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Introduction: Posterior native hip dislocations (NHD) are high-energy injuries. Thompson-Epstein Type I dislocations describe those without significant associated femoral or acetabular fracture. The aim of this study was to compare the clinical and radiological outcomes of patients with Type I NHDs. We also evaluate the association between radiological indicators of femoroacetabular impingement (FAI) and NHD. Patients and methods: A retrospective study from January 2012 to May 2021 compared skeletally mature patients (⩾16 years) with Type I posterior NHD to age and gender-matched controls with Type II–V posterior NHD. Patient demographics, mechanism of injury, complications and patient-reported outcome measures (PROMs) are presented. Post reduction radiographs and computed tomography were used to assess for FAI. Univariate analyses were performed to evaluate radiological outcomes. Results: 13 patients (77% male) with Type I posterior NHD were compared to a control group of 40 patients (80% male) with Type II–V posterior NHD. 11 patients in the study group and 14 in the control group experienced isolated injuries (p = 0.01). Post-reduction complications were similar. The study group had significantly lower post-injury osteoarthritis incidence (n = 0) compared to controls (n = 18, p = 0.0083). Patients reported a mean Oxford Hip Score of 43.5 ± 2.2 and EQ-5D-VAS score of 87.1 ± 7.4, with 6 patients indicating minimal symptoms across all EQ-5D-5L domains. Radiological femoroacetabular impingement (FAI) was prevalent in both groups, especially among males. Conclusions: Patients who underwent emergent closed reduction of Type I NHD demonstrated good short to medium term outcomes. Our radiological findings suggest a high prevalence of FAI. Future work should aim to quantify longer term outcomes following this injury. We call for further comparative studies of patients who suffer NHD with and without fractures to aid our understanding of risk factors. Given the rarity of this injury, multicentre efforts will be required to capture large numbers of patients. [ABSTRACT FROM AUTHOR]

Introduction: Perioperative multimodal protocols following total joint replacements have significantly decreased the amount of perioperative and postoperative opioids. Further identification of those requiring more or less opioids through individualisation, may further aid in reducing the amount prescribed. Therefore, the purpose of the study was to evaluate whether a patient's grit, the measurable psychological strength of character to persevere during hardship, measured by postoperative opioid consumption. Methods: Consecutive patients who had undergone either primary or revision total knee arthroplasty (TKA) or total hip arthroplasty (THA) from February 2019 to August 2020 at our institution logged their opioid use for the first 2 weeks postoperatively, detailing the type, dosage, and number of narcotics they consumed. Those who completed their logs and a grit questionnaire had their average morphine equivalent dose (MED) and grit score calculated. Analysis was then performed to evaluate if any association existed between these 2 variables. Results: There was no correlation between grit score and postoperative opioid consumption in the first 2 weeks following discharge after total joint arthroplasty. A total of 144 patients were eligible to participate and a total of 86 patients met inclusion criteria, 48 patients in the TKA group and 38 in the THA group. Of all patients, 63% were male. The average MED was 95.5 for THAs and 192 for TKAs. The average grit score was 4.23 for THAs and 4.19 for TKAs. Conclusions: There is not an apparent association between grit score and postoperative opioid consumption in the first 2 weeks after total joint arthroplasty. General psychological resiliency may not be an important predictor of postoperative opioid use with modern postoperative protocols. [ABSTRACT FROM AUTHOR]

Introduction: Osteotomy of the greater trochanter is a commonly used procedure in complex revision hip arthroplasty in order to achieve a wide exposure to the femoral stem and acetabular components. There is no clinical evidence in favour of a specific fixation method. The aim of this study was to compare cable-plate with figure-of-eight cerclage wire fixation in patients requiring a trochanteric "slide" osteotomy. Material and methods: In a retrospective study, 51 greater trochanteric "slide" osteotomies in complex acetabular revision arthroplasties were included. Patients were divided into 2 groups: 28 hips were fixed with 1 of 2 cable-plate systems (Dall-Miles staple, Stryker or Cable-Ready plate, Zimmer) and 23 with a figure-of-eight cerclage wire. Consolidation, osteolysis, migration of greater trochanter, bursitis of the trochanteric area, Trendelenburg gait and removal of osteosynthesis material were studied at 6 months follow-up. Results: Both groups showed good union rates. The lysis rate was similar with 32% in the cable-plate group versus 29% in the cerclage wire group (p = 0.084). 43% of the hips with cable-plate and 22% of the cerclage wire had trochanteric migration (p = 0.297). Pain at the greater trochanter was less frequent in the cerclage wire group (9%) as compared to the cable-plate group (43%) (p = 0.007). Implant removal was more frequent in the cable-plate group (4 vs. 0 patients). Trendelenburg gait was found in 3 patients in the cerclage wire group as compared to 10 in the cable-plate group (p = 0.054). Conclusions: The cerclage wiring had superior clinical outcomes with similar radiographic results. The authors recommend the use of figure-of-eight cerclage wire when fixing a greater trochanteric "slide" osteotomy in complex revision hip arthroplasty. [ABSTRACT FROM AUTHOR]

Introduction: The determination of adequate reduction is difficult perioperatively due to inadequate radiographic scanning and objective measurement methods. The purpose of the present study is to evaluate an objective measurement of the weight bearing acetabular dome congruency. The sensitivity and specificity of 2 measurement methods after acetabular fracture fixation are compared. Patients and methods: Postoperative acetabular reduction was assessed based on postoperative anteroposterior radiographs according to hip joint congruency and Matta's classification in 55 patients. For hip joint congruency measurements, one circle was drawn as superior femoral head border and another one was drawn as weight-bearing acetabular dome border. The difference between the centres of the circles was measured in millimetres. Comparative studies were performed between groups according to reduction quality and clinical and radiological results. Results: The threshold value for the difference between the 2 circle centres was found as 4.4 mm according to the clinical outcomes; 3.8 mm according to radiological outcomes in joint congruency method. The sensitivity of this method was found as 90.2% and 92.7%, and specificity as 64.3% and 57.1% considering the clinical and radiological results, respectively. In the assessment of joint congruency, false positive rate was lower than assessing reduction quality using the method defined by Matta. Conclusions: Joint congruency assessment based on a postoperative anteroposterior radiograph in patients treated with open reduction internal fixation for acetabular fractures is a suitable method for assessing the adequacy of reduction. This method can be used intraoperatively using fluoroscopy imaging during surgery. [ABSTRACT FROM AUTHOR]

The aim of this work is to evaluate an acetabular antibiotic loaded bone cement spacer in 2-stage revision surgery as a potential approach able to reduce complications during the inter-stage period (i.e. dislocation, acetabular wear), as well as simplify 2-stage hip revision surgery and improve hip biomechanics.~Purpose~Objective~We performed a retrospective comparative study and evaluated clinical, radiological and surgical data of 71 patients affected by periprosthetic hip infection who were treated with 2-stage exchange. 31 patients were treated using an acetabular spacer in addition to the femoral (group A) while 40 underwent a standard revision surgery (femoral spacer only, group B).~Methods~Methods~Mean time of surgery for the first stage was 148 ± 59 minutes and 142 ± 45 minutes for group A and B respectively; we noted a statistically significant reduction (26 min, p = 0.015) in the same parameter for the second stage (83 ± 35 minutes for group A and 109 ± 36 minutes for group B). We observed the following interstage complications: 5 femoral spacer dislocations (1 for group A and 4 for group B); 1 spacer fracture (group B), 1 spacer fracture (group A), 2 periprosthetic fractures (group B) and 2 patients with acetabular spacer instability (group B). Additionally, we observed a significant improvement in leg length restoration for group A (p = 0.03).~Results~Results~Our data show that the acetabular spacer technique is able to reduce the interstage complication rate and allow improved hip biomechanics restoration.~Conclusions~Conclusions [ABSTRACT FROM AUTHOR]

To assess the accuracy of a novel digital templating methodology for total hip arthroplasty (THA) in patients with osteonecrosis of the femoral head (ONFH).~Purpose~Objective~A retrospective study was carried out on 77 hips in 58 patients who had undergone uncemented THA for ONFH. Preoperative radiographs were templated using a 2-step procedure: (i) calculation of basic cup and stem sizes based on the anatomical morphology; (ii) adjustment of the basic sizes to account for variables such as femoral external rotation, osteoporotic changes in the femur, osteosclerotic changes in the acetabulum, and the type of stem. Basic and adjusted sizes were compared with the actual sizes of the implants used.~Methods~Methods~Before adjustment, the overall accuracy was 69% and 70% for stem size and the cup respectively. Among all the cases, 31 femoral components (40%) and 17 acetabular components (22%) required adjustment. After adjustment, the accuracy of templating for stem and cup sizes in these adjusted cases improved from 52% to 87% (p = 0.002), and 41% to 82%, respectively (p = 0.032). And the overall templating accuracy improved to 83% on the stem side (p = 0.038) and 79% on the cup side (p = 0.195).~Results~Results~Preoperative digital templating was useful in predicting cup and stem sizes in patients with ONFH. Radiographic signs of femoral rotation or osteoporotic changes call for appropriate adjustment to improve the accuracy of templating for THA.~Conclusions~Conclusions [ABSTRACT FROM AUTHOR]

Large acetabular defects remain a challenge in hip revision arthroplasty. Experience with Trabecular Titanium¿ (TT) cups (Limacorporate S.p.a.) has not been widely reported. Therefore, we assessed the survivorship and clinical and radiological outcomes of patients receiving TT cups, with or without supplementary trabecular titanium hemispherical modules for acetabular reconstruction, in primary and revision total hip arthroplasty (THA).~Background~Background~Between January 2009 and July 2014, we performed 67 revisions and 5 primary THAs using TT cups in 69 patients. To achieve stability and/or restore the hip's centre of rotation, hemispherical modules were used in 17 cases based on preoperative templating and/or intraoperative findings. Mean follow-up was 30.5 months. Acetabular bone defects were classified according to the Paprosky classification. Survivorship, functional outcomes (Merle d'Aubigné) and radiological outcomes were analysed.~Methods~Methods~8 patients underwent cup revision: 2 for loosening, 3 for infection, and 3 for hip dislocation. The remaining cases did not present radiological signs of loosening. None of the cases with Paprosky type I classifications needed revision, while 4 with type II and 4 with type III needed revision (p = 0.028). The respective mean values for pain, walking, and range of motion (Merle d'Aubigné scores ± standard deviation) were 3.6 ± 1.4, 3.7 ± 0.7, and 3.8 ± 0.6 preoperatively, and 5.7 ± 0.7, 5.3 ± 0.7, and 5.6 ± 0.7 at the latest follow-up (p<0.001).~Results~Results~In the short term, results with TT cups appear to be encouraging, with satisfactory survival rates for both simple and complex cases.~Conclusions~Conclusions [ABSTRACT FROM AUTHOR]

To evaluate mid-term effectiveness of core decompression (CD) followed by injection of bone-marrow concentration (BMC) in osteonecrosis of the femoral head (ONFH) compared with CD alone.~Purpose~Objective~We retrospectively studied 60 hips in 45 patients with ONFH Ficat I-II after a mean follow-up of 45 (range 24-171) months. Group A (19 hips) were treated with CD, and Group B (41 hips) with CD plus autologous BMC. Necrotic lesions were classified according to MRI findings in: (i) the lesion angle; and (ii) the relation of the necrotic area to the weight-bearing portion. Outcomes included clinical changes and radiographic femoral head collapse. Risk factors associated with radiological collapse were evaluated by Cox regression analysis.~Methods~Methods~Postoperative Merlé D´Aubigne and Postel hip score was similar in both groups. Femoral head collapse was observed in 10/19 hips in Group A and 22/41 in Group B. At 24 months, the probability of not having a collapse was 56.4% (95% CI, 33.6%-79.1%) for Group A and 57.6% (95% CI, 41.7%-73.4%) for Group B (p = 0.47). The risk of collapse increased in hips with a lesion angle higher than 150° (p<0.02, hazard risk [HR] 4.073) in both groups.~Results~Results~With the standard BMC technique performed without monitoring the number of progenitors in the concentrate, we are uncertain to observe a significant decrease in femoral head collapse compared to CD alone. Improved outcomes may require the monitoring of progenitor cells injected into the femoral head, particularly in large lesions.~Conclusions~Conclusions [ABSTRACT FROM AUTHOR]

Second- and third-generation cementless Zweymüller stems have achieved good long-term outcomes in total hip arthroplasty (THA). The PPF cementless proximal press-fit femoral stem (Biomet Inc.) is based on the Zweymüller stem, with some prominent design differences. This study was designed to assess its performance in terms of survivorship, clinical function, and radiographic outcomes.~Purpose~Objective~We retrospectively analysed 250 patients (303 hips) who underwent THA between 1998 and 2011. Patients attended a follow-up visit a mean 10.9 ± 2.6 years after the procedure. All patients underwent radiographic examination and were clinically assessed for Forgotten Joint Score (FJS) and pain visual analogue scale (VAS). Survivorship was calculated using Kaplan-Meier analysis.~Methods~Methods~Clinical data were available for 142 patients (192 hips) and radiographic data for 79 patients (109 hips). Stem survival was 99.1% (95% confidence interval [CI] 96.6%-99.8%) at 10 years and 95.6% (95% CI 96.6%-99.8%) at 15 years. The median postoperative FJS was 91 (interquartile range [IQR], 75-100). The median VAS score was 0 (IQR, 0-2). Radiolucent lines were observed in 47 hips (43.1%). 25 hips (22.9%) had Grade I ossification, 17 (15.6%) Grade II, and 2 (1.8%) Grade III. 12 hips (11.0%) had osteolysis in at least 1 femoral zone.~Results~Results~The cementless proximal press-fit femoral stem was associated with good mid- to long-term survival and functional outcomes. The current design can be considered equivalent to the second- and third-generation Zweymüller stems.~Conclusions~Conclusions [ABSTRACT FROM AUTHOR]

A comparison was made of the clinical and radiological results of cylindrical fully porous-coated femoral stems (Group A) and Zweymüller-type femoral stems (Group B) used for the treatment of hip osteoathrosis, secondary to Crowe III and IV dysplasia, with total hip arthroplasty combined with femoral transverse shortening osteotomy.~Purpose~Objective~This study is a retrospective evaluation of 86 hips in 50 patients. Group A comprised of 43 hips and Group B comprised of 43 hips. During final follow-up evaluation, patients were clinically assessed with Harris Hip Score (HHS), Merle d'Aubigne-Postel scale (MAP), and SF-36 scale. For radiological examination the Gulman THA score was used. Femoral osteotomy union, osteolysis around the components and component migration were also recorded and evaluated.~Method~Methods~In Group B, nonunion of the osteotomy site was found in 18.6% and delayed union in 20.9% of the hips. In Group A, delayed union was found in 7% of the hips. Patients' mean daily walking distance was found to be lower in Group A when compared to Group B. When the postoperative clinical HSS, and MAP and the radiological Gulman scores were compared, no statistically significant differences (p = 0.275) were found.~Results~Results~Patients with hip osteoarthritis secondary to Crowe III and IV dysplasia, who were treated with THA and transverse osteotomy showed a higher incidence of osteotomy complications when the Zweymüller femoral stem was used. However, these complications did not affect clinical outcomes.~Conclusions~Conclusions [ABSTRACT FROM AUTHOR]

Developmental dysplasia of the hip (DDH) is a common cause of hip pain in young patients, and may require treatment with total hip arthroplasty (THA). This study evaluates implant survival and describes patient-reported outcomes after primary THA in DDH patients aged 35 or younger.~Background~Background~A retrospective study with prospective follow-up was conducted at a major academic medical centre. Patient charts were reviewed to identify young THA patients with DDH, and follow-up surveys were conducted to determine implant survival and patient-reported outcomes. Kaplan-Meier survival analysis was performed to evaluate implant survival, and the hip disability and osteoarthritis outcome score (HOOS) was used to describe patient-reported outcomes.~Methods~Methods~This study included 61 patients (75 THAs, 75% follow-up), and the mean time to follow-up was 13 years (range 3-25 years). The 10-year and 20-year implant survival was 87% (95% CI, 78%-94%) and 55% (95% CI, 37%-72%), respectively, and implant survival was significantly better in patients over the age of 25 at the time of surgery (p value <0.01). The mean HOOS patient scores were 83 for pain (SD 20.29), 78 for symptoms (SD 19.72), 83 for ADLs (SD 20.89), and 74 for sports (SD 25.92). Patients that were younger at the time of surgery or required custom implants reported worse HOOS-Symptom scores at follow-up (p value = 0.02).~Results~Results~Young patients with DDH have good outcomes after surgery. Patient factors and implant characteristics should be considered when predicting implant survival and outcomes after THA in young patients with DDH.~Discussions~Conclusions [ABSTRACT FROM AUTHOR]

The RM Classic® cup shows very good results. The RM Pressfit® cup has an equatorial pressfit; it is a monoblock implant without metalback. The aim of this study was to evaluate retrospectively the survival of this implant, monitoring patients for at least 5 years in all consecutive cases operated in our centre.~Aim~Objective~Between February 2006 and December 2008, our department performed 189 consecutive nonselected primary total hip arthroplasties using the RM® Pressfit cup, and all of these were included in the study. The operative technique involved an anterolateral approach. The latest follow-up evaluation was performed at a minimum of 5 years after the index arthroplasty.~Methods~Methods~The mean follow-up was 6.5 years (5-8 years). We had preoperative information for 186 of the 189 patients. 102 patients were seen in consultation (54.0%), 46 (24.3%) patients were contacted by phone, 37 (19.6%) patients died, and 4 patients (2.1%) were lost for unknown reasons. Of the 189 arthroplasties, 6 (3.2%) required revision; 4 (2.1%) for infection, 1 (0.5%) for significant haematoma with persistent deglobulisation and 1 (0.5%) for periprosthetic calcification during the 5 to 8 years following the operation. No hip was revised because of aseptic loosening. The mean annual wear rate based on the last follow-up at 5 years minimum was 0.065 mm per year. We observed no migration, 1 femoral loosening and no acetabular loosening.~Results~Results~Our study finds a good survival rate which is compatible with the 94% at 20 years with RM Classic®. These results are suggestive but must be confirmed with long-term studies.~Conclusions~Conclusions [ABSTRACT FROM AUTHOR]

Hip arthroscopy has allowed the diagnosis and treatment of chondral injuries.~Background~Background~We retrospectively analysed the intraoperative data of 359 patients treated with hip arthroscopy from January 2012 to December 2013. We estimated the frequency, location and extension of acetabular cartilage (AC) injuries and their correlation to femoroacetabular impingement (FAI).~Methods~Methods~Grade 1 and 2 acetabular chondral lesions were not statistically significant in incidence, location and extension. Chondral lesions were absent on the acetabulum in 3.9% of cases, significantly lower compared to the femoral head (32.0%). 101 (28.1%) were affected by an acetabular chondral lesion. In 244 (68.0%) the chondral lesion was located on both acetabulum and femoral head. On the acetabulum, peripheral superior and superior-posterior area were frequently involved. Grade 4 acetabular chondral defects showed a significant high location on the superior-anterior, superior and superior-posterior area, involving both the peripheral and central surface. Delamination was present in 113 (31.5%) patients. Patients affected by acetabular delamination showed a reduced injury extension if compared to grade 3 or 4. 81 patients (25%) revealed acetabular chondral lesions grade 2a, 3 and 4 without any radiological, clinical or arthroscopic sign of FAI.~Results~Results~Location, extension and degree of hip chondral lesions show a progression toward a progressive degeneration. The high percentage of chondral delamination in the hip must be taken in consideration. The presence of symptomatic chondral lesion in cases with no radiological evidence of FAI, suggests that their aetiopathogenesis could be related to biomechanical alterations.~Conclusions~Conclusions [ABSTRACT FROM AUTHOR]

To compare the functional outcomes of patients undergoing arthroscopic surgery for the treatment of femoroacetabular impingement (FAI) performed with either the classic or the outside-in access to the hip.~Purpose~Objective~Data regarding patients arthroscopically treated for FAI from January 2009 to June 2013 were retrospectively reviewed and compared regarding the type of access.~Methods~Methods~101 hips (91 patients) with a minimum of 12 months follow-up (mean 22 months, range 12-40 months) were included. Classic access was used in 48 cases while outside-in access was performed in 53 cases. Mean age was 37 years (range 15.7-59.6 years). Both groups were comparable with respect to preoperative characteristics. Mean operating time was 162 minutes for the outside-in group and 172 minutes for the classic access group. Complications between both groups showed no statistically significant differences but for the presence of heterotopic calcifications, which was more frequently observed regarding the outside-in access. Outcomes measured by the modified Harris Hip Score showed no overall differences regarding both types of access, except for patients under 35 years old, where there was a statistically significant increase in excellent and good outcomes with the use of the classic access in comparison to the outside-in technique. Postoperative hip motion was also significantly higher in the classic access group.~Results~Results~No differences have been found in outcomes regardless the access used. Classic access seems to offer a higher postoperative range of motion and lower risk of heterotopic ossifications.~Conclusions~Conclusions [ABSTRACT FROM AUTHOR]

The main objective of this study was to evaluate the midterm results of cementless THA with the use of monoblock stems combined with step-cut femoral shortening derotational osteotomy for DDH.~Introduction~Background~A total of 66 hips of 49 patients with Crowe type IV developmental hip dislocation, with a mean follow-up of 90 (range 26-207) months, were reviewed retrospectively. Subtrochanteric step-cut shortening osteotomy and monoblock femoral stems were used. The cup was placed in the true acetabulum in all cases. 21 hips had previous femoral valgisation osteotomies. Anteroposterior and lateral radiographs of both hips were obtained preoperatively and at the last follow-up examination. The Harris Hip Score (HHS) was used for pre- and postoperative clinical evaluation.~Materials and Methods~Methods~The mean HHS increased from 49 to 86 points. A total of 13 hips of 10 patients (the isolated acetabular component in 7 hips of 6 patients, the femoral component in 3 hips of 3 patients, and both components in 2 patients) were revised during the follow-up period. Dislocation occurred in 3 hips, deep periprosthetic infection in 2, superficial wound infection in 2, and femoral vein injury and sciatic nerve palsy in 1. Nonunion was observed in 3 osteotomy sites. 10-year survival probabilities of 91% for femoral components for all cases and 78% for acetabular components were found.~Results~Results~THA with subtrochanteric femoral shortening osteotomy was proven to be an effective technique for avoiding neurological complications for Crowe IV DDH. Cementless THA with the use of monoblock stems showed overall survival rates of 95% at 5 years and 85% at 10 years.~Conclusions~Conclusions [ABSTRACT FROM AUTHOR]

The direct anterior approach (DAA) for total hip arthroplasty (THA) is claimed to be as effective but less invasive than the conventional posterior approach (PA). However, the higher risk of femoral fracture and soft tissue damage cannot be underestimated. The present authors believe that the difficult femoral exposure and the surgeon's knowledge of possible complications related to femoral preparation may result in a higher rate of undersized stems when compared to PA, even when a short femoral component is employed to minimise these risks.~Purpose~Objective~A retrospective study was performed to compare the effective adherence of surgical sizing to preoperative planning in a series of 112 short stem THAs, of which 59 were implanted through PA and 53 through DAA without intraoperative imaging, by a single surgeon skilled in both techniques.~Methods~Methods~the frequency of stems smaller than expected was 3-times higher with DAA than with PA (54.72% vs 16.95%, p<0.001), while the frequency of stems at least 2 sizes smaller than expected was more than 6-times higher with DAA than with PA (24.53% vs 3.39%, p = 0.001). Conversely, no differences of size discrepancy distribution were found for cups and prosthetic heads. Postoperative x-rays confirmed an inferior mean canal fill in the DAA group, but excluded a different incidence of frontal malalignment between the groups.~Results~Results~The technical difficulty of femoral preparation and the surgeon's knowledge of possible related complications might lead to implant undersized stems more frequently through DAA than through PA, especially if intraoperative imaging controls are not used.~Conclusions~Conclusions [ABSTRACT FROM AUTHOR]

Periprosthetic joint infection (PJI) is a devastating complication in hip arthroplasty surgery. Debridement, antibiotics (AB) and implant retention (DAIR) is recommended in early PJI in association with stable implants. The aim of this study was to evaluate the success rate of DAIR in early PJI (<4 weeks) and to identify factors predicting the outcome.~Introduction~Background~This cohort study included a consecutive series of 35 patients (median age 74 years, 25 women, 26 primary arthroplasties) treated with DAIR for an early PJI in a regional hospital.~Methods~Methods~28 patients (80%) had their infection eradicated. DAIR-only eradicated the PJI in 22 (63%) patients with a median follow-up of 50 (24-84) months. In 17 (49%) patients, oral AB had been given prior to intraoperative cultures, which delayed first debridement with average 6 days and delayed hospital stay. Primary surgery for a hip fracture increased the risk of DAIR-failure. Surgical experience did not affect the outcome. 17% (n = 6) of the patients sustained a secondary infection during their hospital stay; the majority was beta-lactam resistant coagulase negative Staphylococcus aureus.~Results~Results~The success rate of DAIR was inferior to pervious controls from experienced revision centers. Hip fracture patients should be informed about the increased risk of DAIR treatment failure. In order not to delay surgery, empirically based oral AB should not be administered prior to deep cultures.~Conclusions~Conclusions~ClinicalTrials.gov Identifier: NCT02087020.~Trial Registration~Background [ABSTRACT FROM AUTHOR]

Transfusion of packed red blood cells (RBCs) stored for >14 days has been associated with a higher risk of infection but there is no data about the impact in revision hip arthroplasty.~Purpose~Objective~We retrospectively reviewed 280 patients who underwent revision hip arthroplasty from January 2002 to May 2012. Relevant risk factors and prosthetic joint infection (PJI) rate after 100 days after surgery were collected.~Methods~Methods~10 patients out of 280 (3.6%) had a PJI within the first 100 days after revision surgery. The PJI rate in patients receiving an early transfusion (during surgery or within the first 12 hours) of packed RBCs with a length of storage >14 days was higher (8.0%) than the rate in nontransfused patients (1.8%) or those receiving an early transfusion of packed RBCs with a length of storage ¿14 days (2.6%, p = 0.05). A Cox regression model identified transfusion of packed RBCs stored >14 days as the only independent predictor of PJI (hazard ratio [HR] = 4.54; 95% confidence interval [CI], 1.13-18.15; p = 0.032).~Results~Results~The only independent predictor of PJI was early transfusion of packed RBCs stored >14 days. Therefore, a potential way for reducing the PJI rate could be the selection of young packed RBCs.~Conclusions~Conclusions [ABSTRACT FROM AUTHOR]

This study aimed to describe the epidemiology of the causative organism in a series of primary hip arthroplasties revised for a diagnosis of periprosthetic joint infection (PJI) in England and Wales.~Introduction~Background~Patient data from the National Joint Registry (NJR) was linked to microbiology data held by Public Health England (PHE) which identified a series of 248 primary hip arthroplasties revised for PJI between 2003 and 2014. Definitive cultures, isolated at time of revision surgery, were available for all cases. Total hip arthroplasty (n = 239, 96%) and hip resurfacing (n = 5, 2%) were the most commonly performed primary procedures. A two-stage revision was the most common operative management (n = 174, 70%).~Methods~Methods~202 (81%) cases were infected with a single genus microorganism and the most commonly implicated genus was Staphylococcus species (70% of all single genus infections). Staphylococcus species were also the most commonly identified microorganism in mixed genus infections (74% of patient's cultures). There was a significant difference in microorganism distribution when comparing uncemented vs cement implant fixation, with a higher incidence of Gram-negative infection observed in the uncemented group (p = 0.048, Chi-square).~Results~Results~Both prophylactic and therapeutic antibiotic regimes should be focused on targeting Staphylococci.~Conclusions~Conclusions [ABSTRACT FROM AUTHOR]

Osteonecrosis of the femoral head is a pathologic condition that commonly affects young patients and requires treatment with total hip arthroplasty (THA). The most common factors associated with osteonecrosis in young patients have not been previously described in the literature. A retrospective study was conducted to describe the most common factors associated with osteonecrosis in patients aged 35 or younger requiring a primary THA. This study included 235 patients and found that the most common factor associated with osteonecrosis was corticosteroid use (61%), followed by idiopathic causes (11%), trauma (9%), other causes (8%), haemoglobinopathies (7%), and alcoholism (3%). There was no significant difference in age between risk groups (p-value = 0.35), however there were significant differences in sex (p-value = 0.02) and unilateral versus bilateral surgery (p-value<0.01). Several factors are associated with the development of osteonecrosis of the femoral head in young patients, and these factors should be given consideration in determining disease aetiology and counselling patients. [ABSTRACT FROM AUTHOR]

Polyethylene (PE) wear and osteolysis is a recognised problem with non-cross linked PE liners and first generation modular cup designs. Wear particles induce osteolysis leading to aseptic loosening. We retrospectively compared the linear PE wear and implant survival and revision rates of the Reflection Cup and the Duraloc 300. After a mean clinical follow-up of 13 years (range 11-15 years), the 2D linear PE wear-rate of the Reflection liner (n = 68) was 0.23 mm/year, with a mean total wear of 3.14 mm (1.04-7.36), SD 1.45. The wear-rate of the Duraloc 300 cups (n = 32) was 0.14 mm/ year, with a mean total wear of 1.84 mm (0.55-4.63), SD 1.07. The difference in PE wear-rate as well as mean total wear was highly significant (p = 0.0001). There was a positive correlation between wear-rate and both Oxford Hip Score and Harris Hip Score (p = 0.02). Large acetabular cup size (>54 mm), HA coating on the stem and age <50 years did not influence PE wear. The higher wearrate in the Reflection liners could be related to the EtO sterilisation. Intermediate and long-term follow-up is advisable. [ABSTRACT FROM AUTHOR]

Patient reported outcome measures (PROMs) are used to gauge clinical performance. The PROMs outcome programme at our centre achieves a preoperative data capture rate of 99%. This falls to 90.6%, 89%, 83% and 79% at the six-week, six-month, one-year and two-year time points, respectively. The study aims were to determine factors associated with patients who did not respond to outcome questionnaires following total hip replacement (THR), and the potential implications this may have when assessing patients following THRs. During the first year of the PROMs programme, 1,322 patients underwent unilateral primary THR at our institution. Of these, 1,311 completed preoperative questionnaires. Thirty-eight patients (2.9%) died within two years of surgery and have been excluded. For the remaining 1,273 patients, we identified those who did not return postoperative questionnaires at each of our review time points. Younger age, lower baseline EQ5D and Oxford Hip scores (OHS) were significantly associated with non-response (p<0.001). Patients with lower satisfaction scores, OHS and EQ5D scores, were less likely to respond to subsequent questionnaires. A significant association between non-response and deprivation (p<0.001) was demonstrated. Our findings suggest that the more satisfied patients are over-represented and our reported outcome results are better than they would have been if all patients had responded. This phenomenon may apply to studies where those categorised as “lost to follow-up” represent a subset of patients who have disengaged due to poor outcome or satisfaction. [ABSTRACT FROM AUTHOR]

Reduction for displaced quadrilateral plates in complicated acetabular fractures is difficult and requires wide exposure. The purpose of this study is to assess the usefulness of the additional cable in this complicated fracture and to evaluate the potential danger of compressing the superior gluteal artery and nerve with cable application. We evaluated 31 hips (these included 25 hips with fractures of both columns, two posterior wall and column fractures, three anterior column and posterior hemitransverse fractures, and one high T-shaped fracture) with an average six-year follow-up. Clinical outcomes were evaluated using a modification of the Matta grading system and radiographic arthritic grades. We assessed the postoperative clinical outcomes in relation with other variables such as anatomical reduction, delayed operation, seagull sign, and femoral head injuries. We determined whether the superior gluteal artery and nerve were compressed by cerclage with the help of femoral angiography and EMG. Clinical outcomes were graded as very good to excellent for 18 patients, good for five, fair for three and poor for five. Preoperative femoral head injury (P = 0.011), a seagull sign (P = 0.001), poor reduction (P = 0.015), and delayed reduction (P = 0.05) were found to statistically influence clinical results. We found that there were no injuries to the superior gluteal artery and nerve in spite of using a cable. Cerclage methods can be useful for initial reduction of displaced medial plates in acetabular fractures. These methods reduce operation time and blood loss as compared with other methods. [ABSTRACT FROM AUTHOR]