at the most recent follow-up.ConclusionFor advanced secondary coxarthrosis, total hip arthroplasty with the use of the proximal modular femoral stem yielded good mid-term results with respect to the clinical and radiological criteria.

Revision Total Hip Arthroplasty Using an Extensively Porous Coated Femoral Stem

BackgroundTo determine the benefit of an extensively porous coated femoral stem in patients receiving revision total hip arthroplasty.MethodsThis study reviewed the results of 35 patients who received a revision total hip arthroplasty with extensively porous coated femoral stem between August, 1996, and December, 2002. The mean follow-up period was 77.5 months. The clinical and radiological results were evaluated by the Harris hip score and serial roentgenographic findings.ResultsThe preoperative and postoperative Harris hip score was 68.3 and 92.5, respectively. Radiographically, none of the acetabular components showed any evidence of migration, tilt, rotation, or shedding of metal particles. In addition, none of the femoral components showed evidence of subsidence, pedestal, or shedding of metal particles. Twenty-two hips had a mild stress shield and 2 hips had a moderate stress shield. The perioperative complications encountered were deep vein thrombosis (1 case), mild heterotopic ossification (4 cases), intraoperative periprosthetic fractures (1 case), and nonunion of the trochanteric osteotomy site (2 cases).ConclusionsExtensively porous coated femoral stems and acetabular components produce excellent clinical and radiological results in revision total hip arthroplasty.

Hip Hemiarthroplasty Using Extensively Porous Coated Femoral Stem in Femoral Neck Fracture Aged 70 Years or Older

Purpose: The aim of this study was to determine the utility of cementless extensively porous coated femoral stem in the patients older than 70 years, who had received a bipolar hemiarthroplasty. Materials and Methods: From June 1996 to June 2001, this study reviewed the clinical and radiographic results of 31 femoral neck fracture patients (31 hips, 9 men and 22 women), who underwent a bipolar hemiarthroplasty using a cementless extensively porous coated femoral stem, were 70 years or older and were followed up more than 2 years. The mean age at surgery was 79.3 (70-84). The mean follow up period was 31.2 months (range, 24 to 52). The clinical and radiological results were evaluated by the Harris Hip Score (HHS) and the serial X-ray findings, respectively. Results: Clinically, the mean HHS at the last follow up was 84.1 (69-92). Radiographically, there was no evidence of subsidence, pedestal and osteolysis of the femoral stem. A radiolucent line was bserved in 11 cases, but there was no evidence of progression. Therefore, all femoral stems were confirmed to be stable. Stress shielding was observed in 22 cases, mild in 20 cases and moderate in 2 cases. Conclusion: Bipolar hemiarthroplasty using a cementless extensively porous coated femoral stem in patients 70 years or older showed good clinical and radiological results. Therefore it is a useful prosthesis for bipolar hemiarthroplasty in patients 70 years or older.

Hydroxyapatite Coated CLS Femoral Stem in Patients with Rheumatoid Arthritis: Minimum 5 Year Results

Purpose: The study was undertaken in order to characterize the clinical and radiological results of total hip arthroplasty using a fully rough blasted stem with proximal hydroxyapatite coating in rheumatoid arthritis patients. Materials and Methods: Twenty three total hip arthroplasties were performed using CLS stems in rheumatoid arthritis patients. Mean patient age of the patients and follow-up period were 53 and 6.8 years, respectively. Both clinical and radiographical parameters were evaluated. Results: Chronological change of Harris hip score showed good results after 1 year. Harris hip score and the incidence of thigh pain at the last follow-up were 94 and one case, respectively. The mean time weight bearing without support was 12.5 weeks. Most endosteal bone formations around the stem appeared in the first 3 to 6 months. This was present in more than 80% of cases in zones 1, 2, 6, 7 and from 50 to 70% of cases even in zones 3, 4, 5 at the final follow-up. Loosening or implant failure was not found. Incomplete calcar fracture occurred in three cases, liner fracture around the femoral stem in one, heterotrophic ossi-fication in one and superficial infection in one. Conclusion: The total hip arthroplasty using a CLS stem with a proximal HA coating may be a good choice in rheumatoid arthritis patients requiring hip arthroplasty.

Five to Seven Years Survival Analysis of a Modular Titanium Alloy Stem Primary Total Hip Replacement

We report the results of a retrospective study of 94 primary total hip replacements with a modular implant (Howse II /Ultima) at a minimum of five years’ follow-up, performed since June 1991 to December 1993 for osteoarthritis of the hip. Twenty-one patients (22 THRs) had died and four patients were lost to follow-up. Mean Harris Hip score of 47 ± 8.7 (range 24–64) pre-operatively rose to 84.9 ± 21.5 (range 22–97). The survival rate of femoral stem in patients who had revisions for aseptic loosening was 91% and no stem was diagnosed as radiologically loose in the first five years of insertion. Using radiological criteria by Harris, three stems were definitely loose (3.2%), three were probably loose (3.2%) and two were possibly loose (2.1%). Survival rate of the Ultima cup for aseptic loosening in patients who had revisions was 87% at seven years. At the final follow-up, three sockets were definitely loose, four were probably loose and four more were possibly loose. Risk of failure of primary total hip replacements increased with increased weight (BMI of greater than 1.25 as compared to below 1.0 (p=0.04, chi test); in patients with osteonecrosis (p=0.048, chi test) and patients who were younger than 65 years of age (p=0.039, chi test). This study represented the outcome of Ultima hip arthroplasties performed by a variety of surgeons and included patients in all age groups and all aetiologies leading to osteoarthritis.