Technique For Total Hip Arthroplasty Research Articles

Navigated Acetabular Cup Fixation for Acetabular Deformity or Revision Total Hip Arthroplasty.

PurposeTo evaluate the usefulness of navigated acetabular cup fixation for total hip arthroplasty in patients with acetabular deformity or revision total hip arthroplasty.Materials and MethodsThis study enrolled 28 patients with at least 12 months' follow-up. The safe zone of the acetabular cup was defined as 40°±10°in inclination and 15°±10°in anteversion. The authors used the navigation and radiographic data to determine whether the acetabular cup was located within the safe zone or not. To evaluate the clinical outcomes, preoperative and last follow-up Harris hip scores were checked, and the occurrence of complications was evaluated.ResultsAccording to the navigation data, the mean inclination and anteversion were 38.5°±4.7°(range, 32°-50°) and 16.6°±4.0°(range, 8°-23°), respectively. According to the radiographic data the mean inclination and anteversion were 40.5°±4.6°(range, 32°-50°) and 19.4°±4.2°(range, 8°-25°), respectively. In both cases, all values were within the safe zone. Harris hip score was improved in all patients from preoperative 52.3±14.4 points (range, 29-87 points) to 88.0±9.0 points (range, 65-99 points) at the last follow-up. There was no dislocation or loosening of both cases.ConclusionNavigated acetabular cup fixation is a useful technique for total hip arthroplasty in patients with acetabular deformity or revision total hip arthroplasty because it prevents the malposition and related complications.

SHORTAND MIDDLE-TERM RESULTS OF HIP ARTHROPLASTY FOR TUMORS OF THE PROXIMAL FEMUR

A purpose of the study was to evaluate the immediate and medium-term outcomes of the treatment of patients with primary tumor lesions of proximal femur after the lesion resection together with total hip arthroplastyby total revision systems. Material and methods. 34 patients with primary tumors of proximal femur [chondrosarcoma - 9 (26.5%),giant cell tumor - II (32.4%),osteosarcoma - 2 (5.8%), other malignancies - 5 (14.7%),benign neoplasms - 7 (20.6%)] underwent the conserving surgery at R.R. Vreden Russian Research Institute of Traumatology and Orthopedics since 2003 through 2013. The follow-up was from one to five years. The age of patients ranged from 16 to 70 years, patients younger than 40 years accounted for 61.8%. Acetabulum was replaced by standard components. To replace post-resection defects of proximal femur, in 21 (61.8%) patents revision legs of cementless fixation Wagner Revision (Zimmer) were used, in 10 (29.4%) - “Fenix”, and in 3 (8.8%) - Solution (DePuy, J&J). Results. A technique of total hip arthroplasty with the use of revision systems demonstrated excellent and positive results in 32 (94.2%) cases. Complications leading to revision surgery occurred in 3 (8.8%) patients. Conclusion. The method allows achievement of favorable functional outcomes and early patients’ activation without worsening the oncologic component of treatment and being not inferior to expensive modular systems.

Total Hip Replacement with Use of a Direct Anterior Approach

Total hip surgeons have tried to improve on the approximately 80% twenty-five-year survival rate associated with Charnley total hip arthroplasty1. For instance, investigators have addressed the risk of complications, the recovery time, and the longevity after total hip arthroplasty. Proponents of minimally invasive total hip arthroplasty techniques have pointed to traits such as shortened surgical scar lengths, decreased soft-tissue trauma, diminished blood loss, and quicker pain and functional recovery2. Many variations of minimally invasive techniques involving single to multiple incisions have been developed over the years. Opponents, however, have pointed to the increased difficulty of obtaining optimal implant positioning, the lack of evidence demonstrating improvement in clinical measures, and the importance of implant positioning as the key variable affecting longevity. According to these opponents, if implant positioning is compromised in favor of a shorter incision, the long-term survival of the implant may be jeopardized2-6. In recent years, the direct anterior surgical approach has been associated with minimally invasive total hip arthroplasty5. As more surgeons have adopted this method, the question has arisen as to whether or not claims of earlier functional recovery are balanced with the unique complications and drawbacks associated with this approach. In the present study, we …

Periprosthetic femoral fractures in total hip arthroplasty.

Periprosthetic fractures in total hip arthroplasty (THA) are a significant problem facing hip surgeons, and were responsible for revision surgery in 9% of single stage revision THAs recorded in the National Joint Registry of England and Wales (NJR) in 2012; the 5th most common cause after aseptic loosening, osteolysis, pain and dislocation. The incidence has increased along with the number of THAs performed. Implants and techniques of THA continue to evolve, surgical indications are expanding and the number performed annually continues to rise. Furthermore, patients are undergoing THA earlier and living longer, leading to a rise in the average number of years at risk for periprosthetic fracture. In this review we will discuss the epidemiology of femoral periprosthetic fractures, their prevention, classification and the evidence base for their treatment.

Der Einfluss der Kapselrekonstruktion auf die Luxationsrate nach primärer Hüftendoprothetik: eine retrospektive Analyse von 1972 Fällen

Dislocation is the second most frequently encountered complication in primary total hip arthroplasty (THA) and occurs more commonly in the early postoperative rehabilitation phase. Sir Charnley recommended the "avoidance of resection of the capsule" and emphasised its contribution to hip joint stability in THA. Several authors, however, doubted its significance and considered resection of the capsule to be essential. Since 2002, some surgeons increasingly adopted a modified, less invasive technique of THA via Bauer approach, including the preservation and repair of the hip joint capsule with focus on maintaining its acetabular origin. Another group of surgeons applied the traditional technique including the resection of the joint capsule via an anterolateral approach. In this case-control study we investigated whether the dislocation rate can be reduced through joint capsule reconstruction and whether any negative impact on patient satisfaction, functional results or revision rate is observed. All cases of primary THA performed in our institution in a timeframe between 2002 and 2009 were included with the only exceptions of resurfacing arthroplasty, dual mobility and tumour hip replacements. Joint capsule repair cases were gathered in the study group (SG), capsule resection cases in the control group (CG). Additional patient-related data were taken from the anaesthesia records. The WOMAC score and a questionnaire focusing on detection of dislocations and revision surgeries was sent out for each case. Further targeted research was conducted that included requesting records and reports from external hospitals. In the case of non-responding patients, all available data (operating room documentation, electronic files, archive, X-rays) were reviewed for incidents of dislocation and revision surgery. Groupings and classifications were exclusively performed by senior surgeons. SG and CG were compared regarding epidemiologic, implant-associated and surgery-specific data. Statistical evaluations were performed using the Chi-squared test and the Mann-Whitney U test. 1972 cases of primary THA were included: 992 in the SG and 980 in the CG. The follow-up rates were 92.7 % in the SG and 76.4 % in the CG, the mean follow-up times 33.5 months and 73.4 months, respectively, with a follow-up of at least 12 months in all cases. In the SG, the dislocation rate was 0.3 % (n = 3) and thus significantly lower than the 2.55 % in the CG (n = 25, p < 0.001). Both the WOMAC score (SG: 1.46 ± 1.73; CG: 1.53 ± 1.80; p > 0.05) and the revision rate (SG: 5.24 %; CG: 6.84 %; p = 0.139) showed no significant differences. Preservation and repair of the hip joint capsule causes an 88-%-reduction of the dislocation rate in primary THA in this large series including 1972 cases, operated via the Bauer or the anterolateral approach. Several authors reported comparable results after THA using similar techniques of soft tissue and capsular repair through the posterior or posterolateral approach. Sparing and reconstructing the hip joint capsule therefore seems to reduce the dislocation rate after primary THA by one order of magnitude regardless of the surgical approach and, especially, if the acetabular origin is preserved. Capsule-related specific complications such as an increased revision rate, malfunction or pain were neither recorded in our study nor by others. Thus, careful preservation and reconstruction of the hip joint capsule may be expressly recommended in primary THA.

Experience in posterolateral mini-incision total hip arthroplasty

To explore the surgical techniques in posterolateral mini-incision total hip arthroplasty and clinical efficacy. A total of 94 patients (98 hips) had posterolateral mini-incision total hip arthroplasty, from December 2006 to December 2008, and were randomly divided into a posterolateral miniincision total hip arthroplasty group (Group A) and a conventional group of posterolateral incision for total hip arthroplasty (Group B). Forty-nine patients (50 hips) in Group A had posterolateral small incision total hip arthroplasty [26 males, 23 females, between 37.0 and 95.0 years (average 68.9 years), body mass index (BMI) between 20.3 and 29.7 (average BMI 25.4)]. Forty-five patients (48 hips) in Group B had the conventional posterolateral incision [27 males, 18 females, between 45.0 and 92.0 years (average 69.7 years), BMI between 18.7 and 34.1 (average BMI 26.9)]. The incision length, blood loss, drainage, operation time, and postoperative Harris scores were compared between the 2 groups. The incision length was 6.0~10.5 (average length 7.4) cm, average blood loss was 387.6 (140.0~1000.0) mL, average drainage was 143.1 (63.0~375.0) mL, average blood transfusion was 77.6 (0~400.0) mL, average operation time was 84.6 (63.0~130.0) min, and vitalock abduction angle imaging after the operation was 41.6° (averagely 38.0°~57.0°) in Group A. The incision length was 15.0~23.0 (average length 20.0) cm, average blood loss was 513.1 (210.0~1350.0) mL, average drainage was 152.3 (70.0~520.0) mL, average blood transfusion was 142.2 (0~800.0) mL, average operation time was 84.0 (71.0~115.0) min, and postoperative radiographic acetabular cup abduction angle was 42.3° (37.0°~54.0°) in Group B. The follow-up showed that the prosthesis of the 2 groups was in a good position, Harris score was significantly improved with no complications after total hip arthroplasty in the 2 groups. With the correct selection of indications and adept operation skills and other circumstances, posterolateral mini-incision total hip arthroplasty may do little damage to the soft tissue with a small scar on the skin. The imaging evaluation after the operation and the Harris score show no difference between the 2 groups. Patients are satisfied with their joint function and postoperative recovery.

Total Hip Arthroplasty Using Imageless Computer-Assisted Hip Navigation: A Prospective Randomized Study

In a prospective randomized study of two groups of 65 patients each, we compared the acetabular component position when using the imageless navigation system compared to the freehand conventional technique for cementless total hip arthroplasty. The position of the component was determined postoperatively on computed tomographic scans of the pelvis. There was no significant difference for postoperative mean inclination (P=0.29), but a significant difference for mean postoperative acetabular component anteversion (P=0.007), for mean deviation of the postoperative anteversion from the target position of 15° (P=0.02) and for the outliers regarding inclination (P=0.02) and anteversion (P<0.05) between the computer-assisted and the freehand-placement group. Our results demonstrate the importance of imageless navigation for the accurate positioning of the acetabular component.

Total Hip Arthroplasty with Subtrochanteric Shortening Osteotomy for Crowe Grade 4 Dysplasia Using the Direct Anterior Approach

Between September 2006 and June 2011, 1521 primary total hip arthroplasties were performed using the direct anterior approach on a standard surgical table. In 12 hips, subtrochanteric shortening osteotomy was required. Full weight bearing was allowed 1 week after surgery. The mean follow-up period was 3.7 years. All patients limped preoperatively, but no patient had a positive Trendelenburg or Duchenne limp at the last follow-up. On the basis of our findings, we believe that the direct anterior approach is a safe and reproducible technique for total hip arthroplasty with subtrochanteric shortening osteotomy in the case of Crowe grade 4 dysplasia. It allows the steady recovery of the abductor muscles, a shorter period to postoperative partial weight bearing, and elimination of limping.

MAASH Technique for Total Hip Arthroplasty: A Capsular Work.

BackgroundDislocation and leg length discrepancy are major complications following total hip arthroplasty (THA). Many surgical approaches for THA have been described, but none suggest a capsular incision that assures good exposure while maintaining adequate capsule integrity in closure.PurposesModified anterolateral approach for stable hip (MAASH) is a modification of the classical Hardinge approach, but specifically preserves the anterior iliofemoral lateral ligament and pubofemoral ligament excising the “weak area” of the capsule, in the so called “internervous safe zone” and introducing the “box concept” for the anterior approach to the hip. This is the main difference of the MAASH approach. This technique can be used as a standard for all THA standard models, but we introduce new devices to make it easier.MethodsFrom November 2007 to May 2012, data were collected for this observational retrospective consecutive case study. We report the results of 100 THA cases corresponding to the development curve of this new concept in THA technique.ResultsMAASH technique offers to hip surgeons, a reliable and reproducible THA anterolateral technique assuring accurate reconstruction of leg length and a low rate of dislocation. Only one dislocation and six major complications are reported, but most of them occurred at the early stages of technique development.ConclusionMAASH technique proposes a novel concept on working with the anterior capsule of the hip for the anterolateral approach in total hip arthroplasty, as well as for hemiarthroplasty in the elderly population with high dislocation risk factors. MAASH offers maximal stability and the ability to restore leg length accurately.Electronic supplementary materialThe online version of this article (doi:10.1007/s11420-013-9332-1) contains supplementary material, which is available to authorized users.

Comparison of Limb-length Discrepancy After THA: With and Without Computer Navigation

Limb-length discrepancy following total hip arthroplasty (THA) is often cited as a reason for patient dissatisfaction and for hip instability. Various intraoperative techniques have been described to help restore normal limb length after THA. The purpose of this study was to assess whether a computer-navigated surgical technique would help restore limb-length equality following THA.A retrospective study of 150 consecutive patients compared a free-hand (non-navigated) THA technique vs a computer-navigated THA technique. Each group contained 75 patients. The primary outcome measurement was limb-length discrepancy, which was evaluated using a digital anteroposterior pelvic radiograph. Secondary outcome measurements included a Harris Hip Score questionnaire and a single question evaluating the subjective feeling of the operative limb (longer, shorter, or equal). At a minimum 1-year follow-up, results showed that computer-navigated THA helped restore limb-length equality. An average leg-length difference of 0.3 mm (SD=0.3 mm) was found with computer-navigated THA compared with a leg-length difference of 1.8 mm (SD=0.7 mm) when a non-navigated THA was used. This was statistically significant. Both groups had similar Harris Hip Scores (computer-navigated group, 84.8; non-navigated group, 84.2; P=.835), and no difference was found between the 2 groups regarding the patient's perception of the operative limb length.This study demonstrated that computer-navigated THA resulted in improved restoration of normal limb length and limited significant outliers but did not show improvement in Harris Hip Scores or patient's perception of limb-length equality.

Trust, but Verify

Trust, but Verify

Evidence-based computer-navigated total hip arthroplasty: an updated analysis of randomized controlled trials

Total hip arthroplasty (THA) has evolved over the years to be a reliable, reproducible, and successful orthopedic procedure. Nowadays, THA is increasingly performed on patients using less invasive, tissue-preserving techniques. Accordingly, the use of computer navigation in total joint arthroplasty has become more prevalent. However, there is still lack of high-quality evidence to verify the most effective technique for THA. A search was conducted in PubMed, Medline, Embase, Cochrane Central Register of Controlled Trials, and Google Scholar databases. Clinical trials published from 1966 to Feb 2012 that assess conventional techniques THA or computer-navigated techniques THA for placing the acetabular component. The main outcome measures included abduction angles, anteversion angles, percentage of acetabular outliers, operation time, decrease in Hb/24 h, and wound secretion/48 h. The pooled analysis across all studies showed a significant difference in anteversion angles and acetabular outliers (difference -0.22, 95% CI -0.67, 0.24; p = 0.346, I (2) = 71.9%) and (difference 8.34, 95% CI 4.15, 16.74; p = 0.000, I (2) = 0.0%). However, no significant difference in abduction angle and decrease in Hb/24 h (difference -0.22, 95% CI -0.67, 0.24; p = 0.346, I (2) = 71.9%) and (difference 0.03, 95% CI -0.36, 0.41; p = 0.888, I (2) = 0.0%). For the operation time, computer-navigated THA was longer (difference -0.73, 95% CI -1.32, -0.15; p = 0.014, I (2) = 74.4%). This meta-analysis demonstrated computer-navigated THA was a more favorable method for placing the acetabular component and decreased the number of acetabular cups implanted outside the desired range of alignment. More high-quality RCTs were needed to support the evidence.

A minimally invasive approach for total hip arthroplasty does not diminish early post-operative outcome in obese patients: a prospective, randomised trial

The benefits of minimally invasive surgical techniques in total hip arthroplasty (THA) are well known, but concerns about applying those techniques in obese patients are controversial. We prospectively compared patients with increased body mass index (BMI ≥ 30) undergoing THA with normal weight patients. A total of 134 patients admitted for unilateral THA were randomised to have surgery through either a transgluteal or a minimally invasive approach (MicroHip). In each group a BMI ≥ 30 was used to define obese patients. Pre- and early post-operative demographics, intraoperative data, baseline haematological values, hip function (Harris Hip Score, Oxford Hip Score) and quality of life (EQ-5D) were assessed with follow-up at three months. Duration of surgery, blood loss, C-reactive protein levels, radiographic measurements and complication rates were comparable in all groups. There was a tendency for lower serum creatine kinase levels in the MicroHip group. Intraoperative fluoroscopic time and dose area products were significantly elevated in patients with a BMI exceeding 30 regardless of the approach used. Time points of mobilisation, length of hospital stay and functional outcome measurements were similar in the different weight groups. Our data suggest that obese patients gain similar benefit from MicroHip THA as do non-obese patients. The results of this study should be further investigated to assess long-term survivorship.

Development and evaluation of an image-free computer-assisted impingement detection technique for total hip arthroplasty

Periprosthetic or bony impingement in total hip arthroplasty (THA) has been correlated to dislocation, increased wear, reduced postoperative functionality with pain and/or decreased range of motion (ROM). We sought to study the accuracy and assess the reliability of measuring bony and periprosthetic impingement on a virtual bone model prior to the implantation of the acetabular cup with the help of image-free navigation technology in an experimental cadaver study. Impingement-free ROM measurements were recorded during minimally invasive, computer-assisted THA on 14 hips of 7 cadaveric donors. Preoperatively and postoperatively the donors were scanned using computed tomography (CT). Impingement-free ROM on three-dimensional CT-based models was then compared with corresponding, intraoperative navigation models. Bony/periprosthetic impingement can be detected with a mean accuracy limit of below 5° for motion angles, which should be reached after THA for activities of daily living with the help of image-free navigation technology.

Making the Case for Anterior Total Hip Arthroplasty

Total hip arthroplasty (THA) performed through the Smith–Peterson surgical approach has seen renewed interest among arthroplasty surgeons, as a minimally invasive intervention. Several reports have described the functional outcomes related to direct anterior THA. Most of these have shown that early surgical recovery parameters are improved, with satisfactory component position and an acceptable low risk of complications. Other authors have encountered a higher risk of complications, most often related to surgeon inexperience during early learning. Here, we have summarized the literature pertaining to direct anterior THA, to facilitate informed choices in adopting and learning this technique of THA.

High complication rate in the early experience of minimally invasive total hip arthroplasty by the direct anterior approach

Background and purpose There is growing interest in minimally invasive surgery techniques in total hip arthroplasty (THA). In this study, we investigated the learning curve and the early complications of the direct anterior approach in hip replacement.Methods In the period January through December 2010, THA was performed in 46 patients for primary osteoarthritis, using the direct anterior approach. These cases were compared to a matched cohort of 46 patients who were operated on with a conventional posterolateral approach. All patients were followed for at least 1 year.Results Operating time was almost twice as long and mean blood loss was almost twice as much in the group with anterior approach. No learning effect was observed in this group regarding operating time or blood loss. Radiographic evaluation showed adequate placement of the implants in both groups. The early complication rate was higher in the anterior approach group. Mean time of hospital stay and functional outcome (with Harris hip score and Oxford hip score) were similar in both groups at the 1-year follow-up.Interpretation The direct anterior approach is a difficult technique, but adequate hip placement was achieved radiographically. Early results showed no improvement in functional outcome compared to the posterolateral approach, but there was a higher early complication rate. We did not observe any learning effect after 46 patients.

Der minimal-invasive anteriore Zugang

The minimally invasive direct anterior approach for total hip arthroplasty (THA) was first published in 1985. Since then the technique has been further improved and the indications have been extended. The approach utilizes the muscle gap between the tensor fasciae latae muscle on the lateral side and the sartorius muscle on the medial side. This muscle gap allows a direct and quick approach to the hip joint with good muscle preservation. During preparation of the femur the tensor fasciae latae muscle is at risk of being damaged. The lateral cutaneous nerve of the thigh (NCFL) and its branches are also in danger of being damaged during skin incision and dissection of the subcutaneous tissue. In this article the technique, risks and current clinical results of THA using the minimally invasive direct anterior approach are described. The results from the literature, as well as own results are compared to the traditional transgluteal lateral Bauer approach and discussed. Reviewing the literature, special attention has been given to the incidence of NCFL lesions, damage of the tensor fasciae latae muscle and positioning of the cup. Especially for the latter, the general view is hindered in the minimally invasive technique.

The direct anterior approach: initial experience of a minimally invasive technique for total hip arthroplasty

BackgroundLess invasive approaches for hip arthroplasty have been developed in order to decrease traumatisation of soft tissue and shorten hospital stay. However, the benefits with a new technique can be at the expense of a new panorama of problems. This manuscript describes, with emphasis on postoperative complications, our experience from the first 200 cases of unilateral hip replacement using the direct anterior minimally invasive (MIS) approach.MethodsA straight incision in front of the greater trochanter was used and the tensor muscle was approached subfascially and retracted laterally. The joint was opened and the femoral head was removed. Usually excellent acetabular exposure was obtained. In order to get access to the proximal femur, the hip capsule was released posterolaterally so that the femur could be lifted using a special retractor behind the tip of the trochanter. After insertion of the prostheses, the wound was closed using running sutures in the fascia overlying the tensor, sub- and intracutaneously.ResultsThere was a small influence of BMI on the duration of surgery, and obese patients tended to have the cup positioned at a higher degree of deviation. There were in total 17 complications of which 5 necessitated revision surgery; 3 peroperative femoral fractures and 2 dislocations. Another 4 dislocations were treated with closed reduction and did not recur. 3 cases of nerve injury were noted, all resolved within 12 months. Three cases of DVT were diagnosed as well as 2 cases of postoperative infection; none of these led to chronic disability.ConclusionsThe technique is perhaps more technically demanding than the lateral approaches used today due to the somewhat limited surgical exposure. Morbidly obese or very muscular patients as well as patients with a short femoral neck or acetabular protrusion can represent particular problems. Our results indicate that there are certain risks when adopting this procedure but the complications noted are avoidable.

Stand der zementierten Hüftendoprothetik in Deutschland 2010

The results of a national survey from 1998 showed that only around 10 % of orthopaedic surgeons in Germany had strictly implemented modern third-generation cementing techniques in total hip arthroplasty (THA). A 2005 update showed an improvement up to 29.4 %. The study was repeated in 2010 in order to evaluate the current situation and to determine whether modern cementing techniques have become more popular. A detailed, slightly modified questionnaire regarding cement and bone preparation, cementing techniques on acetabulum and femur, and implant types was sent to 492 German orthopaedic and trauma hospitals, as well as to visiting surgeons with an interest in THA. The survey was conducted over 6 months. The response rate was 51.8 %, 255 questionnaires were available for evaluation and statistical analysis. Palacos R+G bone cement remained the most widely used cement (52.2 %). The mixing times given varied significantly. Vacuum mixing systems have again become more popular (85.2 %). In the femur 78.6 % of the surgeons attempted to preserve cancellous bone and 77.8 % used pulsatile (jet) lavage. Retrograde cement application via a cement gun was done in 85.8 %. Cement restrictors were used in more than 98 %. Only 72.7 % of the surgeons implemented sustained cement pressurisation and preferred a cement mantle thickness over 2 mm (55.2 %). Only 18.1 % drilled multiple small acetabular keyholes and 66.5 % used jet lavage. In 67.9 % no cement gun was used and in 70.7 % the cement was applied at high viscosity. Cement pressurisation was done manually in 89.1 %. The Müller straight stem device remained the most popular implant. Only 7.4 % of the centres implanted less than 20 and 40.3 % more than 100 cemented stems per year, whereby higher THA volumes correlated with better cementing technique. The results of this survey demonstrate that, in comparison to 2005, the current state of cemented THA, in particular cementing technique has generally significantly improved. Future emphasis should focus on continued surgeon education and training, as the cementing techniques are of utmost importance for long-term durability.

Modified minimally invasive two-incision total hip arthroplasty using large diameter femoral head

Background:Minimally invasive (MI) total hip arthroplasty (THA) is an alternative to standard THA, but has created much controversy among orthopedic surgeons. The authors modified the original minimally invasive two-incision THA technique and used large-diameter (32 mm, 36 mm) ceramic-on-ceramic articulation.Materials and Methods:One hundred and seventy patients that underwent unilateral MI two-incision THA were retrospectively reviewed, and surgical morbidity, functional recovery, radiological properties, and complications were assessed.Results:Mean Harris hip score (HHS) improved from 41.8 to 96.1 at last followup, and mean Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score from 66.2 to 26.9. The mean lateral opening angle of the acetabular component was 38.2° and the mean stem position was valgus 1.9°. There was an intraoperative femur fracture and one revision surgery due to stem subsidence. No patient had dislocation.Conclusions:Our data suggest that this modified technique combined with large ceramic femoral head is safe and reproducible in terms of achieving proper implant positioning and early functional recovery.