Revision Total Hip Replacement Research Articles

Allograft bone banking experience in Pakistan.

To share our experience of establishing a bone bank in Pakistan, and the clinical use of these indigenously produced bone grafts. We retrospectively reviewed our experience of the procurement, processing, and storage of bone grafts at a bone bank in Karachi, Pakistan, the first bone bank to be established in a public sector hospital in Pakistan. The bone bank was established at Sindh Institute of Urology and Transplantation (SIUT), Karachi, in collaboration with Department of Orthopaedic Surgery, Dow University of Health Sciences/Civil Hospital, Karachi (CHK) in May, 2015. Since then, a large number of bone grafts from the tissue bank have been used for various orthopedic procedures. This paper describes the problems and challenges faced in establishing and running a tissue bank in a Muslim and a developing country and the progress of the bone bank over the first 4years. A total of 93 bone grafts were retrieved and preserved in the bone bank over the 4-year period. Among these, 56 (60.2%) bones were retrieved from male donors and 37 (39.8%) from females. The mean age of all donors was 55.9 ± 15.34years (range: 16-90years). All bone donors were living patients. No c bones were obtained from deceased donors. Types of bone grafts included: femoral heads, 68; head with neck of femur, 19; radius and ulna, 1; lower femur, knee joint, lower leg and foot bones, 4; and skull bone, 1. All grafts were subjected to aerobic and anaerobic bacterial cultures, as well as fungal cultures. Microbiological contamination was observed in 18/93 (19.35%). All culture positive bones were discarded. Bone grafts issued from the bank and transplanted were 51/93 (54.8%) in all. Bone grafts were used in a variety of tumor and non-tumor orthopaedic procedures in CHK. Nine bone grafts were donated to the other hospitals to be used for revision total hip replacement and tumor surgeries. There were no service charges. Two patients (3.92%) developed infections postoperatively, one superficial and one deep. No other complications were noted. This is the preliminary report on the establishment and functioning of a bone bank in a public sector hospital in Pakistan. The favorable outcome has inculcated confidence in orthopedic surgeons for greater use of bone allografts for a variety of indications in this country.

Functional and radiological outcomes of impaction grafts and cemented cup for the treatment of acetabular bone deficiency in total hip arthroplasty

Background and Aim Acetabular bone defects are one of the most difficult problems in both primary and revision total hip replacements. Many techniques have been described to deal with acetabular bone defects in total hip replacement, including the use of cement with or without cages and rings, structural bone grafting, and impaction bone grafts with cementless or cemented cups. The aim of this study was to asses short-term to midterm clinical and radiological outcomes of acetabular reconstruction by impaction bone grafts and cemented cups in both primary and revision cases indicated for total hip arthroplasty (THA) with acetabular bone deficiency. Patients and methods This is a retrospective study that included 26 patients with total hip arthroplasty (THA) who underwent acetabular bone defect reconstructions with grafting and cemented cups between December 2014 and January 2019. The mean age at operation was 45.3 years. Among the procedures, 12 were primary THAs, whereas 14 procedures were revision THAs. The morselized grafts were used in eight cases only, along with combined strut graft and morselized grafts in five cases, acetabular rim mesh and morselized grafts in 12 cases, and Kerboul cross-ring with morselized grafts in one case. All cases were clinically evaluated by Harris hip score in addition to radiological evaluation. Results All the patients except one showed clinical improvement, where the mean postoperative Harris hip score became 84. Radiograph follow-up for all the cases showed graft incorporation without loosening or any significant cup migration, except one case, which was revised owing to loosening around the cup. Conclusion The use of impaction graft and cemented cups is safe and reproductive even in young patients. Moreover, this technique reconstitutes bone and gives a stable platform of bone stock for further revision, especially in young population.

421 Intrapelvic Protrusion of a Femoral Head in A Ceramic-on-Ceramic Total Hip Replacement, A Case Report

Abstract Introduction Ceramic on ceramic bearing in Total Hip Replacement (THR) is associated with a low but evident risk of ceramic linear fracture, which can lead to catastrophic failure if not diagnosed and treated early. Case presentation: A 59-year-old male patient, who underwent a ceramic-on-ceramic THR 8 years ago, presented to our centre with a five-week history of right hip pain, after he suddenly twisted his upper body and felt a sharp pain in his groin. Prior to the injury he had an excellent functional level with the prosthesis. His examination findings confirmed a reduced range of movement with pain in the groin on internal and external rotation. X-ray and CT of the hip confirmed a ceramic liner fracture with protrusion of the femoral head into the pelvis. A revision THR was subsequently performed. Discussion The usual pattern of liner fracture in this type of bearings is that the femoral head stays contained inside the metal cup. In our case, the ceramic femoral head uniquely fractured the liner and passed into the pelvis. To the best of our knowledge, this is the third reported case in literature where a ceramic femoral head protrudes through the metal cup into the pelvis.

Comparing the performance of a deep convolutional neural network with orthopedic surgeons on the identification of total hip prosthesis design from plain radiographs.

A crucial step in the preoperative planning for a revision total hip replacement (THR) surgery is the accurate identification of the failed implant design, especially if one or more well-fixed/functioning components are to be retained. Manual identification of the implant design from preoperative radiographic images can be time-consuming and inaccurate, which can ultimately lead to increased operating room time, more complex surgery, and increased healthcare costs. In this study, we present a novel approach to identifying THR femoral implants' design from plain radiographs using a convolutional neural network (CNN). We evaluated a total of 402 radiographs of nine different THR implant designs including, Accolade II (130 radiographs), Corail (89 radiographs), M/L Taper (31 radiographs), Summit (31 radiographs), Anthology (26 radiographs), Versys (26 radiographs), S-ROM (24 radiographs), Taperloc Standard Offset (24 radiographs), and Taperloc High Offset (21 radiographs). We implemented a transfer learning approach and adopted a DenseNet-201 CNN architecture by replacing the final classifier with nine fully connected neurons. Furthermore, we used saliency maps to explain the CNN decision-making process by visualizing the most important pixels in a given radiograph on the CNN's outcome. We also compared the CNN's performance with three board-certified and fellowship-trained orthopedic surgeons. The CNN achieved the same or higher performance than at least one of the surgeons in identifying eight of nine THR implant designs and underperformed all of the surgeons in identifying one THR implant design (Anthology). Overall, the CNN achieved a lower Cohen's kappa (0.78) than surgeon 1 (1.00), the same Cohen's kappa as surgeon 2 (0.78), and a slightly higher Cohen's kappa than surgeon 3 (0.76) in identifying all the nine THR implant designs. Furthermore, the saliency maps showed that the CNN generally focused on each implant's unique design features to make a decision. Regarding the time spent performing the implant identification, the CNN accomplished this task in ~0.06s per radiograph. The surgeon's identification time varied based on the method they utilized. When using their personal experience to identify the THR implant design, they spent negligible time. However, the identification time increased to an average of 8.4min (standard deviation 6.1min) per radiograph when they used another identification method (online search, consulting with the orthopedic company representative, and using image atlas), which occurred in about 17% of cases in the test subset (40 radiographs). CNNs such as the one developed in this study can be used to automatically identify the design of a failed THR femoral implant preoperatively in just a fraction of a second, saving time and in some cases improving identification accuracy.

Anterolateral Bone Window for Revision Broken Cemented Stem of Unipolar Hemiarthroplasty.

Background Fractured stem of the hip prosthesis is well documented in the literature. Although it is rare, it is considered as a challenging problem. Many techniques have been described to solve this problem. Purpose of the Study. Evaluation of the effect of anterolateral bone window for extraction of the cemented femoral stem of hemiarthroplasty in revision total hip replacement. Methods The study included eight revision hip arthroplasties in eight patients, with a broken stem of cemented (Thompson) hemiarthroplasty, which has been revised by the anterolateral proximal femoral window. All cases received cemented cups and cement-in-cement stems, except one case who received cementless long stem. Clinical follow-up of cases by Harries hip score (HHS) and X-ray. Results Functional improvement of HHS of all cases, with no signs of loosening, after a mean follow-up period of 1.5 years. Conclusion Extraction of broken stem is a challenging procedure. Many techniques have been described for revision of cases with a fractured stem of hip prosthesis, but we think that the anterolateral femoral bone window is a reproducible technique due to the characteristics of simplicity, short-time procedure, less invasive, not requiring extra instruments, and can be successful for most patients.

Distal fixation stems for revision of total hip replacement

The purpose of this study was to retrospectively assess patients treated with modular, non-cemented, tapered, fluted, distal fixation stems. We included patients with 24 months mínimum follow-up. Diagnosis that led to revisions were described. The radiographic analysis was made with preoperative, immediate postoperative and last control postoperative X-rays. Sixty-seven patients met inclusion criteria. We observed 59,7% (n=40) Osteointegration, 34,3% of Stable Fibrosis and 5,97% Unstable fibrosis. Stress Shielding was registered with 10,44% and Subsidence was observed in 34,3% of the patients. Modular, fluted, tapered, distal fixation stems have an excellent survival rates.

Femoral Revision Total Hip Arthroplasty Performed through the Interval of the Direct Anterior Approach.

Background: we report the clinical outcomes for femoral revision total hip replacement (THR) using the Direct Anterior Approach (DAA) interval. Methods: 149 patients (165 hips) with a mean age of 68.9 years (range, 33.2–91.0 years) and a mean follow-up of 4.2 years (1.1–8.9 years) were included. The indication for revision surgery was aseptic stem loosening in 131 (79.4%) hips, periprosthetic fracture in 29 (17.6%) hips, revision for stem malalignment in one (0.6%) hip, and prosthetic failure in four (2.4%) hips. Results: an endofemoral approach was used for 156 hips, and a Wagner transfemoral osteotomy was used for nine hips. An additional cup revision was done in 52 hips (uncemented cup: n = 29; cemented cup: n = 21; acetabular cage: n = 2). The overall complication rate was 14.5% (24 complications). Ten patients (10 hips) were revised (8 cups, 2 liners, 2 stems) with an average time to revision of 6 months (range, 3–23 months). The median preoperative Western Ontario McMasters Osteoarthritis Score (WOMAC) score was 52.5 (Inter Quartile Range (IQR): 33.3), which improved to 27.2 (IQR: 30) postoperatively (p < 0.01). Conclusion: use of the DAA achieved similar results when compared with other surgical approaches in terms of clinical outcomes and complications, including dislocation rate. These results suggest that femoral revision using the DAA interval can be a safe and reliable procedure.

Dair approach in 7 infected total hip arthroplasties: our experience and current concepts of the literature.

Introduction:Periprosthetic joint infection (PJI) is one of the most challenging complications following total hip arthroplasty. In early infection, within four to twelve weeks from surgery, debridement, antibiotics and implant retention (DAIR) can be the initial treatment. The aim of this study is to report our case series and review current concepts reported in the literature about this topic.Materials and Methods:This was an observational cohort study that included 7 patients managed with DAIR for PJI following primary total hip replacement (THR) between 2014 and 2020. Inclusion criteria were a primary THR, direct anterior or lateral approach, DAIR procedure, and PJI. Exclusion criteria were a PJI following a revision total hip replacement or hemiarthroplasty, posterolateral approach, 1-stage revision, 2-stage revision, and Girdlestone procedure without prior DAIR. For each patient demographic characteristics, laboratory values, microorganisms involved, antibiotic therapy and outcome at one-year follow-up were registered.Results:The mean duration between THR and DAIR was 19 days. In all cases only one DAIR procedure was performed. Most infections were caused by Staphylococcus aureus (4 cases) [one methicillin resistant (MRSA)]. The other infections were caused by Streptococcus agalactiae, Staphylococcus coagulase negative and Escherichia coli. At the final follow-up, the procedure was considered as successful in 6 out of 7 patients (85%). The one with unsuccessful outcome underwent to a two-stage revision.Discussion:Our results were comparable with those of a recent systematic review of the literature. Factors that have been postulated to influence the outcome of DAIR in the management of PJIs include the timing and numbers of debridement, the exchange of components, the responsible microorganism and the duration of antibiotic treatment. In conclusion, the outcomes following DAIR are better as the indications are refined and risk factors identified. PJI prevention remains the key but the current literature still lacks well documented and effective PJI prevention protocols. (www.actabiomedica.it)

Utility of rotational thromboelastometry in total hip replacement revision surgery (case-control study).

Total hip replacement revision surgery is accompanied by significant blood loss. Using rotational thrombelastometry (ROTEM) perioperatively to diagnose coagulopathy may help to provide rapid aimed therapy and thus decrease blood loss and the consumption of transfusion products. The aim of this case-control study was to find out whether point of care using of ROTEM may reduce blood loss and the consumption of blood transfusion products in hip replacement revision surgery.Data were prospectively collected from patients who underwent hip replacement revision surgery in the period 2017 to 2018 when the management of bleeding and coagulopathy was based on the results of ROTEM. Data were compared with a group of historical controls for the period 2015 to 2016 when bleeding and coagulopathy management was not based on ROTEM results. The consumption of blood transfusion products and perioperative blood loss were compared between the groups.The total number of analyzed patients was 90. Forty five patients were analyzed in the ROTEM group and the same number of patients were analyzed in the non-ROTEM group. Significantly decreased perioperative consumption of fresh frozen plasma and packed red blood cells was found in the ROTEM, as well as decreased perioperative blood loss comparing to non-ROTEM group. All data were statistically different with P < .05.Perioperative management of bleeding and coagulopathy based on the results of ROTEM during hip replacement revision surgery seems to help to decrease perioperative blood loss and the consumption of blood transfusion products, especially fresh frozen plasma.

Antibiotic Dispensing Before and After Primary and Revision Total Hip Replacement: An Australian Orthopaedic Association National Joint Replacement Registry Linkage Study

IntroductionInfection is a major complication following joint replacement (JR) surgery. However, little data exist on baseline use of antibiotics following primary JR and how use changes with subsequent revision surgery.&#x0D; Objectives &amp; ApproachOur study objectives were to describe community use of antibiotics before and after primary total hip replacement (THR) and change in use pre and post revision procedure.&#x0D; Registry data were linked with national medication dispensing data using probabilistic record linkage. Patients with THR for osteoarthritis in a private hospital between 1999 and 2017 were included. Three groups were analysed: patients with primary procedures revised for infection, revised for non-infection reasons and those not revised. Rate of antibiotic dispensing/month was calculated as number of patients dispensed at least one antibiotic in a given month divided by number of patients at-risk.&#x0D; ResultsThere were 102,577 patients included in the non-revised group, 3,156 revised for non-infection and 520 revised for infection. Prior to primary THR, baseline antibiotic dispensing rate was 9-11%/month in all groups. Post-primary rates were similar (10-11%) for non-revised and revised non-infection patients but higher (16-17%) for revised-infection patients. In 1, 6 and 12 months preceding revision for infection, antibiotic use was 55%, 27% and 22%, respectively. For patients revised for non-infection, antibiotic use was 21%, 14%, 13%, respectively. One-month following revision for infection, 82% of patients were dispensed antibiotics, remaining high (38%) at 6-months and 28% at 12-months. In the revision non-infection group, antibiotic use was 48% first month post-surgery, reducing rapidly to 15% at 6-months.&#x0D; Conclusion / ImplicationsNon-revision and revision non-infection patients had similar antibiotic dispensing before and after surgery. Revision infection patients however, maintained higher antibiotic dispensing post-primary, pre and post revision. This may reflect either ongoing infection, need for long-term suppressive therapy or reluctance of treating physicians to terminate treatment.

Uncemented or cemented stems in first-time revision total hip replacement? An observational study of 867 patients including assessment of femoral bone defect size

Background and purpose — Uncemented stems are gradually replacing cemented stems in hip revision surgery. We compared the risk of re-revision between uncemented and cemented revision stems and assessed whether the different fixation methods are used in similar femoral bone defects. Patients and methods — 867 patients operated on with uncemented or cemented stems in first-time hip revision surgery due to aseptic loosening performed 2006–2016 were identified in the Swedish Hip Arthroplasty Register. Preoperative femoral bone defect size was assessed on radiographs of all patients. Cox regression models were fitted to estimate the adjusted risk of re-revision during different postoperative time periods. Re-revision of any component for any reason, and stem re-revision, as well as risk of cause-specific re-revision was estimated. Results — Most patients in both fixation groups had Paprosky class IIIA femoral bone defects prior to surgery, but there were more severe bone defects in the cemented group. The adjusted risk of re-revision of any component for any reason was higher in patients with uncemented compared with those with cemented revision stems during the first 3 years after index surgery (hazard ratio [HR] 4, 95% confidence interval [CI] 2–9). From the 4th year onward, the risk of re-revision of any component for any reason was similar (HR 0.5, CI 0.2–1.4). Uncemented revision stems conferred a higher risk of dislocation compared with cemented stems (HR 5, CI 1.2–23) during the first 3 years. Interpretation — Although not predominantly used in more complex femoral defects, uncemented revision stem fixation confers a slightly higher risk of re-revision during the first years, but this risk is attenuated after longer follow-up.

Protection of the Femoral Trunnion During Acetabular Revision Hip Surgery—A Novel Technique

Revision of a failed acetabular component in the presence of an intact femoral prosthesis comprises approximately 20% of revision total hip replacements performed by the senior author. During this procedure, the femoral trunnion is at risk of damage because of scratching from retractors, reamers, or other instruments. Scratching can result in mechanically assisted crevice corrosion or adverse local-tissue reaction or trunnionosis leading to implant failure. We have used a variety of techniques for protection of the femoral taper over the last 30 years. We describe our current method of taper protection, using a cut segment of #5 silicon laryngeal airway, which is a simple and effective method.

Use of a Constrained Acetabular Liner to Prevent and Treat Recurrent Dislocation after Total Hip Replacement Arthroplasty.

The aim of the present study was to evaluate the dislocation rate and the risk factors leading to instability after primary and revision total hip replacement arthroplasty (THRA) with constrained acetabular liners (CAL), as well as treatment strategies for prevention of dislocation. From 1999 to 2017, drawing on two institutions' THRA registries, we retrospectively identified 46 THRA cases using a CAL that had been followed up for a minimum of 4 years. The patients comprised 39 women and 7 men, with an average age of 69.1 years (age range, 41–98). Of the 46 patients, CAL were used in 12 patients for prevention of dislocation in primary THRA and in 34 patients for treatment of recurrent dislocation after primary THRA. Clinical and radiological evaluation were performed. We evaluated the failure rate of CAL as well as the risk factors. The 12 patients who used CAL for prevention of dislocation in primary THRA had no dislocation. However, 12 (35%) of the 34 hips had a dislocation after use of CAL in revision THRA. Patients with an abductor muscle weakness grade of ≤3 had a higher rate of dislocation than those with a grade of ≥4 (grade 1; likelihood ratio = ∞, grade 2; likelihood ratio = 1.83, grade 3; likelihood ratio = 1.05, grade 4; likelihood ratio = 0.46, and grade 5; likelihood ratio = 0). The group of primary THRA with CAL had no dislocations, and this is a proper way for prevention of dislocation in high‐risk patients. The group of revision THRA with CAL had a high dislocation rate (35%). Abductor muscle weakness below grade 3 was a risk factor for failure of CAL for hip dislocation. We recommend treating patients with recurrent dislocations with the presence of abductor muscle weakness below grade 3 with not only THRA using CAL but also applying additional abductor muscle reconstruction to reduce the risk of dislocation.

Opioid use among veterans undergoing major joint surgery managed by a multidisciplinary transitional pain service

BackgroundChronic postsurgical pain and opioid use is a problem among patients undergoing many types of surgical procedures. A multidisciplinary approach to perioperative pain management known as a transitional pain service...

Cup-on-cup technique: a reliable management solution for severe acetabular bone loss in revision total hip replacement.

The management of acetabular bone loss is a challenging problem in revision total hip arthroplasty (rTHA). The goals of treatment are a stable acetabular fixation, implant stability, and restoration of hip centre of rotation.This study aims to report clinical, radiological outcomes and complications at short-term to mid-term follow-up of the cup-on-cup technique in the management of severe acetabular bone loss in rTHA. We retrospectively reviewed the records of patient receiving rTHA performed with double porous tantalum cup technique in a single Joint Replacement Unit from 2014 to 2017. Objective and subjective clinical scores (Harris Hip Score, Oxford Hip Score, and visual analogue scale), radiological parameters (centre of rotation, leg-length discrepancy, heterotopic ossification, osseointegration, loosening and radiolucencies) and complications were recorded. We analysed the implant survival rate and periprosthetic joint infection rate. We included 9 patients (9 hips) with a mean follow-up of 35.3 ± 10.8 months. Functional scores showed a statistically significant improvement at the final follow-up (p < 0.01). All patients rated their surgery as satisfactory. The cup-on-cup construct demonstrated radiological osseointegration with the centre of rotation restoration and leg length discrepancy improvement. In 1 patient, periprosthetic joint infection was diagnosed and treated with suppressive antibiotic therapy. No patients underwent acetabular components revision surgery for any reason. Cup-on-cup technique is a valid and safe solution for reconstruction of selected Paprosky type IIIA and IIIB bone defects with satisfactory clinical and radiographic results at short-term and mid-term follow-up.

A Surgical Robotic System for Treatment of Pelvic Osteolysis Using an FBG-Equipped Continuum Manipulator and Flexible Instruments.

This paper presents the development and experimental evaluation of a redundant robotic system for the less-invasive treatment of osteolysis (bone degradation) behind the acetabular implant during total hip replacement revision surgery. The system comprises a rigid-link positioning robot and a Continuum Dexterous Manipulator (CDM) equipped with highly flexible debriding tools and a Fiber Bragg Grating (FBG)-based sensor. The robot and the continuum manipulator are controlled concurrently via an optimization-based framework using the Tip Position Estimation (TPE) from the FBG sensor as feedback. Performance of the system is evaluated on a setup that consists of an acetabular cup and saw-bone phantom simulating the bone behind the cup. Experiments consist of performing the surgical procedure on the simulated phantom setup. CDM TPE using FBGs, target location placement, cutting performance, and the concurrent control algorithm capability in achieving the desired tasks are evaluated. Mean and standard deviation of the CDM TPE from the FBG sensor and the robotic system are 0.50 mm, and 0.18 mm, respectively. Using the developed surgical system, accurate positioning and successful cutting of desired straight-line and curvilinear paths on saw-bone phantoms behind the cup with different densities are demonstrated. Compared to the conventional rigid tools, the workspace reach behind the acetabular cup is 2.47 times greater when using the developed robotic system.

Dual mobility THR: Resolving instability and providing near normal range of movement

BackgroundDislocation is a common complication of Total Hip Replacement (THR), particularly when performed in primary (indications with increased risk of instability) and in revision scenarios. Dual mobility THR (DMTHR) minimizes the risk of instability in such scenarios, however most of the evidence is from western literature. Results of DMTHR in Indian scenarios where patient want to go back to their normal routine activities of squatting and sitting cross-legged is lacking. The aim of our study was to evaluate the short to mid-term results of DMTHR for varied indications (both primary and revision) in Indian scenario. To evaluate the outcome of the DMTHR in terms of functional range of motion and the ability to go back to their pre-injury level of activity. MethodsThis is a retrospective study of 150 patients operated with DMTHR between January 2015 to February 2019 with a minimum follow-up of 12 months. Patients were evaluated clinically using Modified Harris Hip Score (HHS), Range of Motion (ROM), and Patient Reported Outcome Measures (PROM) like ability to squat and sit cross legged. Radiological evaluation was done using radiographs to assess loosening, stress shielding, osteolysis. ResultsMean follow up in our study was 25.2 months (Range 12–46 months). Mean Modified HHS was 71.8 ± 8.11 at 6 weeks post-op and 85.8 ± 7.62 at last follow-up. HHS showed excellent outcome in 36 hips (26.7%), good outcome in 76 hips (56.7%), fair outcome in 20 hips (14.6%), poor outcome in 3 hips (2%). All our patients were allowed to squat and sit cross-legged at a mean follow-up period of 13 weeks (8 weeks–20 weeks) except 10 cases of Revision THR where patients were advised not to squat or sit cross-legged. All patients were able to resume their activities of daily living. ConclusionDMTHR in patients of all ages has shown a good short to midterm clinical outcome which is comparable to conventional THR. It confers the benefit of stability allowing our patients to squat and sit cross legged which is often one of the expectation and requirement of a patient undergoing THR in India. DMTHR in both primary and revision scenarios exhibit a low risk of dislocation, complications and revision surgery.

Assessment and reliability of the World Health Organisation quality of life (WHO QOL-BREF) questionnaire in total hip replacement patients

BackgroundSeveral functional scoring tools are available to evaluate the outcomes of total hip replacements (THRs) for diseased or damaged hips. Majority of these scores were devised in western countries and their cross-cultural compatibilities are rarely demonstrated. The World Health Organisation quality of life (WHO QOL-BREF) questionnaire with 4 domains, is one of the best known multilingual instruments for such assessment. Its reliability has never been demonstrated for THRs and the present study was conceptualised for the same. MethodsTHRs done over 6 years were followed up retrospectively. Revision THRs and hemiarthroplasties were excluded. All the cases were done by a single senior arthroplasty surgeon. Clinical examination was done and questionnaires for WHO QOL-BREF and Harris Hip scores were given to the patients. ResultsThe number of patients included in the study was 96 with 115 operated hips. The average age of these patients was 41.40 years ranging from 17 to 80 years. There was strong male preponderance in our series of patients with 90 THRs. The mean score of domain 1 was 70.8 (SD 21.6), domain 2: 72.4 (SD 18.8), domain 3: 74.7 (SD 16.8) and domain 4: 75.4 (SD 14.8); showed significant functional improvement post THR in domain 2 (P = 0.0001), domain 3 (P = 0.0010) and domain 4(P = 0.0001), when compared to scores of general healthy population. Similarly, the scores were significantly improved in all domains as compared to cohorts of post-operative acetabular and hip fractures. The score was found to be a reliable tool with Cronbach’s alpha of 0.912 and strong correlation was present with the standard Harris hip scores (p = 0.000). ConclusionWHO QOL-BREF is a potent tool to assess the quality of life in patients undergoing THRs. It can be used as a single index of measurement and it is simple, reproducible and reliable.

Gluteal insufficiency

Gluteal insufficiency or hip abductor mechanism deficiency mainly following (revision) total hip replacement is associated with highly painful complaints and severesufferingofpatients. It represents a great diagnostic and therapeutic challenge. Differentiated conservative treatment pathways, open surgical and endoscopic anatomic repair techniques with intact gluteal musculature and muscle transfer are available as salvage procedures for chronic not anatomically reconstructable mass ruptures. Astepwise diagnostic and therapeutic approach is required for restoration of the quality of life and painless or almost painless mobility of affected patients in occupation and daily life.

Short Term Result of Revision Total Hip Replacement after Failed Hemiarthroplasty

Background: Total hip arthroplasty is the most common surgery performed for complications of hip hemiarthroplasty. Hemiarthroplasty has been a good method of treating displaced fracture neck of femur. With the increased demands placed on the prosthesis by highly active patients, the failure rate increased following hemiarthroplasty. Pain is the most reliable complaint that indicates failure. Pain may be due to many complications related to hemiarthroplasty as loosening, sepsis, protrusio, dislocation, and periprosthetic and prosthetic fractures. Conversion to total hip replacement is a good method for treating patients with painful hemiarthroplasties. Objective: This study aimed to evaluate the result of revision total hip replacement after failed hemiarthroplasty. Patients and Methods: This is a retrospective study included 62 patients with ages ranged from 38 years to 75 years with a mean (62.7±11.38), with the conversion of failed hip hemiarthroplasty to total hip arthroplasty between 2000 and 2015 with a minimum follow up 5 years and maximum follow up 10 years at Zagazig University Hospital. Males represented 54.8% (34 cases) and females were 45.2% (28 cases). Results: Our study that the mean Harris hip score significantly increased from 21.87±8.31 preoperative to 74.21±18.3 postoperative P=0.00** and postoperative radiologically we find that 58 patients (93.5%) has fixed implants and 4 patients (6.5%) has loose implants. Conclusions: This present study showed that the conversion of failed hemiarthroplasty to THR is a good way of treatment for painful hemiarthroplasties. Conversion is a complicated surgery with a higher rate of complications both intra and postoperatively.