Mean Oxford Hip Score Research Articles

Responsiveness and ceiling effects of the Forgotten Joint Score-12 following total hip arthroplasty.

ObjectivesTo assess the responsiveness and ceiling/floor effects of the Forgotten Joint Score -12 and to compare these with that of the more widely used Oxford Hip Score (OHS) in patients six and 12 months after primary total hip arthroplasty.MethodsWe prospectively collected data at six and 12 months following total hip arthroplasty from 193 patients undergoing surgery at a single centre. Ceiling effects are outlined with frequencies for patients obtaining the lowest or highest possible score. Change over time from six months to 12 months post-surgery is reported as effect size (Cohen’s d).ResultsThe mean OHS improved from 40.3 (sd 7.9) at six months to 41.9 (sd 7.2) at 12 months. The mean FJS-12 improved from 56.8 (sd 30.1) at six months to 62.1 (sd 29.0) at 12 months. At six months, 15.5% of patients reached the best possible score (48 points) on the OHS and 8.3% obtained the best score (100 points) on the FJS-12. At 12 months, this percentage increased to 20.8% for the OHS and to 10.4% for the FJS-12. In terms of the effect size (Cohen’s d), the change was d = 0.10 for the OHS and d = 0.17 for the FJS-12.ConclusionsThe FJS-12 is more responsive to change between six and 12 months following total hip arthroplasty than is the OHS, with the measured ceiling effect for the OHS twice that of the FJS-12. The difference in effect size of change results in substantial differences in required sample size if aiming to detect change between these two time points. This has important implications for powering clinical trials with patient-reported measures as the primary outcome.Cite this article: Dr D. F. Hamilton. Responsiveness and ceiling effects of the Forgotten Joint Score-12 following total hip arthroplasty. Bone Joint Res 2016;5:87–91. DOI: 10.1302/2046-3758.53.2000480.

The Wagner Cone Stem for the Management of the Challenging Femur in Primary Hip Arthroplasty

BackgroundSplined conical stems offer design features that facilitate their use in the misshapen, dysplastic proximal femur. MethodsThis study assessed the survivorship of a conical prosthesis when applied to secondary coxarthrosis because of a range of pathologies. Fifty-one prostheses were implanted in 50 patients with a mean age of 50 (range, 15-80) and a median follow-up of 34 months (range, 24-73 months). Indications for the stem included developmental (36), neuromuscular (7), post-traumatic or surgical (7), and inflammatory conditions (1). Survivorship, functional outcome (WOMAC [Western Ontaria and McMaster University Osteoarthrits Index], Oxford Hip Score, and UCLA [University of California Los Angeles]), health status (short form-12 [SF-12]), satisfaction, and osseointegration were determined. ResultsSurvivorship for aseptic loosening was 100% at 2 years and 98.04% for septic revision. Eight patients required reoperation, 4 for instability, and 1 each for infection, impingement, adverse reaction to metal debris, and pelvic insufficiency fracture. The mean WOMAC score was 85 (standard deviation [SD], 18), the mean Oxford Hip Score 84 (SD, 18), the mean physical SF-12 score was 48.3 (SD, 8.6), and the mean mental SF-12 was 53.7 (SD, 9.2), the mean satisfaction score was 91.5 (SD, 3.9), and the mean UCLA was 6 (SD, 1.6). All femoral components demonstrated osseointegration. ConclusionThe cone femoral prosthesis demonstrates excellent early survival and osseointegration when applied to the challenging femur. Because of these encouraging results, we recommend this prosthesis be considered for the small, abnormal femur in primary hip arthroplasty.

Outcomes following subcapital osteotomy for severe slipped upper femoral epiphysis.

Slipped upper femoral epiphysis (SUFE) is the most common hip disorder to affect adolescents. Controversy exists over the optimal treatment of severe slips, with a continuing debate between in situ fixation versus corrective surgery. We present our experience in a series of 57 patients presenting with severe unilateral SUFE (defined > 50°) managed with a subcapital cuneiform osteotomy. Between 2001 and 2011, 57 patients (35 male, 22 female) with a mean age of 13.1 years (9.6 to 20.3, SD 2.3) were referred to our tertiary referral institution with a severe slip. The affected limb was rested in slings and springs before corrective surgery which was performed via an anterior Smith-Petersen approach. Radiographic analysis confirmed an improvement in mean head-shaft slip angle from 53.8(°) (standard deviation (SD) 3.2) pre-operatively to 9.1(°) (SD 3.1) post-operatively, with minimal associated femoral neck shortening. In total 50 (88%) patients were complication free at a mean follow-up of seven years (2.8 to 13.9 years, SD 3). Their mean Oxford hip score was 44 (37 to 48) and median visual analogue pain score was 0 out of 10 (interquartile range 0 to 4). A total of six patients (10.5%) developed avascular necrosis requiring further surgery and one (1.8%) patient developed chondrolysis but declined further intervention. This is a technically demanding operation with variable outcomes reported in the literature. We have demonstrated good results in our tertiary centre.

Trabecular Metal Use in Paprosky Type 2 and 3 Acetabular Defects: 5-Year Follow-Up

BackgroundThe reconstructive challenge of achieving a stable acetabulum in revision total hip arthroplasties in the presence of major osteolytic lesions has led to debate about the most appropriate surgical strategy to minimize implant-related failures. Trabecular metal (TM) implants have become popular but ongoing surveillance of their performance is required. MethodsWe reviewed the clinical and radiological outcome of a consecutive series of 52 patients (55 hips) who had undergone revision total hip arthroplasty for Paprosky type 2 or 3 acetabular defects with TM revision acetabular shells between 2002 and 2008. ResultsFour implant failures occurred (2 infections and 2 dislocations). Eleven patients from this cohort died (representing 12 hips) before the 5-year follow-up period giving us a follow-up of 78.2%. Implant survival at 5 years was 92% (95% confidence interval: 80.2%-96.9%). There were no cases of radiological loosening. The mean Oxford hip score was 34 (range, 5-48) at a mean follow-up of 63 months (range, 34-105 months). ConclusionsWe conclude that the use of TM revision shells for complex acetabular reconstruction yields satisfactory results.

Clinical and radiographical results of labral reconstruction.

Treatment of femoroacetabular impingement (FAI) includes correction of underlying bony deformities. Labrum preservation is recommended whenever possible. In hips, where the labrum is missing or damaged beyond preservation, labral reconstruction is an option to restore labral seal. Between 2008 and 2011, 84 hips underwent treatment for FAI by means of a surgical hip dislocation. In 13 of these hips (11 patients), the severely damaged or missing labrum was reconstructed with ligamentum capitis femoris. Pre- and postoperative radiographic and clinical data were analysed with a mean follow-up of 38 months (range: 19–65 months). Clinical outcome was determined with Oxford hip score (OHS) and overall satisfaction, rest and load pain with a visual analogue scale (VAS; 0–100). Clinical outcome was compared with a control group where labral refixation was performed. Mean OHS improved significantly (P ≤ 0.001) from 29 (SD 8) to 44 (SD 4). Overall satisfaction with the hip increased significantly (P = 0.002) from 44 (SD 35) to 87 (SD 15). Mean VAS for rest pain decreased significantly (P = 0.0004) from 45 (SD 35) to 5 (SD 7) as well as for load pain (P = 0.0007) from 59 (SD 26) to 16 (SD 19). There were no significant differences between the two groups. Reconstruction of the acetabular labrum with ligamentum capitis femoris yields good clinical results. Technical superiority of open labral reconstruction may explain the unexpected, excellent outcome.

Pseudotumour incidence, cobalt levels and clinical outcome after large head metal-on-metal and conventional metal-on-polyethylene total hip arthroplasty: mid-term results of a randomised controlled trial.

We compared the incidence of pseudotumours after large head metal-on-metal (MoM) total hip arthroplasty (THA) with that after conventional metal-on-polyethylene (MoP) THA and assessed the predisposing factors to pseudotumour formation. From a previous randomised controlled trial which compared large head (38 mm to 60 mm) cementless MoM THA with conventional head (28 mm) cementless MoP THA, 93 patients (96 THAs: 41 MoM (21 males, 20 females, mean age of 64 years, standard deviation (sd) 4) and 55 MoP (25 males, 30 females, mean age of 65 years, sd 5) were recruited after a mean follow-up of 50 months (36 to 64). The incidence of pseudotumours, measured using a standardised CT protocol was 22 (53.7%) after MoM THA and 12 (21.8%) after MoP THA. Women with a MoM THA were more likely to develop a pseudotumour than those with a MoP THA (15 vs 7, odds ratio (OR) = 13.4, p < 0.001). There was a similar incidence of pseudotumours in men with MoM THAs and those with MoP THAs (7 vs 5, OR = 2.1, p = 0.30). Elevated cobalt levels (≥ 5 microgram/L) were only associated with pseudotumours in women with a MoM THA. There was no difference in mean Oxford and Harris hip scores between patients with a pseudotumour and those without. Contrary to popular belief, pseudotumours occur frequently around MoP THAs. Women with a MoM THA and an elevated cobalt level are at greatest risk. In this study, pseudotumours had no effect on the functional outcome after either large head MoM or conventional MoP THA.

Revision arthroplasty for periprosthetic femoral fracture using an uncemented modular tapered conical stem.

Periprosthetic femoral fracture (PFF) is a potentially devastating complication after total hip arthroplasty, with historically high rates of complication and failure because of the technical challenges of surgery, as well as the prevalence of advanced age and comorbidity in the patients at risk. This study describes the short-term outcome after revision arthroplasty using a modular, titanium, tapered, conical stem for PFF in a series of 38 fractures in 37 patients. The mean age of the cohort was 77 years (47 to 96). A total of 27 patients had an American Society of Anesthesiologists grade of at least 3. At a mean follow-up of 35 months (4 to 66) the mean Oxford Hip Score (OHS) was 35 (15 to 48) and comorbidity was significantly associated with a poorer OHS. All fractures united and no stem needed to be revised. Three hips in three patients required further surgery for infection, recurrent PFF and recurrent dislocation and three other patients required closed manipulation for a single dislocation. One stem subsided more than 5 mm but then stabilised and required no further intervention. In this series, a modular, tapered, conical stem provided a versatile reconstruction solution with a low rate of complications.

A Cannulated Tri-Tapered Femoral Stem for Total Hip Arthroplasty: Clinical and Radiological Results at Ten Years

We report the ten-year clinical and radiological outcomes of a novel cannulated, tri-tapered femoral stem, used in primary total hip arthroplasty (110 stems in 98 patients). At ten years, two Tri-taper stems had been revised for infection and dislocation. The mean Oxford Hip Score improved from 13.46 pre-operatively, to 37.04. Radiological analysis revealed radiolucent lines in 57 cases, but none exceeded 2 mm thickness. Stem subsidence was identified in 63 cases, with mean distal tip migration of 3.8 mm. Survivorship with revision for aseptic loosening as the end point was 100% at 10 years. Stem survival with revision for any cause was 98.2% (95% CI, 92.9% to 99.5%). The ten-year results of the Tri-taper stem are comparable to other polished, tapered femoral stems.

Early surveillance of ceramic-on-metal total hip arthroplasty.

Ceramic-on-metal (CoM) is a relatively new bearing combination for total hip arthroplasty (THA) with few reported outcomes. A total of 287 CoM THAs were carried out in 271 patients (mean age 55.6 years (20 to 77), 150 THAs in female patients, 137 in male) under the care of a single surgeon between October 2007 and October 2009. With the issues surrounding metal-on-metal bearings the decision was taken to review these patients between March and November 2011, at a mean follow-up of 34 months (23 to 45) and to record pain, outcome scores, radiological analysis and blood ion levels. The mean Oxford Hip Score was 19.2 (12 to 53), 254 patients with 268 hips (95%) had mild/very mild/no pain, the mean angle of inclination of the acetabular component was 44.8(o) (28(o) to 63(o)), 82 stems (29%) had evidence of radiolucent lines of > 1 mm in at least one Gruen zone and the median levels of cobalt and chromium ions in the blood were 0.83 μg/L (0.24 μg/L to 27.56 μg/L) and 0.78 μg/L (0.21 μg/L to 8.84 μg/L), respectively. The five-year survival rate is 96.9% (95% confidence interval 94.7% to 99%). Due to the presence of radiolucent lines and the higher than expected levels of metal ions in the blood, we would not recommend the use of CoM THA without further long-term follow-up. We plan to monitor all these patients regularly.

A double mobility acetabular implant for primary hip arthroplasty in patients at high risk of dislocation.

Dislocation following total hip replacement continues to be a problem for which no completely satisfactory solution has been found. Several methods have been proposed to reduce the incidence of hip dislocations with varying degrees of success, including elevated rim liners, constrained liners and large diameter bearings. We present our experience with the double mobility acetabular component in patients at high risk of instability. This was a retrospective review of 65 primary total hip arthroplasties in 55 patients (15 men, 40 women), performed between October 2005 and November 2009. The majority (80%) of patients had at least two and 26% had at least three risk factors for instability. The mean age was 76 years (range: 44-92 years). The patients were followed up for a mean duration of 60 months (range: 36-85 months). Fourteen patients died and one was lost to follow-up, leaving fifty hips for final assessment. Until the final follow-up appointment, no patients had dislocation and none required revision surgery. The mean Oxford hip score improved from 45.0 to 26.5 (p<0.0001). The mean Merle d'Aubigné pain score improved from 1.4 to 4.9 (p<0.0001), the walking score from 2.3 to 3.1 (p<0.07) and the absolute hip function score from 5.4 to 10.8 (p<0.0001). There were no clinical or radiographic signs of loosening. The double mobility acetabular component was successful at preventing dislocation during early to medium-term follow-up. However, as data are still lacking with regard to polyethylene wear rates at the additional bearing surface, it would be prudent to restrict the use of this implant to selected patients at high risk of instability.

Continued good results with modular trabecular metal augments for acetabular defects in hip arthroplasty at 7 to 11 years.

Reconstruction of large acetabular defects remains a substantial challenge in hip arthroplasty. There remains a paucity of data on the long-term results of acetabular trabecular metal augments. The purpose of this study was to assess the survivorship, clinical outcomes, restoration of center of rotation of the hip, and radiological signs of component fixation of trabecular metal augments in the context of reconstruction of acetabular defects. Between 2002 and 2005, we performed 56 revision (n=53) and primary (n=3) THAs using trabecular metal augments in combination with a trabecular metal acetabular component. Of the 56 patients, 16 (29%) died during followup. Of the 40 surviving patients, 37 (93%) had complete radiological followup, 23 (58%) had complete outcome questionnaire followup, and 17 (42%) provided partial questionnaire responses in the clinic or over the telephone. Median followup was 110 months (range, 88-128 months). During that period, we used these implants when preoperative templating indicated that an augment would be required to achieve acetabular implant stability with restoration of the hip center of rotation. We also chose during surgery to use an augment when we could not achieve a stable acetabular trial component without one. The combination of trabecular metal augments and trabecular metal shells was used in 18% (53 of 292) of our acetabular revisions during that time. Survivorship, functional outcome (WOMAC and Oxford hip score), health status (SF-12), and osseointegration according to the criteria of Moore and presence of radiolucencies were determined. Survivorship of the augments at 10 years was 92% (95% confidence interval, 81%-97%). Four patients underwent cup revision, one for infection and three for loosening. The mean WOMAC global score was 79 (SD 17), the mean Oxford hip score 76 (SD 18), the mean physical component SF-12 score was 39 (SD 11), and the mean mental component SF-12 score was 52 (SD 9). The center of rotation was corrected from more than 35 mm above the inter-teardrop line in 48 of 56 patients preoperatively to only five of 46 postoperatively. One patient had radiographic findings suggestive of loosening, but this patient was asymptomatic. The results of the acetabular trabecular metal augments continue to be encouraging in the medium to long term with low rates of revision or loosening in this complex group of patients. We continue to recommend the use of these augments in the reconstruction of complex acetabular defects. Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Outcome of proximal femoral fractures caused by cycling in the young and mid-aged

BackgroundCycling is gaining more popularity both as a sport, on and off-road and also as a means of commute. Cycling accidents harbour significant injury risks including fractures. Proximal femoral fractures are uncommonly associated with cycling in the young adult population. The purpose of this study is to describe this unique pattern of injury as well as the outcome of proximal femoral fractures caused by cycling in the young to mid age population. MethodsStudy design: retrospective cohort study. 23 fractures in 22 patients were available for analysis. 11 were femoral neck fractures, with six displaced ones, and the rest trochanteric fractures. 21 patients were male patients, and the average age was 42 (range 27–60). All patients but two were operated within 24h from admission. Radiographic analysis included reduction quality, fracture classification and arthritic changes. Clinical outcome was measured using SF-12 and Oxford hip scores. ResultsAll fractures healed. Two patients with displaced femoral neck fractures developed avascular necrosis requiring arthroplasty. One patient developed an AVN 2 years after a stable trochanteric fracture but did not require an arthroplasty as of yet. Eight patients required hardware removal due to symptoms. 77% of patients had resumed cycling at the pre-injury level. Mean SF-12 score was 47.1±11.7 for the physical component and 53.7±6.3 for the mental component. Mean oxford hip score as was 40.1±12.2. Radiographic analysis revealed good to acceptable reduction quality. Fracture type, age, cycling type and reduction were not significantly associated with outcome. ConclusionProximal femoral fractures caused by cycling in young to mid-aged adults are an emerging pattern of injury. Overall favourable result can be expected in the majority of cases, with displaced femoral neck fractures having a risk for AVN. Further delineation of the exact cause for this phenomenon is required with possible intervention for injury prevention.

Hip resurfacing arthroplasty at a non-specialist centre

INTRODUCTIONFew studies have reported the outcome of hip resurfacing arthroplasty (HRA) with respect to implant characteristics from non-specialist centres. We report the survival, clinical and radiological outcomes of a single surgeon series of HRA with an average follow-up duration of five years.METHODSAll consecutive HRAs performed by a single surgeon between 2003 and 2011 at a district general hospital were retrospectively examined clinically and radiologically.RESULTSA total of 85 patients underwent 109 HRAs (58 male [53.2%] and 51 female patients [46.8%]) with a mean follow-up period of 62 months (range: 12–102 months). The median age was 57 years (range: 25–75 years). The mean acetabular and femoral head component sizes were 54mm (range: 48–64mm) and 48mm (range: 42–58mm) respectively with a mean acetabular inclination angle of 42.9º (range: 20–75º).The survival rate was 95% with five revisions due to aseptic loosening (n=3) and fracture (n=2): these were predominantly for female patients (n=4), with significantly smaller mean acetabular (51mm, p=0.04) and femoral (44mm, p=0.02) implant sizes. Furthermore, they had a higher mean acetabular inclination angle of 48.1º (p=0.74). The mean Oxford hip score was 43.8 (range: 25–48) and the mean University of California Los Angeles (UCLA) activity score was 6.8 (range: 3–10). Radiological findings included heterotopic ossification in 13 (11.9%), radiolucent lines in 6 (5.5%), femoral neck thinning in 2 (1.8%) and femoral neck notching in 5 patients (4.6%).CONCLUSIONSWe have shown that HRA at a non-specialist centre has short to medium-term outcomes comparable with those at specialist centres. HRA therefore remains a viable option although vigilance is required in case selection and follow-up according to national guidance.

Efficacy and Safety of Bone Marrow Concentrate for Osteoarthritis of the Hip; Treatment Registry Results for 196 Patients

Introduction: We investigated the efficacy and safety of autologous bone marrow concentrate (BMC) for the treatment of symptomatic hip osteoarthritis. Methods: Treatment registry data for 216 hips treated among 196 patients who underwent a BMC procedure for hip osteoarthritis (OA) were analyzed. Data regarding adverse events (AEs), subjective percentage improvement, Oxford Hip Scores (OHS), and numeric pain scale (NPS) scores were assessed and compared to baseline at 1, 3, 6 months, and annually after treatment. Results: The mean reported subjective percentage improvement across all 216 treated hips was 30.2%. The mean OHS change was 6.4 points improved (p<0.001). The NPS scores from baseline to post treatment decreased from 4.5 to 3.3 (p<0.001). Twelve AEs were reported, none of which were serious or persisting. Patients ≤ 55 years old were substantially more likely to report improvement on the OHS [OR: 11.1 (1.6-77.8)] and also more likely to report greater than 50% improvement on the subjective percentage improvement scale [OR: 2.8 (1.2-6.7)]. Conclusion: The present study of BMC injections for hip OA demonstrated encouraging results for improved outcomes with no significant complications. We found that patients younger than 55 years old were more likely to report improvement on the OHS and subjective percentage improvement scales. Further study with randomized trials is warranted to confirm the reported results.

Predictive outcomes of revision total hip replacement—A consecutive series of 1176 patients with a minimum 10-year follow-up

The burden of revision total hip replacement (THR) surgery is increasing. With an increasing life expectancy and younger age of primary surgery this trend is set to continue. There are few data on the long-term outcome of revision THR. This retrospective study of 1176 consecutive revision THRs with a minimum 10-year follow-up from a University Teaching Hospital was undertaken to review implant survival and patient reported outcomes.Mean follow-up was 11 years with implant survival at 10 years of 82% (CI: 80–85). Implant survival varied between 58% (unexplained pain) to 84% (aseptic loosening) depending on the indication for revision surgery. Positive predictors of survival were age greater than 70 at the time of surgery (p=0.011), revision for aseptic loosening (p<0.01) and revision of both components or just the acetabular component (p<0.01). At the last review, mean Oxford Hip Score (OHS) was 34 (SD: 11.3) and 92% of the living patients with unrevised hips were satisfied with the outcome of revision surgery.This long term study has demonstrated that positive predictors of survival and outcome of revision THR surgery are age greater than 70 years, revision for aseptic loosening and component revision. This should aid surgeons in their counselling of patients prior to surgery.

Functional Outcome, Revision Rates and Mortality after Primary Total Hip Replacement – A National Comparison of Nine Prosthesis Brands in England

BackgroundThe number of prosthesis brands used for hip replacement has increased rapidly, but there is little evidence on their effectiveness. We compared patient-reported outcomes, revision rates, and mortality for the three most frequently used brands within each prosthesis type: cemented (Exeter V40 Contemporary, Exeter V40 Duration and Exeter V40 Elite Plus Ogee), cementless (Corail Pinnacle, Accolade Trident, and Taperloc Exceed), and hybrid (Exeter V40 Trilogy, Exeter V40 Trilogy, and CPT Trilogy).Methods and FindingsWe used three national databases of patients who had hip replacements between 2008 and 2011 in the English NHS to compare functional outcome (Oxford Hip Score (OHS) ranging from 0 (worst) to 48 (best)) in 43,524 patients at six months. We analysed revisions and mortality in 187,201 patients. We used multiple regression to adjust for pre-operative differences. Prosthesis type had an impact on post-operative OHS and revision rates (both p<0.001). Patients with hybrid prostheses had the best functional outcome (mean OHS 39.4, 95%CI 39.1 to 39.7) and those with cemented prostheses the worst (37.7, 37.3 to 38.1). Patients with cemented prostheses had the lowest reported 5-year revision rates (1.3%, 1.2% to 1.4%) and those with cementless prostheses the highest (2.2%, 2.1% to 2.4%). Differences in mortality according to prosthesis type were small and not significant (p = 0.06). Functional outcome varied according to brand among cemented (p = 0.05, with Exeter V40 Duration having the best) and cementless prostheses (p = 0.01, with Corail Pinnacle having the best). Revision rates varied according to brand among hybrids (p = 0.05, with Exeter V40 Trident having the lowest).ConclusionsFunctional outcomes were better with cementless cups and revision rates were lower with cemented stems, which underlies the good overall performance of hybrids. The hybrid Exeter V40 Trident seemed to produce the best overall results. This brand should be considered as a benchmark in randomised trials.

Accelerated polyethylene wear and early failure of the uncemented Reflection acetabular component: a ten to fifteen-year follow-up study

The Reflection® second-generation uncemented acetabular component was designed to address increased rates of failure observed with the early acetabular designs. However, the reported survivorship of this acetabular component has been conflicting. The aim of this study was to describe the ten to 15-year survivorship and polyethylene wear rate for the uncemented Reflection® acetabular component performed as part of a primary total hip replacement. One hundred and four consecutive Reflection® uncemented acetabular components in 97 patients were identified from a prospective arthroplasty database with a minimum of ten years of follow-up. No patient was lost to follow-up. Mean cohort age was 59.1 years. There were 24 revisions of the acetabular component. The all-cause survival rate at ten years was 77.2% [95% confidence interval (CI) 73.9-80.5]. Mean linear wear was 0.20 mm [standard deviation (SD) 0.08] per year and the volumetric wear was 106.2 mm(3) per year. At final follow-up, more than half the patients had osteolysis identified around the femoral component. The mean Oxford Hip Score was 35.6 (SD 9.8) at a mean follow-up of 11.9 years, with six (11.1%) excellent, 26 (48.1%) good, 17 (31.5%) fair and five (9.3%) poor outcomes. Despite the fact that more than a third had a fair or poor outcome, only four (7.4%) were not satisfied with their hip. Due to the high rate of relatively asymptomatic polyethylene wear and osteolysis associated with this acetabular component, in our department, we now review all surviving patients both clinically and radiographically on an annual basis.

Circumferential Reconstruction of Severe Acetabular Labral Damage Using Hamstring Allograft: Surgical Technique and Case Series

With excessive acetabular coverage, such as coxa profunda or protrusio, contact between the femoral neck and acetabular rim cause direct damage to the labrochondral junction, and indirect edge loading from a levering effect which may result in hip arthrosis. Arthrosis may be delayed or avoided by addressing the overcoverage and restoring mechanical function of the labrum. We describe four cases of adjunctive complete acetabular labral replacement for circumferential, irreparable labral injury using fresh frozen semitendinous allografts through surgical hip dislocation. Over a two-year period four patients (age range: 20 to 47 years) underwent surgical hip dislocation to address femoroacetabular impingement with rim trimming, femoral osteochondroplasty, and labral reconstruction. Pre- and postoperative patient reported outcomes were assessed by Oxford Hip Score (OHS), Hip Outcome Score (HOS), and Global Treatment Outcome (GTO) score. Disease progression was graded using AP pelvic radiographs and arthroMR. The average LCE correction was 18º (range 7-25º), achieving an average LCE of 33º (range 32-35) postoperatively. Using protected weight bearing all trochanteric osteotomies healed within six weeks after surgery. OA did not progress in any hips. Mean OHS and HOS scores improved 6.3 and 19.8 at one-year follow up. All four patients reported good results according to the GTO. There were two adverse events that resolved and did not affect outcome. Despite complex deformities and preexisting cartilage and labrum wear in this young cohort, three of four patients reported significant functional improvement after treatment of this rare condition. Preliminary experience with circumferential labral reconstruction using hamstring allografts is promising, although long-term data needs to be established.

Acceptable Symptom State after Surgery for Femoroacetabular Impingement Compared with Total Hip Arthroplasty

The aim of the study was to examine whether patients undergoing total hip arthroplasty (THA) are better able to accept a given level of pain and disability than patients undergoing surgery for femoro-acetabular impingement (FAI). Before surgery, 417 THA and 162 FAI patients completed the Oxford Hip Score (OHS). At 12-months follow-up (FU), they were requested to complete the OHS again, rate the global treatment outcome, and state whether their symptom state was acceptable. Preoperatively, THA had worse (p<0.001) OHS scores than FAI. At 12 months, 99% THA and 86% FAI patients reported various degrees of improvement. The proportions of patients perceiving notable improvement and considering their current state acceptable were higher (p<0.0001) in THA (95-99%) than FAI (66-70%) and THA had greater (p<0.0001) improvements in OHS scores than FAI. The mean OHS score of the patients perceiving notable improvements at follow-up did not differ (p>0.05) between THA and FAI groups. Higher "success rates" in THA than FAI are not due to a better acceptance of pain and disability, because the OHS of patients considering their current state to be acceptable was similar for both groups. The difference is simply the result of more THA than FAI patients actually achieving an acceptable status after surgery.

Revision of the acetabular component in dysplastic hips previously reconstructed with a shelf autograft

In this retrospective study we evaluated the proficiency of shelf autograft in the restoration of bone stock as part of primary total hip replacement (THR) for hip dysplasia, and in the results of revision arthroplasty after failure of the primary arthroplasty. Of 146 dysplastic hips treated by THR and a shelf graft, 43 were revised at an average of 156 months, 34 of which were suitable for this study (seven hips were excluded because of insufficient bone-stock data and two hips were excluded because allograft was used in the primary THR). The acetabular bone stock of the hips was assessed during revision surgery. The mean implant-bone contact was 58% (50% to 70%) at primary THR and 78% (40% to 100%) at the time of the revision, which was a significant improvement (p < 0.001). At primary THR all hips had had a segmental acetabular defect > 30%, whereas only five (15%) had significant segmental bone defects requiring structural support at the time of revision. In 15 hips (44%) no bone graft or metal augments were used during revision. A total of 30 hips were eligible for the survival study. At a mean follow-up of 103 months (27 to 228), two aseptic and two septic failures had occurred. Kaplan-Meier survival analysis of the revision procedures demonstrated a ten-year survival rate of 93.3% (95% confidence interval (CI) 78 to 107) with clinical or radiological failure as the endpoint. The mean Oxford hip score was 38.7 (26 to 46) for non-revised cases at final follow-up. Our results indicate that the use of shelf autografts during THR for dysplastic hips restores bone stock, contributing to the favourable survival of the revision arthroplasty should the primary procedure fail.