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Commonly used total hip arthroplasty scores take into account pain, function, walking, and range of motion. The purpose of this study was to evaluate the value of patient activity level as part of the outcome of total hip arthroplasty. Using linear regression analysis, the relationship between patient activity level (University of California Los Angeles activity score), the Harris Hip Score, and the Short Form-12 health survey was evaluated in 152 patients (mean age, 58.7 years) with a mean follow-up 5.2 years (range, 2-21 years). The University of California Los Angeles activity scale had an R(2) value of 0.39 and 0.19 to the Short Form-12 physical and mental components, respectively, and 0.32 to the Harris Hip Score. By evaluating patient activity level, one obtains important qualitative information in assessing the clinical outcome after total hip arthroplasty.

Eighty-four hips with Ficat stage III and IV osteonecrosis were treated: 56 with metal-on-metal surface arthroplasty (MMSA) and 28 with hemi-surface arthroplasty (HSA). Average follow-up was 4.9 years. UCLA hip scores were significantly better for MMSA versus HSA for function and activity as well as Harris Hip scores and physical component of the SF-12 scores. In the MMSA group, 2 hips were revised to total hip arthroplasty for femoral loosening, and 5 hips had adverse radiological changes. In the HSA group, 4 hips were revised (1 sepsis and 3 for pain). There was no evidence of any femoral loosening or neck narrowing in the HSA group. Although the functional clinical outcome of MMSA is superior to HSA, long-term follow up of MMSA will determine the reliability of the femoral fixation.

Forty-two McMinn metal-on-metal surface arthroplasties were implanted in 23 males and 16 females, average age 47.5 years old. The overall survivorship at 7 years was 79%; with any reoperation surgery as endpoint, 80%; and 93%; with aseptic loosening of the socket and femoral component, respectively. The average Surface Arthroplasty Risk Index of patients who had failed or were at risk of failing on the femoral side was significantly greater than for the rest of the cohort, 3.9 versus 1.9. The overall survivorship of the McMinn component was unacceptably low, with the majority of failures occurring with the cemented acetabular components. The recent reintroduction of surface arthroplasty of the hip using metal-on-metal bearings and cementless acetabular components may benefit young patients with hip arthritis with appropriate patient selection.

Management of Ficat stage III and IV osteonecrosis of the hip remains challenging, with the average patient aged in the mid 30s. Joint- and bone-preserving procedures such as free vascularized fibular graft, redirectional osteotomies, and hemiresurfacing hip arthroplasty are often considered. If these treatments fail, that is, after progression of joint destruction or persistent pain and decreasing function, total hip arthroplasty is often the procedure of choice. We describe the case of a patient with failed bilateral free vascularized fibular graft treated with bilateral hemiresurfacing arthroplasty.