Head Total Hip Arthroplasty Research Articles

Short-term outcomes with routine use of size ≥40 femoral heads in THA: A retrospective cohort study

BackgroundUsing larger femoral heads during total hip arthroplasty (THA) may result in a more stable hip. Greater volumetric wear and frictional torque, however, may result in increased postoperative complications. The purpose of this study was to compare outcomes of patients with femoral head size ≥40 mm compared to those with femoral head size <40 mm. Materials and methodsA retrospective chart review of 504 THAs performed by a single surgeon at a single institution from 2009 to 2016 was conducted. Following exclusions, 131 THAs were identified with femoral heads ≥40 mm and 348 THAs were identified with femoral heads <40 mm. In addition to demographic data, all postoperative complications were recorded. Plain radiographs were used to rule out/in periprosthetic osteolysis and/or acetabular loosening. Chi-square tests and Student's t-tests were used to compare categorical and continuous variables, respectively. ResultsMean follow-up period for the entire cohort was 5.5 years. Complications with ≥40 mm femoral heads included 1 superficial infection and 1 deep periprosthetic joint infection (PJI). There were no cases of dislocation, osteolysis, acetabular loosening, or trunnionosis. In contrast, complications with <40 mm femoral heads included 9 dislocations and 7 PJIs. ConclusionThe routine use of large femoral heads (≥40-mm) during THA appears to be a safe option for patients at short-term clinical follow-up. Notably, 0 patients had a clinical course complicated by dislocation, osteolysis, acetabular loosening, or trunnionosis. Level of evidenceLevel III Retrospective Cohort Study.

Failure Following Revision Total Hip Arthroplasty After Cobalt-Chrome Femoral Heads are Placed on a Retained Femoral Stem

BackgroundFailure due to trunnionosis with adverse local tissue reaction (ALTR) has been reported with cobalt-chrome (CoCr) heads in total hip arthroplasty (THA); however, there are limited data on the use of these heads in the revision setting. The purpose of this study was to analyze the outcomes of patients who underwent revision THA with a retained femoral component and received a CoCr femoral head on a used trunnion. MethodsIn this retrospective review, we identified all patients who underwent revision THA with a retained femoral component and received a CoCr femoral head between February 2006 and March 2014. Demographic factors, implant details, and postoperative complications, including the need for repeat revisions, were recorded. In total, 107 patients were included (mean age 67 years, 74.0% women). Of the 107 patients, 24 (22.4%) required repeat revisions. ResultsPatients who required repeat revision were younger than those who did not (mean age: 62.9 versus 69, P = .03). The most common indications for repeat revision were instability (8 of 24, 33.3%), ALTR (5 of 24, 20.8%), and infection (4 of 18, 16.7%). Evidence of ALTR or metallosis was identified at the time of reoperation in 10 of the 24 patients who underwent re-revision (41.7%). ConclusionsThe placement of a new CoCr femoral head on a used trunnion during revision THA with a retained femoral component carries a significant risk of complication (22.4%) and should be avoided when possible.

Safety of using a large femoral head on thin polyethylene for total hip arthroplasty based on different types of polyethylene

The use of a large femoral head in total hip arthroplasty (THA) to stabilize and reduce the incidence of dislocation is on the increase, but concerns arise when combining them with small acetabular components due to potential mechanical failures in thin polyethylene (PE) liners. A single-institution, retrospective cohort study was conducted on 116 patients with minimum 2-year follow-up who received 36-mm femoral heads and acetabular components ≤ 52 mm, using either remelted highly cross-linked polyethylene (remelted HXLPE) or vitamin E-infused HXLPE (VEPE). Osteolysis and implant loosening were not observed in either group. Although a fracture of the PE liner was observed in each group (1.7%), the clinical outcomes were excellent, as the mean modified Harris Hip Score (mHHS) at the last follow-up was 93.5. Moreover, the mean linear wear rates measured by digital imaging software in both groups were low, with 0.035 mm/y in remelted HXLPE and 0.030 mm/y in VEPE. In conclusion, The use of a large femoral head on a thin PE liner can be a viable treatment option in patients who need to prioritize stability; however, careful attention should be paid to mechanical fractures of the PE liner.

Preoperative Templating for Total Hip Arthroplasty: A Method for Calibrating Digital Radiographs Using Patient Demographics and Anthropometric Measurements.

Background Preoperative templating aids the surgeon in estimating implant size and placement. Calibration markers are used to set the correct magnification of digital images before templating. Improper marker placement or complete absence can lead to inaccuracy or an inability to calibrate images altogether. Aims This study describes a method for calibrating images using a patient's femoral head size (FHS) predicted using demographics and anthropometric data. Materials and methods A formula predicting the FHS was derived from a cohort of 507 patients who underwent hemiarthroplasty for an intracapsular fractured neck of the femur through multivariate regression analysis. A separate validation cohort (n=50) who had undergone total hip arthroplasty (THA) had postoperative radiographs calibrated using the predicted FHS and the native contralateral hip as a surrogate calibration marker. The THA femoral head implant size was subsequently measured and compared with the actual implant size selected intraoperatively. Measurements were performed by two independent assessors to determine intra- and interobserver reliability. Results Multivariate regression analyses showed four variables significantly correlated with the size of the femoral head: gender (p < 0.001), height (p < 0.001), weight (p < 0.001), and race (Asian) (p = 0.01). Using these, a regression model to predict the FHS was obtained with an R2 value of 0.65 and a standard error of 2.18 mm. The validation cohort showed that THA head implant size could be accurately measured with an average root-mean-squared error (RMSE) of 1.41 mm (SD = 0.97 mm; %RMSE = 4.7%). The implant head size was measured to be within 5%, 10%, and 15% RMSE in 57.5%, 93.0%, and 100.0% of cases, respectively. There was excellent intraobserver (R2= 0.94 and 0.95) and interobserver (R2= 0.94) reliability. Conclusions The novel method proposed and validated in this study, using a predicted FHS to calibrate digital images, provides an alternative means of templating THA for fractured neck of the femur patients, in whom external calibration markers are often absent.

Routine Pathologic Examination of the Femoral Head in Total Hip Arthroplasty: A Survey Study of the American Association of Hip and Knee Surgeons

BackgroundCurrent literature does not provide conclusive evidence on whether routine pathologic examination of femoral heads from total hip arthroplasty is indicated or cost-effective. As a result, there is substantial variation in opinion among surgeons related to this issue. Our study aim was to determine factors that impact surgeon propensity to order pathologic examination of femoral heads. MethodsA 12-question survey was created to evaluate surgeon practices, indications, and patient care implications surrounding routine pathologic examination of femoral heads. The email survey was distributed to all members of the American Association of Hip and Knee Surgeons (n = 2598). ResultsThere were 572 survey respondents. Out of all respondents, 28.4% always send femoral heads to pathology, and 27.6% reported an institutional requirement to do so. Of the 572 surgeons, 73.6% report femoral head pathology has never resulted in a change in patient disease course. Factors that increase the likelihood of surgeons ordering femoral head pathologic examination include institutional requirements, medicolegal concern, and prior experience with femoral head pathologic examination changing patients' disease course (P < .001). Cost concern decreases the likelihood of surgeons ordering femoral head pathologic examination (P = .0012). ConclusionsA minority of surgeons routinely send femoral heads from total hip arthroplasty for pathologic examination, mostly because of institutional requirement. The majority of surgeons feel that femoral head pathologic examination never changes patient management, although others have infrequently detected malignancy and infection. Institutional policy, concern for litigation, and prior experience with discordant pathologic diagnoses increase femoral head pathologic examinations, while cost concern decreases them.

Ceramic-on-Ceramic Bearings in Total Joint Arthroplasty. Part 1

Summary. Ceramic bearings were first employed as alternatives to polyethylene (PE) bearings in total joint arthroplasty about a decade after Sir John Charnley introduced the first durable total hip arthroplasty (THA) with a metal-PE articulation. Charnley’s approach was based on a metal stem bonded to bone with polymethylmethacrylate (PMMA) and an acetabular component made of ultra-high-molecular-weight PE (UHMWPE). Microscopic particulate debris in the joint space from bearing wear has been shown to lead to periprosthetic inflammation, osteolysis, and implant loosening. Cross-linking can reduce the wear of UHMWPE, but it also compromises UHMWPE’s mechanical properties. Accordingly, there are concerns related to potential brittleness if UHMWPE implants are not positioned optimally. Also, the smaller particles generated from cross-linked UHMWPE may present an increased particulate load in vivo. Thus, there is a need for data on the long-term outcomes of cross-linked UHMWPE. Any technology that can reduce bearing wear rates in THA and total knee arthroplasty (TKA) can potentially decrease the morbidity and risks associated with premature revision surgery related to wear. Improved wear resistance also allows the use of large-diameter femoral heads in THA, leading to increased arc of movement and less risk of prosthesis dislocation. The ideal joint bearing for THA and TKA would be able to withstand high cyclic loading for several decades without undergoing corrosion or fretting at modular metal tapers, and would possess proven biocompatibility and material stability in vivo, as well as ultralow wear rates. The search for the ideal total joint bearing has led to the development of ceramic bearings.

O014 Oxidised zirconium versus cobalt-chrome femoral heads in total hip arthroplasty: a multi-centre prospective double-blinded randomised controlled trial with 10-years follow-up

Abstract Introduction This study reports the ten-year polyethylene liner wear rates, incidence of osteolysis, clinical outcomes and complications of a three-arm, multicentre randomised controlled trial comparing Cobalt-Chrome (CoCr) and Oxidised Zirconium (OxZr) femoral heads with ultra-high molecular weight polyethylene (UHMWPE) versus highly cross-linked polyethylene(XLPE) liners in total hip arthroplasty (THA). Methods Patients undergoing THA from four institutions were prospectively randomised into three groups. Group A received a CoCrfemoral head and XLPE liner; Group B received an OxZrfemoral head and XLPE liner; and Group C received an OxZr femoral head and UHMWPE liner. Patients and observers recording study outcomes were blinded to the treatment groups at each follow-up interval. The outcomes of 262 study patients were analysed at ten years follow-up after THA. Results At ten years follow-up, increased linear wear rates were recorded in group C compared to group A (0.133 ± 0.21 mm/yr vs 0.031 ± 0.07 mm/yr respectively, p&amp;lt;0.001) and group B (0.133 ± 0.21 mm/yr vs 0.022 ± 0.05 mm/yr respectively, p&amp;lt;0.001). Patients in group C were associated with increased risk of osteolysis and aseptic loosening requiring revision surgery compared with group A (7/133 vs 0/133 respectively, p=0.007) and group B (7/133 vs 0/135 respectively, p=0.007). Conclusion The use of UHMWPE was associated with progressively increased annual liner wear rates after THA. At ten years follow-up, this translated to UHMWPE leading to an increased incidence of osteolysis and aseptic loosening requiring revision THA, compared with XLPE. Take-home message THA using XLPE liners is associated with improved long-term implant survivorship and reduced revision surgery compared with UHMWPE liners at long-term follow-up.

Experimental Investigation of Material Transfer on Bearings for Total Hip Arthroplasty-A Retrieval Study on Ceramic and Metallic Femoral Heads.

Metallic deposition is a commonly observed phenomenon on the surface of revised femoral heads in total hip arthroplasty and can lead to increased wear due to third bodies. In order to find out the origin and composition of the transfer material, 98 retrieved femoral heads of different materials were examined with regard to the cause of revision, localization, pattern and composition of the transfer material by energy dispersive X-ray spectroscopy. We found that in 53.1%, the deposition was mostly in the region of the equator and the adjacent pole of the femoral heads. The most common cause for revision of heads with metallic deposition was polyethylene wear (43.9%). Random stripes (44.9%), random patches (41.8%) and solid patches (35.7%) were most prevalent on retrieved femoral heads. Random patches were a typical pattern in ceramic-on-ceramic bearing couples. The solid patch frequently occurred in association with dislocation of the femoral head (55%). The elemental analysis of the depositions showed a variety of different materials. In most cases, titanium was an element of the transferred material (76.5%). In addition to metallic components, several non-metallic components were also detected, such as carbon (49%) or sulfur (4.1%). Many of the determined elements could be assigned with regard to their origin with the help of the associated revision cause. Since the depositions lead to an introduction of third-body particles and thus to increased wear, the depositions on the bearing surfaces should be avoided in any case.

Oxidized zirconium versus cobalt-chrome femoral heads in total hip arthroplasty: a multicentre prospective randomized controlled trial with ten years' follow-up.

This study reports the ten-year wear rates, incidence of osteolysis, clinical outcomes, and complications of a multicentre randomized controlled trial comparing oxidized zirconium (OxZr) versus cobalt-chrome (CoCr) femoral heads with ultra-high molecular weight polyethylene (UHMWPE) and highly cross-linked polyethylene (XLPE) liners in total hip arthroplasty (THA). Patients undergoing primary THA were recruited from four institutions and prospectively allocated to the following treatment groups: Group A, CoCr femoral head with XLPE liner; Group B, OxZr femoral head with XLPE liner; and Group C, OxZr femoral head with UHMWPE liner. All study patients and assessors recording outcomes were blinded to the treatment groups. The outcomes of 262 study patients were analyzed at ten years' follow-up. Patients in Group C were associated with increased mean liner wear rates compared to patients in Group A (0.133 mm/yr (SD 0.21) vs 0.031 mm/yr (SD 0.07), respectively; p < 0.001) and Group B (0.133 mm/yr (SD 0.21) vs 0.022 mm/yr (SD 0.05), respectively; p < 0.001) at ten years' follow-up. Patients in Group C were also associated with increased risk of osteolysis and aseptic loosening requiring revision surgery, compared with patients in Group A (7/133 vs 0/133, respectively; p = 0.007) and Group B (7/133 vs 0/135, respectively; p = 0.007). There was a non-statistically significant trend towards increased mean liner wear rates in Group A compared with Group B (0.031 mm/yr (SD 0.07) vs 0.022 mm/yr (SD 0.05), respectively; p = 0.128). All three groups were statistically comparable preoperatively and at ten years' follow-up when measuring normalized Western Ontario and McMaster Universities Osteoarthritis Index (p = 0.410), 36-Item Short Form Health Survey (p = 0.465 mental, p = 0.713 physical), and pain scale scores (p = 0.451). The use of UHMWPE was associated with progressively increased annual liner wear rates after THA compared to XLPE. At ten years' follow-up, the group receiving UHMWPE demonstrated an increased incidence of osteolysis and aseptic loosening requiring revision surgery compared to XLPE. Femoral heads composed of OxZr were associated with trend towards reduced wear rates compared to CoCr, but this did not reach statistical significance and did not translate to any differences in osteolysis, functional outcomes, or revision surgery between the two femoral head components. Cite this article: Bone Joint J2022;104-B(7):833-843.

Large Femoral Heads in Total Hip Arthroplasty With Vitamin E Highly Cross-Linked Polyethylene: Head Penetration Rates Compared to Highly Cross-Linked Polyethylene.

Highly cross-linked polyethylene with vitamin E (VE-HXLPE) has shown superior tribological properties and has been rapidly adopted in total hip arthroplasty. However, the majority of studies compare VE-HXLPE to conventional or moderately cross-linked polyethylene using standard femoral head sizes. This study's purpose was 2-fold: (1) compare radiographic femoral head penetration (FHP) between VE-HXLPE and HXLPE and (2) evaluate FHP in large femoral heads ≥40 mm. One hundred forty-two consecutive primary total hip arthroplasties using ceramic femoral heads (n = 84 VE-HXLPE; n = 58 HXLPE) in a single implant system were retrospectively reviewed. FHP was measured radiographically utilizing Martell method at 4-week, 1-year, and latest radiographs. FHP, cup position, and demographic variables were compared between VE-HXLPE and HXLPE liners. Median linear FHP was lower for VE-HXLPE compared to HXLPE during the initial "bedding-in" period between 4-week and 1-year (0.383 vs 0.551 mm, P = .650) and between 1-year and latest follow-up (0.131 vs 0.270 mm/y, P = .636) although without statistical significance. Acetabular cup inclination and anteversion did not influence linear or volumetric FHP (P ≥ .204). Large femoral heads (≥40 mm) were predictive of higher FHP during the early bedding-in period (P ≤ .025) but did not have an effect beyond 1 year in multivariate regression with numbers available. No radiographic osteolysis was observed in any case. These findings support others that VE-HXLPE is the optimal polyethylene bearing surface to minimize FHP during the bedding-in period and beyond. Surprisingly, large ceramic femoral heads appear to influence FHP during the initial bedding-in period but do not increase FHP beyond 1 year. Further longer term follow-up remains warranted. III.

Instability After Primary Total Hip Arthroplasty: Dual Mobility Versus Jumbo Femoral Heads.

The use of dual mobility (DM) articulations has grown substantially over the last decade to help minimize dislocation risk. The purpose of this study is to compare the results of DM articulations to jumbo femoral heads of equivalent sizes as they relate to postoperative dislocation. This is a retrospective cohort study of primary total hip arthroplasties (THAs) performed at a single institution between 2005 and 2018. DM articulations and large-diameter metal-on-metal femoral heads were included. Patients were followed with Harris Hip Scores and standard radiographs. Complications were prospectively recorded. Statistical analyses included chi-squared and Brown-Forsythe tests. In total, 1,288 Magnum femoral head THAs and 365 Active Articulation DM THAs were included for analysis. The same monoblock cup was implanted via a posterior approach in all cases. Age, gender, body mass index, and diagnosis were similar between groups. Average follow-up in the DM group was 49 months, and 126 months in the jumbo head group. The average head sizes in the DM and jumbo head groups were 50 mm. There were no dislocations in the DM hips and only 2 (0.2%) in the jumbo femoral head group. Both groups had significant improvements in Harris Hip Score from their preoperative baseline. Our study found similarly low dislocation rates in DM and jumbo femoral heads in primary THA. No evidence currently exists showing a benefit of the DM articulation beyond that of the large effective head size, and we recommend making every attempt at maximizing head size prior to using DM articulations.

A prospective comparative study of functional outcome of 28 mm versus 36 mm femoral head sizes in uncemented total hip arthroplasty

&lt;div class="WordSection1"&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Incidence of dislocation is about 1% to 6% for primary total hip arthroplasty (THA) and 4.8% to 13% for revision THA. The diameter of the femoral head is one of the important variables under the control of a surgeon. Larger heads with modern necks improve the head-to-neck ratio, increase jump distance, reduce component impingement, instability and increase ROM. Objective were to compare the functional outcome of 28 mm versus 36 mm head sizes in uncemented THA in terms of ROM and functional status.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this prospective comparative study conducted on 30 patients with 36 diseased hips undergoing primary THA with 28 mm and 36 mm femoral head sizes for degenerative arthritis aged between 20-70 years, in Sanjay Gandhi institute of trauma and orthopaedics, Bangalore from November 2019 to April 2021. All patients were followed up at 6, 12 and 24 weeks postoperatively and assessed for ROM and functional status using modified Harris hip score (HHS).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The flexion was 9.31 degrees, extension was 4.0 degrees, adduction was 3.35 degrees, abduction was 4.31 degrees, internal rotation was 6.13 degrees, external rotation was 9.06 degrees and modified HHS was more in patients who received 36 mm femoral head as compared to the patients who received 28 mm femoral head at the end of follow up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;We conclude that the use of 36 mm femoral head provides better improvement in the range of motion, functional outcome, and better patient and surgeon satisfaction than 28 mm femoral head in THA.&lt;/p&gt;&lt;p&gt;&lt;strong&gt; &lt;/strong&gt;&lt;/p&gt;&lt;/div&gt;

Comparison of the long-term cause of failure and survivorship of four hundred and twenty seven metal-on-metal hip arthroplasties: resurfacing versus large head total hip arthroplasty

IntroductionComparison of mid- to long-term cause of failure and survivorship of metal-on-metal (MoM) resurfacing hip arthroplasty (RHA) and large head total hip arthroplasty (THA) remains sparse. This study aimed to identify and compare the cause of failure and survivorship of MoM RHA and THA at a minimum ten year follow-up.MethodsFour hundred twenty-seven MoM hip arthroplasties (286 THA and 141 RHA) were retrospectively analyzed at a mean follow-up of 13 ± three years. Causes of failure were reported as MoM specific (i.e., adverse reaction to metal debris (ARMD) and painful hip with ion elevation) or MoM non-specific (i.e., fracture, infection, and dislocation). Chromium (Cr) and cobalt (Co) ion levels and Co/Cr ratio were compared. Survivorship was compared according to the cause of failure with revision as the endpoint.ResultsThe rate of ARMD was significantly higher in THA (OR = 2.9 [95%-CI: 1–7]; p = 0.02). No significant difference was detected in failure rate due to other causes between the two groups (p = 0.2–0.9). Ion levels and Co/Cr ratio were both significantly higher in THA (p < 0.01). Survivorship was significantly lower in THA compared to RHA at ten years [89% (95%-CI: 85%–91%) vs 96% (95%-CI: 91%–98%); p = 0.01] and 15 years [73% (95%-CI: 67%–78%) vs 83% (95%-CI: 73%–90%); p = 0.01].ConclusionRHA survivorship was significantly higher at any time point. Failure rate due to ARMD was significantly higher in THA while no significant difference in other causes of failure was observed between the two groups. This result emphasizes the role of fretting corrosion at the head-neck junction (i.e., trunnionosis) with significantly higher ion levels and Co/Cr ratio dissociation in THA.

Despite higher revision rate, MoM large-head THA offers better clinical scores than HR: 14-year results from a randomized controlled trial involving 48 patients

BackgroundThe high failure rates of metal on metal (MoM) large diameter head total hip arthroplasty (LDH THA) and hip resurfacing (HR) prevented their long-term comparisons with regards to clinical outcome. Such knowledge would be important as ceramic LDH bearing is now available. With long-term follow-up, we investigated the difference in 1) patient-reported outcome measures (PROMs); 2) revision and adverse events rates, and 3) metal ion levels between MoM LDH THA and HR.MethodsForty-eight patients were randomized for LDH THA (24) or HR (24) with the same MoM articulation. At a mean follow-up of 14 years, we compared between groups different PROMs, the number of revisions and adverse events, whole blood Cobalt (Co) and Chromium (Cr) ion levels, and radiographic signs of implant dysfunction.ResultsLDH THA (all cases: revised and well-functioning) had significantly better WOMAC (94 versus 85, p = 0.04), and more frequently reported having no limitation (p = 0.04). LDH THA revision rate was 20.8% (5/24) versus 8.3% (2/24) for HR (p = 0.4). Mean Co and Cr ion levels were higher in LDH THA compared to the HR (Co: 3.8 μg/L vs 1.7 μg/L; p = 0.04 and Cr: 1.9 μg/L vs 1.4 μg/L, p = 0.1). On radiographic analyses, 2 LDH THAs showed signs of adverse reaction to metal debris, whereas 1 loose femoral HR component was documented.ConclusionIn the long-term, MoM LDH THA had a high trunnion related revision rate but nonetheless showed better PROMs compared to HR. Provided with a well-functioning modular junction, non-MoM LDH THA would offer an appealing option.Trial registrationClinicalTrials.gov (NCT04516239), August 18, 2020. Retrospectively registered.

A bicentric approach evaluating the combination of a hemispheric cup with a novel ceramic head in total hip arthroplasty.

Medical ceramics are frequently used biomaterials as a liner in total hip arthroplasty. Strong efforts have been made to improve material properties over the last decades. Alumina toughened zirconia ceramics seem to be promising alternatives to further reduce fracture rates and squeaking phenomena. To answer the question if alumina toughened zirconia ceramic liners in combination with a cementless, hemispheric cup are able to reduce squeaking phenomena and fracture rates, we initiated a bicentric, mid-term trial. Noise phenomena will be recorded using MONA Score (Melbourne Orthopaedic Noise Assessment). Functional outcome (Harris Hip Score, University of California-Los Angeles, Forgotten Joint Score, EQ-5D Score, Visual Analogue Scale) and radiographic parameters will serve as secondary parameters. The study has been set up for 5 years, with follow-ups after 6-14 weeks, 12, 24 and 60 months.

Correction to: Short‑term clinical and radiographic outcomes of total hip arthroplasty with PMPC‑grafted highly cross‑linked polyethylene liners against 32‑mm femoral heads

A correction to this paper has been published: https://doi.org/10.1007/s10047-021-01258-4

Is large femoral head a better option than a conventional femoral head primary total hip arthroplasty in Indian population

&lt;p class="abstract"&gt;&lt;strong&gt;Background: &lt;/strong&gt;Study aimed to assess and compare the functional outcome in patients underwent the large femoral head THA and conventional femoral head THA.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; It is a comparative prospective cross sectional study conducted among the patients undergoing primary total hip arthroplasty through postero-lateral approach at department of orthopaedics Vydehi institute of medical sciences, Bengaluru during the period of July 2017 to July 2019. Patients aged between 18-80years of both genders undergoing Primary THA for Osteoarthritis (OA), Rheumatoid Arthritis (RA), Ankylosing Spondylitis (AS), Post traumatic arthritis, Avascular necrosis (AVN), Acute fracture neck of femur, Non-union fracture neck of femur (NOF). Patients undergoing primary total hip arthroplasty in Intertrochanteric fracture, Acetabular fracture and patients undergoing Revision Hip Arthroplasty were excluded from study. Patients were grouped as the ones treated with large femoral head THA and conventional femoral head THA.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results: &lt;/strong&gt;This series consisted of 36 patients with 44 diseased hips treated with primary total hip arthroplasty (THA). Out of 36 patients, 9 patients (25%) belonged to an age group of below 30 years of age, 10 patients (27.8%) belonged to the age group between 31-40 years of age, 8 patients (22.2%) belonged to the age group 41-51 years of age and 9 patients (25%) belonged to age group of 51-60 years of age. The mean level of Modified Harris Hip score and improvement of movements in all planes was found to be statistically significantly in the patients treated with large femoral head primary THA compared to those treated with conventional method. (p&amp;lt;0.001)&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Study has shown improved functional outcome (Modified harris hip score) and range of movement in the patients treated with the large femoral head primary THA as compared to those treated with a conventional femoral head.&lt;/p&gt;

Short-term clinical and radiographic outcomes of total hip arthroplasty with PMPC-grafted highly cross-linked polyethylene liners against 32-mm femoral heads

We evaluated the clinical and radiographic outcomes of femoral head penetration and total hip arthroplasties with untreated and poly (2-methacryloyloxyethyl phosphorylcholine) (PMPC)-grafted highly cross-linked polyethylene (HXLPE) acetabular liners against 26-, 28-, and 32-mm cobalt–chromium alloy femoral heads 3 years after the index surgery. Three combinations of the articulating surfaces were evaluated in the present study: untreated or PMPC-grafted HXLPE liner against 26- or 28-mm femoral heads (n = 16, 24) [control (26 or 28 mm) and PMPC (26 or 28 mm)] and PMPC-grafted HXLPE liner against 32-mm femoral heads (n = 64) [PMPC (32 mm)]. The clinical outcomes improved at 3 years postoperatively for the groups. No periprosthetic osteolysis or acetabular component migration was detected, and no revision surgery was performed among the groups. The steady-state wear rate of the PMPC (26 or 28 mm) group (0.021 mm/year) was lower than that of the control (26 or 28 mm) group (− 0.015 mm/year); the steady-state wear was under the clinical threshold. In contrast, the steady-state wear rate of the PMPC (32 mm) group (-0.006 mm/year) showed no significant difference when compared to that of the PMPC (26 or 28 mm) group (p < 0.01). The results obtained in the present study clearly demonstrate that PMPC-grafting onto an HXLPE surface improved the wear resistance of acetabular liners, even when coupled with larger femoral heads. Although further follow-up evaluations are required, PMPC-grafted HXLPE acetabular liners may be a promising approach to extend the longevity of artificial joints.

Dual Mobility Cup: Does It Improve Patient's Satisfaction After Total Hip Arthroplasty? A Prospective Comparative Randomized Study.

Despite the great success of total hip arthroplasty (THA), many patients were fairly dissatisfied after surgery. Therefore, patient-reported outcome measures have become of an utmost importance in assessing the results after joint replacement. This study was conducted to compare the postoperative patient-reported satisfactions after implantation of two commonly used THA designs. Of 180 patients, who initially fulfilled the study selection criteria and received cementless THA, 165 patients were finally eligible and enrolled in this prospective comparative randomized study. All surgeries were carried out between 2010 and 2018. Two groups of homogenous demographic and clinical data were present. Group A patients (n = 80) were treated by large head THA, whereas group B (n = 85) received dual mobility cup designs. The Western Ontario McMaster Universities Osteoarthritis Index and visual analog scale were used for clinical evaluation. The degree of improvement that the patient expected and hoped before undergoing their surgeries was estimated using the score of the new knee society. The self-administered patient satisfaction scale was used to record the levels of patient satisfaction after surgery, and their values were statistically analyzed in relation to preoperative expectation scores (ie, score of the new knee society) and different clinical and sociodemographic variables. After a mean follow-up of 79 ± 4.13 months (range 24 to 96 months), both groups recorded a significant improvement (P < 0.05) in Western Ontario McMaster Universities Osteoarthritis Index and visual analogue scale scores. Patients of group B were significantly more satisfied (P < 0.05) than those of group A up to the first postoperative year. Certain studied variables were linked to superior satisfaction results among group B at the last follow-up. Dual mobility THA provides better patient satisfaction than their standard large head alternatives specifically among elderly patients, socially unsupported individuals, farmers, heavy manual workers, and those with high levels of expectations. Clinical Trials.gov identifier: NCT04333316.

A novel calibration method for digital templating of total hip arthroplasty: a prospective clinical study of dual scale type single marker calibration in supine radiographs.

External calibration markers (ECM) are the standard of care for digital templating in joint replacements. Spherical mono markers are known to be unreliable. Fixed calibration factors (FCF) can reduce the overall error by placement of markers, but do not address individual patient anatomy. Dual scale calibration marker (DSCM) methods were developed to improve precision of calibration but require two markers. This prospective observational study is the first to analyse the application of a dual scale type single marker (DSSM) method in supine radiographs. One hundred patients with unilateral total hip arthroplasty (THA) underwent anterior-posterior pelvis X-ray with ECM and DSSM. The femoral THA head components were used as internal reference (ICM). An empirical fixed calibration factor (FCF; 120%) was used as comparator. Absolute differences of ICM and both ECM and DSSM were calculated. Absolute relative deviations (ARD) were calculated. Mean absolute calibration factor differences of ECM, FCF and DSSM from ICM were 0.105 (0.002-0.182), 0.016 (0.082-0.013) and 0.011 (0.056-0.009), respectively. ARD differences between ECM and DSSM as well as FCF and DSSM were significant (p < 0.001). The DSSM method showed superior results over ECM and FCF to predict the optimal calibration factor in supine radiographs. The novel DSSM method could be used to improve digital templating in supine radiographs without need for additional markers.