Results Of Total Hip Replacement Research Articles

The Effect of Vertebral-Pelvic Mobility on the Technology and Outcomes of Total Hip Replacement

Introduction. Total hip arthroplasty (THA) is one of the most commonly used surgical interventions among patients with diseases of the hip joint. Despite the high frequency and effectiveness of THA, instability is the main reason for repeated surgical interventions, which have a significant impact on the quality of life of patients.Purpose. Analysis of literature data on spinal-pelvic interactions, development of recommendations for eliminating pathologies of the spine and pelvis based on the analyzed data.Materials and methods. The author searched for publications in the electronic databases PubMed and eLibrary. ru using the following search terms: “spinopelvic mobility, total hip replacement, hip arthroplasty, vertebral-pelvic mobility, total hip replacement, hip arthroplasty”.Results and discussion. The orientation of the pelvic component should be planned according to hip motion assessment to position the pelvic portion of the endoprosthesis according to the new safe zone and combined sagittal index. However, the surgeon must take into account that postoperative mobility of the pelvis and spine may differ from preoperative mobility due to joint contracture or physiological aging of the spine. To date, it has not yet been determined how often these changes lead to the pelvic component of the endoprosthesis moving beyond its position and spatial location, increasing the risk of dislocation.Conclusion. A proper understanding of the relationship between the hip joint and the spine, and the impact of their interactions on the positioning of the acetabular component, is critical to reducing the risk of dislocation.

Functional outcomes of total hip replacement by a posterior surgical approach

Functional outcomes of total hip replacement by a posterior surgical approach

Assessment of Cup Placement Impact on Functional Outcomes in Total Hip Replacement: A Retrospective Analysis of 20 Patients

Introduction:Total hip replacement surgery is gaining popularity as a treatment for hip disorders, replacing alternative treatments like excisional arthroplasty, osteotomy, arthrodesis, and hemiarthroplasty. This research aims to evaluate the effect of the acetabular cup on functional outcomes, particularly in younger patients with hip arthritis and femur neck fractures.Materials And Methods:This study aimed to evaluate the placement of the acetabular cup and its association with functional outcomes in total hip replacement (THR). 20 patients were randomly selected from the MRD department and underwent pelvic CT scans postoperatively. Functional results have been analyzed using the Harris Hip Score. The acceptable cup version range was 15 ± 10 degrees, and patients outside this range were closely examined for rotational movements. Results: A study of 20 patients with a neck or femur fracture found that 11 patients had a right knee injury, while 9 had a left knee injury. After a year postoperatively, 18 patients reported no pain, while 2 had mild pain. Functional assessment depicted better outcomes in 17 patients, good outcomes in 2 patients, and fair outcomes in 1 patient. Radiological analysis revealed a mean cup version of 17.77 degrees, with complications including one dislocation and three limb length discrepancies. None of the patients developed an infection.Conclusion:The study found that 90% of patients had excellent functional outcomes, with only 10% exhibiting excessive anteversion. CT scan-based measurements of cup placement provided reliable predictions, consistent with intraoperative assessment of cup positioning.

Functional outcome of total hip replacement in acetabular fractures

Introduction. Total hip replacement (THR) has revolutionized the management of various hip pathologies, including acetabular fractures, which pose significant challenges due to their complex nature and debilitating effects. Acetabular fractures, resulting from high-energy trauma, present with severe pain and functional limitations, constituting a small percentage of all fractures worldwide. While THR offers promising outcomes, variability exists in functional improvement rates and postoperative complications. Aim. This prospective observational study aims to estimate the functional outcomes and complications associated with THR in patients following acetabular fractures, with a focus on guiding clinical practice and optimizing patient care. Methodology. The study included 30 patients undergoing THR after acetabular fractures or post-primary acetabular fixation. Surgical techniques involved the Kocher-Langenbeck approach and meticulous fracture management strategies. Clinical evaluation utilized the Harris Hip Score, while radiographic assessments monitored component positioning, stability, and osteolysis. Postoperative care included pain management and rehabilitation protocols. Results. The majority of patients presented with segmental defects, with intraoperative bone grafting required in 87% of cases. Significant improvements in Harris Hip scores were observed postoperatively, indicating favorable functional outcomes. A majority of patients experienced good to excellent recovery, although postoperative complications such as pain, limping, and heterotrophic ossification were noted in some cases. Radiographic evaluations revealed satisfactory component positioning and long-term survival rates. Conclusion. These findings support the role of THR in restoring functionality and improving the quality of life for affected individuals. Continued advancements and research efforts are crucial to further optimize outcomes in this challenging patient population.

Assessment of Patient Satisfaction with the Results of Total Hip Replacement

Aim. To test a simplified version of assessing the results of total hip replacement based on patient survey data.Materials and Methods. We conducted a cohort retrospective study with historical control. The study included 80 patients interviewed ≥ 1 year after the total hip replacement. Patients were included into the study regardless of gender, age and concomitant pathology. Statistical analysis was performed using EpiInfo software (version 7.2.2.2), Python programming language, and SciPy package version 1.11.4.Results. We developed a compact questionnaire of 33 questions to compare the answers of patients before and after the surgery. After prosthetics, the self-esteem of the patient conditions improved significantly. The results were stratified into 6 blocks of questions by the odds ratio magnitude: emotional state – 49.3 (11.3-215.4); health status – 42.8 (12.4-147.7); ability to move outside the home –14.4 (1.8-113.4); self-care ability at home – 11.7 (5.3-25.7); overall quality of life assessment – 9.3 (3.1-28.4). Such differences before and after surgery were statistically significant for all blocks of questions (p ≤ 0,008). In general, 81.2% (81.2÷81.3) of patients were completely satisfied with the results of the surgery, and 8.8% (8.6÷8.9) were partially satisfied.Conclusion. We tested a study design which allows to evaluate the rate of improvement in selfesteem of patients after the total hip replacement.

Special aspects of total hip arthroplasty in patients with proximal femur pseudarthrosis

IntroductionThe rate of proximal femur fractures (PFF) in the structure of musculoskeletal system injuries among all fractures of long bones ranges from 3.9 to 18%. According to Russian Ministry of Health 2020 data, the incidence of femoral fractures in Russia was up to 61 cases per 100,000 population (90,000 per year); and femoral neck fractures incidence was 4 times higher among people over 75 years of age. The choice of surgical technique and the fixator used depend on many factors, such as fracture location and its nature, the age of the patient, comorbidities, and the quality of bone tissue. Internal osteosynthesis, is the current treatment method of choice for extra-articular proximal femur fracture, but every treatment method has its limitations. a significant number of complications caused by technical errors, vicious union or nonunion with the subsequent development of false joints, the development of femoral head aseptic necrosis, which leads to coxarthrosis and persistent pain syndrome. To solve the above-described problems, it is necessary to use a conversion surgery - total hip replacement. Objectiveslong-term analysis of the results of total hip replacement in patients with proximal femur pseudarthrosis. MethodsThe study was based on clinical and laboratory data analysis and on the results of total hip arthroplasty (THA) in 45 patients aged 56–84 years (mean age 68.3), including 32 (71.1%) women and 13 (26.1%) men. 12 patients initially received conservative treatment, and 33 patients received initial surgical treatment using various metal osteosynthesis procedures. The time from osteosynthesis or from the moment of injury to admission to the hospital for hip arthroplasty ranged from 12 to 30 months. All patients, before conversion arthroplasty and after discharge, were repeatedly invited to the clinical diagnostic department for a clinical examination and for assessment using rating scales. 3, 6 and 12 months after the surgery, pain syndrome and patient quality of life were assessed using the following questionnaire scales: Harris Hip Score, MOS SF-36, VAS. The maximum follow-up period ranged from 12 to 60 months. ResultsBased on the results obtained, patients of all 4 groups after conversion arthroplasty noted a significant quality of life improvement, a decrease in pain severity and functional results improvement. This was probably due to the presence of a severe limitation of range of movements in the joint, intense pain, absence of support ability of the extremity, as well as low operative efficacy expectations.In 1 (2%) patient, acute PJI was diagnosed in the early postoperative period, followed by sepsis and death.In 4 patients (9%) the result was considered unsatisfactory. At 1 year of follow-up after surgery, they complained of pain and claudication in the operated joint.3 (6%) patients underwent reduction of dislocation. ConclusionsStrict adherence to the recommended treatment algorithm for patients with proximal femur pseudarthrosis made it possible to achieve good treatment results in 90% of surgically treated patients. An important step in the treatment of this patients is a careful preoperative planning with thorough assessment of bone tissue quality and muscles condition in the proximal femur area, allowing to choose the optimal endoprosthesis components.

Early results of total hip replacement in avascular necrosis of head of femur in patients with sickle cell disease: a retrospective observational study

Background: Total hip arthroplasty (THA) has become the mainstay of treatment in SCD patients with symptomatic AVN that has progressed to end-stage arthritis. This patient population is often young and active at the time of surgery, potentially predisposing them to a higher risk of implant failure than those undergoing THA for primary osteoarthritis (OA). Methods: This retrospective study included 15 patients (age, 25–45 years; 5 males and 10 females) who underwent THR. The Harris Hip Score (HHS) was used to assess functional outcomes. All patients were followed up at 6-weekly intervals then 6-monthly intervals. Results: The mean follow-up period was 12 to 18 months. The mean preoperative HHSs was 45.22±021. Postoperatively, a subsequent increase in HHS was found, and a significant difference between pre and postoperative pain. Conclusion: THA remains an effective treatment modality for osteonecrosis of the hip in SCD patients. However, these patients are at increased risk of medical and surgical complications. Surgeons should be aware of the unique challenges in this patient population when counseling and managing these patients in the perioperative period.

The effect of previous surgical treatment on the outcome of total hip replacement in young patients with dysplastic coxarthrosis

Introduction Hip dysplasia of various genesis is recognized as a common cause of coxarthrosis. Total hip replacement (THR) is the operation of choice for the patients with the final stage of the pathological process. There are different opinions on the impact of previous surgical treatment of hip dysplasia on THR.The aim of the study was to explore the effects of previous surgical treatment on the outcomes of THR in young patients with dysplastic and secondary coxarthrosis.Material and methods Surgical outcomes of 78 patients (58 females and 20 males; 91 joints) with dysplastic and secondary coxarthrosis (age 14-30 years, average age 24.3 ± 4.3 years) treated witrh THR were retrospectively reviewed. Patients we assigned to two groups. Group I (control) included 27 patients (33 joints) with dysplastic coxarthrosis primarily treated with THR. Group II (treatment group) included 51 patients (58 joints) who had previously undergone THR.Results Patients of group II demonstrated longer duration of surgery by 47.89 %, greater blood loss by 16.92 % and the higher complication rate by 42.1 %.Discussion The treatment group showed a significantly increased frequency of late complications in the form of implant instability. Patients of group II dermonstrated better functional results estimated with HHS as compared to the outcomes of patients of group I.Conclusion Hip reconstructions performed earlier were associated with technical difficulties, aggressive THR procedure, a greater risk of late complications, but showed no significant effect on the outcomes.

Comparative outcome assessment of total hip arthroplasty versus bipolar hemiarthroplasty in intracapsular neck of femur fracture in old age

Background: This prospective study aimed to compare the outcomes of total hip replacement (THR) and bipolar hemiarthroplasty for the treatment of displaced femoral neck fractures in elderly patients. Methods: A total of 30 patients aged over 60 years with femoral neck fractures were included in the study, with 15 patients receiving a bipolar prosthesis and patients receiving THR between June 2021 and January 2023. The patients were followed up for 6 months postoperatively, with functional analysis conducted using the modified Harris hip score. Results: The results showed that the modified Harris hip score was significantly higher in the THR group compared to the bipolar prosthesis group at day 1, 3, 6 and 12 months postoperatively. Pain levels were similar between the two groups at all follow-up intervals. Gait and range of motion were significantly higher in the THR group compared to the bipolar prosthesis group at all-time points. Conclusions: Based on the short-term functional outcomes of this study, THR appears to be a preferable option over bipolar prosthesis for managing femoral neck fractures in elderly.

The Accuracy of Digital Preoperative Templating in Primary Total Hip Replacements.

Background​ Digital templating is an essential part of preoperative planning in elective total hip replacement (THR) surgery. The goals of templating are to predict femoral and acetabular implant sizes, to assess leg length, offset, and implant positioning. Templating markers such as the KingMark device (Brainlab, Munich, Germany) have been developed to improve the accuracy. Although templating is commonly used in many centres, there are challenges related to the accuracy of the process, such as true magnification ideal positioning of the pelvis and hips/body habit (obesity). Objectives The aim of this study was to assess the accuracy of preoperative templating in THR patients, and to assess the difference between templating performed with and without the KingMark device. Methods​ Our retrospective study included 642 consecutive patients who had primary THR at the Royal Bournemouth Hospital in the UK. Four hundred fifty-three (71%) of patients had the KingMark device on their templated radiographs. Patients who had hybrid total hip replacements using an uncemented acetabular component and cemented femoral component were included in the study. Digital templating was done using TraumaCad software (Brainlab). Analysis of the accuracy of predicting component size has been evaluated by comparing preoperative planned sizes with implanted sizes as documented by the surgeons and labels attached to the operative note. ​ ​Results​ The templated size corresponded to the actual femoral implant used in approximately 65.2% of cases. When femoral prostheses within one size above or below the templated size were included,​the accuracy of preoperative templating rose to 97.2%. Regarding the uncemented acetabular component, the templated size corresponded to the actual acetabular implant used in 46.3% of cases. When acetabular cup within one size above or below the templated size were included, the accuracy of preoperative templating rose to 87.5%. Similarly, there was minimal difference between the predicted templated sizes using the KingMark device compared to templating performed without it. ​Conclusions​ Preoperative templating is an essential part in optimizing the outcome of THRs. Templating allows the surgeon to estimate the size of the components to be used. It also provides a starting point, from which the surgeon can proceed from, and saves valuable intraoperative time by assessing the level of the femoral neck osteotomy and the degree of lateral rasping. Multiple factors affect the accuracy of preoperative templating including the patient BMI, external rotation of the hip and surgeon's experience. Although there are different methods of templating, digital templating with 2D radiographs is likely the most cost-effective and efficient process available at this time.

Mid-term functional and radiological outcomes after total hip replacement performed for complications of acetabular fractures

ObjectiveAcetabular fractures can lead to serious complications such as avascular necrosis of the femoral head (AVN), osteoarthritis, non-union. Total hip replacement (THR) is a treatment option for these complications. The purpose of this study was to assess the functional and radiological outcomes of THR at least 5 years after the primary implantation. MethodsThis retrospective study analysed clinical data from 77 patients (59 males, 18 females) who were treated from 2001 to 2022. Data was collected on the incidence of AVN of the femoral head, complications, interval from fracture to THR, reimplantation. The modified Harris Hip Score (MHHS) was used to evaluate outcome. ResultsThe mean age at the time of fracture was 48 years. Avascular necrosis developed in 56 patients (73%), with 3 cases of non-union. Osteoarthritis without AVN developed in 20 patients (26%), non-union without AVN in one patient (1%). The mean time from fracture to THR was 24 months for AVN with non-union, 23 months for AVN alone, 22 months for AVN with arthritis, 49 months for hip osteoarthritis without AVN. The time interval was significantly shorter for cases of AVN than for cases of osteoarthritis without AVN (p = 0.0074). Type C1 acetabular fracture was found to be a risk factor for femoral head AVN (p = 0.0053). Common complications of acetabular fractures included post-traumatic sciatic nerve paresis (17%), deep venous thrombosis (4%), infections (4%). Hip dislocation was the most common complication of THR (17%). There were no cases of thrombosis following THR. According to Kaplan-Meier analysis, the proportion of patients without revision surgery within 10-year period was 87.4% (95% CI 86.7–88.1). The results of the MHHS after THR: 59.3% of patients had excellent results, 7.4% good, 9.3% satisfactory results, and 24.0% had poor results. The mean MHHS was 84 points (95% CI 78.5–89.5). Paraarticular ossifications were observed in 69.4% of patients in the radiological evaluation. ConclusionTotal hip replacement is an effective treatment for serious complications of acetabular fracture treatment. Its results are comparable to THR peformed for other indications, although it is associated with a higher number of paraarticular ossifications. Type C1 acetabular fracture was found to be a significant risk factor for early femoral head AVN.

The accuracy and precision of acetabular implant measurements from CT imaging.

The placement of acetabular implant components determines the short- and long-term outcomes of total hip replacement (THR) and a number of tools have been developed to assist the surgeon in achieving cup orientation to match the surgical plan. However, the accuracy and precision of 3D-CT for the measurement of acetabular component position and orientation is yet to be established. To investigate this, we compared measurements of cobalt chrome acetabular components implanted into 2 different bony pelvic models between a coordinate measuring Faro arm and 3 different low dose CT images, including 3D-CT, 2D anterior pelvic plane (APP) referenced CT and 2D scanner referenced (SR) CT. Intra-observer differences were assessed using the Intraclass correlation coefficient (ICC). The effect of imaging the pelvis positioned in 3 different orientations within the CT scanner was also assessed. The measured parameters were the angles of inclination and version. 3D-CT measurements were found to closely match the "true values" of the component position measurements, compared with the 2D-CT methods. ICC analysis also showed good agreement between the coordinate measuring arm (CMA) and 3D-CT but poor agreement between the 2D SR method, in the results from two observers. When using the coordinate system of the CT scanner, the measurements consistently produced the greatest error; this method yielded values up to 34° different from the reference digitising arm. However, the difference between the true inclination and version angles and those measured from 3D APP CT was below half a degree in all cases. We concluded that low radiation dose 3D-CT is a validated reference standard for the measurement of acetabular cup orientation.

The effect of weight compared to BMI on patient reported outcomes at long term follow up of primary total hip arthroplasty

IntroductionObesity has been linked to the development of osteoarthritis meaning that a large portion of arthroplasty patients are overweight or obese. Whilst the short-term complications associated with obesity are well described there is a paucity of evidence on the effect of weight compared to BMI for long term functional outcomes of total hip replacements (THR). The aim of this study was to investigate the influence of BMI and weight on long-term patient reported outcome measures following primary THR. Methods846 patients who underwent primary THR at the Royal Adelaide Hospital between 2000 and 2009 had a pre-operative height and weight recorded. Patient reported outcome measures (PROMs) were completed at 1, 5 and greater than 10 years follow-up. Categorical comparison of PROMs was performed for patients in weight categories of 0–65 kg, 65–80 kg, 80–95 kg, 95–110 kg and >110 kg; and BMI categories as per the WHO Classifications. ResultsThere was no difference in absolute or change in PROMs for any weight category. BMI did not have an effect on the change in (HHS), however there was a statistically significant decrease in absolute (HHS) values at 1 and 5 years with increasing obesity. 65 patients underwent revision within the first ten years. ConclusionThe results from this study confirm for the first time that there was no impact of weight or BMI on the change in long-term PROMs of THR. There remains a need for larger registry studies to investigate the effect of weight and BMI on long-term patient outcomes and revision rate.

Outcomes of Total Hip Replacement for Failed Hemiarthroplasty.

Our study aims to analyze the outcomes of conversion total hip replacement (THR) done for failed hemiarthroplasty. We retrospectively analyzed 104 consecutive patients who underwent conversion THR for failed hemiarthroplasty between January 2012 and December 2018. The patient's records were analyzed for demographic information, index surgery details, preoperative functional status, and perioperative complications. Patients were analyzed according to the various modes of failure of hemiarthroplasty. The radiographs were analyzed for any progressive osteolysis, cup migration and stem subsidence. All the patients were evaluated using the modified Harris hip score (HHS) for clinical outcome. Complications, revision or reoperation in the follow-up period was recorded. A total of 73 patients were included in the study for final analysis after exclusion criteria. The average follow-up was 48.2 ± 29.6months. There was a significant improvement in mean HHS from 38.5 ± 9.1 preoperatively to 80.9 ± 4.3 at the last follow-up (p < 0.05). The different modes of failure had no statistically significantdifference in the postoperative Harriship score (p = 0.393). None of the patients had progressive radiolucent lines more than 2mm or significant subsidence in the final follow-up compared to the initial postoperative radiograph. There was one deep infection, one patient had grade 2 heterotopic ossification, intraoperative calcar fracture was fixed with cerclage wiring in 11 patients, and postoperative periprosthetic fracture in two patients was treated with plate osteosynthesis. There were no neurovascular complications or dislocation during the follow-up. Conversion THR for failed hemiarthroplasty is a challenging procedure and results in good functional outcome and provides reliable pain relief. Conversion THA for septic loosening by two stage revision have comparable postoperative outcomes like THA for aseptic loosening. Caution is required owing to high incidence of peri-prosthetic fracture during conversion THA. Dislocation rate is negligible even with smaller head provided the prosthesis is implanted in the proper orientation and adequate soft tissue balancing is achieved.

Total Hip Replacement: Psychometric Validation of the Italian Version of Forgotten Joint Score (FJS-12).

One million Total Hip Replacements (THA) are thought to be performed annually. To measure prosthesis awareness throughout daily activities, the FJS-12 patient-reported outcome scale was developed. This article's goal is to undertake a psychometric validation of the Italian FJS-12 among a sample of related THA patients. Between January and July 2019, data from 44 patients were retrieved. The participants were required to complete the Italian version of FJS-12 and of the WOMAC at preoperative follow-up, after two weeks, 1, 3, and 6 months postoperatively. The Pearson correlation coefficient between the FJS-12 and WOMAC was 0.287 (p = 0.002) at preoperative follow-up, r = 0.702 (p < 0.001) at 1 month, r = 0.516 (p < 0.001) at 3 months and r = 0.585 (p < 0.001) at 6 months. The ceiling effect surpassed the acceptable range (15%) for FJS-12 in 1 month (25.5%) and WOMAC in 6 months follow-up (27.3%). The psychometric validation of the Italian version of this score for THA was executed with acceptable results. FJS-12 and WOMAC reported no ceiling and floor effects. Therefore, to distinguish between patients who had good or exceptional results following UKA, the FJS-12 could be a reliable score. Under the first four months, FJS-12 had a smaller ceiling effect than WOMAC. It is recommended to use this score in clinical research concerning the outcomes of THA.

A Simple Device to Determine Ante-Version During Femoral Prosthesis Insertion in Total Hip Replacement

Introduction: Good outcomes in Total Hip Replacement (THR) depend upon correct component alignment. This is influenced by the surgeon’s capacity to recreate a geometrically normal and biomechanically stable hip joint. Mal-positioining of components can lead to various complications and the surgeons have to make vital decisions intra-operatively based on their experience. Materials and Methods: This study describes a simple instrument to aid alignment of femoral stem insertion and hence achieve the normal range of ante-version between 10 º-20 º. Experiments performed on a saw bone model by twenty orthopaedic surgeons, each making six attempts to insert a prosthesis demonstrated improved positioning when compared to unaided insertion. Results: The mean average femoral stem ante-version unaided was 18.3 º (range, 4.9 º to 36.6 º). Device aided ante-version was 14.4 º (range, 9.8 º to 18.9 º) (p&lt;0.001). We also report the practicality of the use of the device which was assessed by use on cadavers. Conclusion: Precise assessment of stem ante-version can be achieved in non-navigated THR if such a device is available intra-operatively.

Using Gait Analysis to Evaluate Hip Replacement Outcomes-Its Current Use, and Proposed Future Importance: A Narrative Review.

Total hip replacement (THR) is one of the most common elective orthopaedic operations. However, evidence suggests that despite postoperative pain improvements, aspects of longer-term physical performance, such as walking ability, do not reach the levels expected when compared to the general population. Walking is best assessed by using gait analysis. This review aims to explain the concept of gait analysis, its use to evaluate THR outcomes, and its proposed future importance when evaluating new technologies proposed to improve functional recovery in individuals undergoing THR surgery. Furthermore, this review discusses the advantages and challenges of gait analysis in THR patients and provides recommendations for future work.

Clinical outcomes of canine total hip replacement utilizing a BFX lateral bolt femoral stem: 195 consecutive cases (2013-2019).

To evaluate the clinical outcomes of total hip replacements (THR) utilizing a BFX lateral bolt stem in dogs with coxofemoral joint disease. Retrospective study. A total of 149 dogs representing 195 THR. Consecutive THRs utilizing a BFX lateral bolt stem were studied. Preoperative, immediate postoperative, 1-, 2-, 3-, 4-, and 12-month postoperative radiographs were performed. All major and minor complications, revisions, outcomes, subsidence, canal flare index (CFI) were recorded. An intraoperative complication rate of 11.8% was observed. The postoperative complication rate was 13.6%, with 9.2% major and 4.4% minor complications. Complications included: postoperative femur fractures (3.6%), coxofemoral luxation (3.6%), stem failure (0.5%), septic loosening (0.5%), aseptic loosening (0.5%), and acetabular fracture (0.5%). Three dogs underwent prophylactic plating after subjective assessment of cortical thickness. Five of 195 (2.6%) cases underwent explant of their prostheses (median=3months). Mean stem subsidence at 1 month postoperatively was 1.22 ± 0.16 mm. An increased CFI was associated with postoperative femur fractures (p < .05). A total of 190 of 195 (97.4%) cases returned to normal function in the long-term follow-up period. Use of the BFX lateral bolt stem resulted in minimal postoperative subsidence, a low femoral stem complication rate, and a high rate of achieving normal limb function. The BFX lateral bolt stem should be considered in canine THR as the femoral failure rate is low and the long-term success rate is high.

Complications and mid to long term outcomes for hip resurfacing versus total hip replacement: a systematic review and meta-analysis.

The long-term results of total hip replacement (THR) are excellent; however, it has higher failure rates in young and active patients. Hip resurfacing arthroplasty (HRA) is an alternative in such patients and gaining popularity. This review was done to compare complications and outcomes between HRA and THA by assessing the latest level 1 studies comparing the two from the past 10years. A systematic review and meta-analysis was conducted using three databases (PubMed, EMBASE and SCOPUS) to compare the complications between THR and HRA in medium to long term follow up. The primary outcome of interest included the complication and revision rate between the two techniques. Functional outcomes and ionic levels at follow up were also compared as secondary outcomes. Risk of bias assessment was done using the Cochrane risk of bias tool. The present review included 6 level 1 studies. These included 308 THR and 304 HRA. On meta-analysis, overall complications rates were significantly lower in HRA compared to the THA group with an Odds ratio (OR) of 2.17 (95% CI 1.21, 3.88; p = 0.009). No difference was seen between the two groups in terms of revision rate (OR 1.06 95% CI 0.57, 1.99; p = 0.85). Functional outcomes in both the groups were satisfactory but the Harris Hip Score was found to be significantly better in the resurfacing group (MD 2.99 95% CI -4.01, -1.96, p < 0.00001). There were increased cobalt and chromium ions in the resurfacing group but no detrimental effect was seen in terms of reported poisoning. Despite similar function and revision rates, HRA was seen to have lesser associated complications and ionic levels may not be a detrimental issue. Hip resurfacing provides relative ease during revisions, especially in younger patients and it may be an alternative to THR in the younger population.

Diabesity: a superadded effect contributing to worse total primary hip replacement operative outcomes for patients with diabetes and obesity.

Although the independent effects of diabetes mellitus and obesity on total hip replacement (THR) outcomes have been widely studied, their combined effect remains uncharacterised. This study aimed to assess the influence of diabesity on primary THR operative outcomes. A retrospective study was performed comparing the outcomes of patients with diabesity (diabetes mellitus and obesity [BMI ≥ 30]) with a control cohort after primary THR using an established arthroplasty database. Data were collected pre-operatively and 12months post-operatively, including Oxford Hip Score (OHS), EuroQol 5-dimensions (EQ5D), post-operative satisfaction and complication rates. 2323 THRs were analysed, of which 94 (4%) had diabesity. Diabesity was independently associated with significantly worse OHS improvement post-operatively (-1.85 points, 95% CI -2.93 to -0.76, p = 0.001). This reduction in addition to the independent effect of obesity (-0.69 points, 95% CI -1.18 to -0.21, p = 0.005) resulted in an overall 2.54 point OHS reduction for patients with diabesity. Diabesity was not associated with EQ5D score change or post-operative satisfaction. Diabesity was independently associated with a worse pre-operative EQ5D score (-0.08 points, 95% CI -0.12 to -0.03, p = 0.002). When combining the associated risk of obesity (Odds Ratio (OR) 1.71, 95% CI 1.15-2.54, p = 0.008) with the superadded effect of diabesity (OR 2.37, 95% CI 1.19-4.71, p = 0.014) the rate of superficial wound infection post-operatively was significantly increased (OR 4.05, 95% CI 1.38-11.95). Obesity was associated with a significantly increased risk of deep infection (OR 3.67, 95% CI 1.55-8.68, p = 0.003), but no additive effect of diabetes was found. Diabesity confers a superadded effect over established associations between THR outcomes and obesity and diabetes individually. Patients with diabesity experience worse improvement in hip-specific functional outcome, worse post-operative quality of life, and an increased risk of superficial and deep wound infection following THR.