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Exeter technique is accompanied by significant prosthesis subsidence, in about 20% to 38% of cases leading to 6 to 11% of early re-revision. This migration may break up the cement and thus yield to particle generation which may induce osteolysis. The goal of the modified technique is to obtain stem stability by limiting reconstruction to it proximal 4/5th, and cementing distal fifth directly to the host bone. Twenty one hips (20 patients) were reviewed. (Average follow-up: 18 months, range: 6–29 months). Radiographic assessment revealed stem stability in 18 cases. Allograft remodeling or cortical reconstitution occurred in 17 cases. Thus loading of the graft consecutive to stem migration is not the sole factor accounting for both allograft remodeling and host bone corticalization. Inversely, this stability protects the cement from possible fractures and their consequences. La reconstruction des pertes de substance osseuse fémorales lors de la chirurgie de reprise de prothèses totales de hanche, constitue un problème difficile. La technique d’Exeter, qui utilise des greffons spongieux morcelés et impactés dans la cavité fémorale, décrite par Simon et Gie apparaît très séduisante. Mais la migration précoce de la pièce fémorale constatée par les promoteurs de la technique et par d’autres reste préoccupante. Gie et Simon considèrent cette migration comme sans risque, puisque la prothèse se stabilise secondairement. Nous restons toutefois soucieux des conséquences de cette migration sur un manteau de ciment fin et irrégulier qui peut se fragmenter. Nous avons donc modifié la technique originale dans le but de donner à la prothèse une stabilité primaire satisfaisante. Une fois la prothèse descellée enlevée, le fémur est alésé pour permettre l’insertion aisée du canon d’un «pistolet à greffon». Celui-ci permet de descendre dans le fémur préalablement obstrué, un cylindre creux de greffons spongieux. Le canon est recouvert d’un treillis de mersylène qui permet de stabiliser le cylindre de greffe en regard du défect à reconstruire mais aussi d’éviter la dispersion de l’os spongieux lors du passage des impacteurs en particulier au travers de pertes de substance segmentaires quand elles existent. Le façonnage et la compaction de la greffe sont obtenus par le passage d’impacteurs de tailles progressivement croissantes, jusqu’à ce qu’ils tiennent fermement dans la greffe. La tige est ensuite scellée de manière rétrograde, directement au contact de l’os du patient pour le cinquième distal et dans la greffe pour les 4/5e proximaux. 21 hanches chez 20 patients ont été opérées selon cette technique entre octobre 1996 et février 1998. Le recul moyen et la médiane de suivie sont de 18 mois (Minimum 6 et maximum 29). La perte de substance osseuse fémorale était souvent sévère, (Cinq type 3A et 5 type 3B selon la classification de Paproski) mais limitée en hauteur. (Pas de type 4 selon la classification de l’Endo Klinik). Elles sont au nombre de 8 et intéressent 7 patients. Deux sont majeures. Une patiente a présenté, à la suite d’une chute, une fracture du fémur sous la queue de la prothèse, 6 mois après l’intervention, reprise par prothèse longue queue pontant la zone de fracture. Un autre patient a présenté une récidive infectieuse qui a conduit à l’ablation de la prothèse et la mise en résection tête... [ABSTRACT FROM AUTHOR]

The aim of that study was to evaluate the place of arthrography for component loosening and of hip aspiration for diagnosing infection. 52 arthrograms were done under local anesthesia in radiology suites under fluoroscopic guidance. If no fluid was aspirated a non bacteriostatic saline solution was injected and reaspirated. Liquid was then analized. Component loosening was evaluated by plain films and by arthrography and compared to the surgical findings in all cases. The sensitivity of arthrography (94.5%) was better than that of plain films (83%) for evaluating socket loosening, but was worse (77% vs 92%) for femoral component evaluation. They were no false positive evaluations in socket loosening, but false negatives occurred in 2 cases with supporting material such as screws and plates. Results for femoral loosening are more difficult to analyse. The sensitivity (77%) and the specificity (81%) of arthrography are lower than plain films (92% and 88%). Most authors consider that the femoral component is loose when more than one third of the stem has a lucent line. 4 patients had such findings and were operated on. In each case the stem was found to be stable at operation. We removed the stem in two cases and left it in place in two old patients. We simply cleaned the granuloma from the proximal part of the femur. It means that arthrography did not really fail to make the diagnosis. But surgical procedures in case of incomplete radiolucent lines are not mandatory and depend on the individual surgeon's philosophy. Sensitivity of hip aspiration to identify periprosthetic germ was 66% and a specificity was 100%. No false positives were found. Only one patient over 41 without any sign of active infection had a positive hip aspiration. This test is not sensitive enough to be a prerequiste test before total hip revision but has to be done in cases of clinical or suspected sepsis. [ABSTRACT FROM AUTHOR]

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Background: Cardiovascular disease and type 2 diabetes are among the largest public health challenges in Sweden. Research indicates that a healthy lifestyle can prevent most cases. The health dialogue is an evidence-based public health programme for primary care with positive results in several regions of Sweden. This study aimed to describe health care professionals' experiences and perceptions of health promotion through the health dialogue intervention during the pilot phase in the Scania region of Sweden., Methods: The study consists of 12 individual interviews with health care professionals educated in the health dialogue method, implementing the intervention in Scania. Qualitative content analysis with an inductive approach was used., Results: The analysis resulted in 10 sub-categories and the four main categories: A more health-promoting mindset would benefit primary care; Empower individuals; Facilitate sustainable lifestyle changes; Challenges, tools and support for the implementation of the health dialogue. One overarching theme emerged: "Health dialogue, a potential start of a paradigm shift in Swedish primary care"., Conclusions: Conclusions imply that the health dialogue is a well-structured method with tools to make health promotion and primary prevention an integrated part of primary care. A respectful and motivating approach during the health dialogue is recommended. It is important to have an ongoing discussion about the approach among the health care professionals. Incorporating the Health Belief Model in the health care professionals' education in the method could increase the focus on self-efficacy during counselling, which could favour the participants' change process., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Introduction: Cemented femoral implants incur a serious risk of potentially fatal accidents in case of bone cement implantation syndrome (BCIS). As French data are sparse regarding this issue, Orthorisq, the official accreditation body for orthopedic surgeons, conducted an inter-professional survey: 1) to assess the frequency of BCIS, 2) to analyze risk factors related to the patient and to professional practices, and 3) to set out guidelines to reduce frequency and/or severity., Hypothesis: French data on BCIS are underestimated and need updating to ease communication between colleagues., Material and Method: In 2019, Orthorisq ran a survey of its members' practices and a "mirror" survey of anesthesiologists. In the decade from 2009 to 2018, the 775 respondent orthopedic surgeons, both occasional and systematic "cementers", reported their experience with a declared annual rate of 80,112 arthroplasties, including 63,799 (79.6%) in scheduled surgery. Some of the survey questions concerned cementing technique. With the help of the French College of Anesthesia and Intensive Care Medicine, 305 anesthesiologists responded to the mirror survey., Results: The 776 orthopedic surgeons reported 1896 cementing accidents with 387 deaths during the study decade. Accidents were 6-fold more frequent in traumatology than in scheduled orthopedic surgery (0.71% versus 0.12%) and, more importantly, were more serious: mortality was 10-fold higher (0.17% versus 0.017% [p<0.001]). Certain "tricks and tips" intended to improve cementing quality, such as a dedicated system and especially a plug, significantly increased the risk of BCIS (p<0.001). Over the same period, the 305 anesthesiologists had been involved in 490 cementing accidents; 88 (29%) had been faced by at least 1 death, most often in emergency settings (60/28). While 753 surgeons (96%) reported warning the anesthetists and 571 (74%) waited for agreement before cementing, only 109 (36%) and 124 (41%) anesthetists reported being systematically alerted to cementing and implant reduction, respectively. The rate of serious accidents was 0.19% and mortality was 0.05%, for a cumulative probability of 0.24% per year. Extrapolated to the data of the ATIH Technical Agency of Hospitalization Information and subtracting arthroplasties by "never-cementers", these figures indicate 311 accidents with 65 deaths in femoral BCIS for 2018., Discussion: In scheduled surgery, BCIS was exceptional, but the rate in traumatology was much higher. Certain techniques intended to improve femoral cementing quality actually increased the risk of BCIS; in high-risk patients, especially in traumatology, non-cemented femoral implants or else a 1st-generation cementing technique should therefore be preferred. Prevention of BCIS and/or reduction of severity require identification of at-risk patients and good communication between surgeons and anesthesiologists, especially at the various steps of the checklist., Level of Evidence: IV; case series., (Copyright © 2021. Published by Elsevier Masson SAS.)

Background: We are not aware of studies conducted in France to assess information provided by surgeons about the impact of total hip arthroplasty (THA) on sexual activity or sexual activity resumption after THA. The objectives of this study in a cohort of patients seen after THA were to evaluate: (1) the time to sexual activity resumption, (2) whether sexual activity resumption was discussed with the surgeon and whether the patients wanted information on this point, and (3) the modalities and experience of sexual activity resumption according to demographic features., Hypothesis: Age and sex influence the timing and modalities of sexual activity resumption after THA., Methods: We conducted a single-centre prospective cohort study in consecutive patients who received follow-up for 6months after THA. Each patient completed an anonymised questionnaire on preoperative sexual activity, modalities of postoperative sexual activity resumption, information delivered by the surgeon, and expectations regarding the delivered information. The patients also specified their age and sex on the questionnaire., Results: Of 101 included patients, 49 were still sexually active before surgery. Of these 49 patients, 35 (71.4%) reported no difference in the frequency of sexual activity before and after THA. Only 4 (8.2%) patients did not resume sexual activity during follow-up. Older age was associated with a lower demand for information [odds ratio, 0.95; 95% confidence interval: 0.91-0.99 (p=0.01)]. Compared to the females, the males more often recovered similar sexual activity to that before surgery regarding frequency [18/20 vs. 17/29 (p=0.02)] and quality of sexual positions [15/20 vs. 9/29 (p=0.003)]. Males resumed sexual activity on average during the first 3weeks [10/20 (p=0.02)], compared to after 6weeks for most females [13/29 (p=0.03)]. Age was not associated with the time to sexual activity resumption [ρ=0.0868; 95% confidence interval: -0.205 to 0.365 (p=0.56)]., Discussion: Among patients who were sexually active before surgery, 71.4% reported having resumed the same frequency of sexual activity 6months after surgery. The main difficulty in both males and females was fear of prosthetic hip dislocation, which was related in part to insufficient preoperative information. Males resumed sexual activity earlier than did females. In patients who were sexually active before surgery, age was not associated with the resumption of sexual activity after surgery., Level of Evidence: IV, prospective study with no control group., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

During October 2019, the West Virginia Bureau for Public Health (WVBPH) noted that an increasing number of persons who inject drugs (PWID) in Kanawha County received a diagnosis of HIV. The number of HIV diagnoses among PWID increased from less than five annually during 2016-2018 to 11 during January-October 2019 (Figure). Kanawha County (with an approximate population of 180,000*) has high rates of opioid use disorder and overdose deaths, which have been increasing since 2016, † and the county is located near Cabell County, which experienced an HIV outbreak among PWID during 2018-2019 (1,2). In response to the increase in HIV diagnoses among PWID in 2019, WVBPH released a Health Advisory § ; and WVBPH and Kanawha-Charleston Health Department (KCHD) convened an HIV task force, conducted care coordination meetings, received CDC remote assistance to support response activities, and expanded HIV testing and outreach., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

In 2019, the West Virginia Bureau for Public Health (WV BPH), Cabell-Huntington Health Department (CHHD), and CDC collaborated to respond to an HIV outbreak among people who inject drugs (PWID). CDC, WV BPH, and CHHD formed a cross-agency communications team to establish situational awareness, identify knowledge gaps, and establish key audiences for messages, including the general population, PWID, and clinical and social service providers. The team disseminated up-to-date information about the outbreak, and prioritized messages addressing stigma related to drug use, syringe services programs, and HIV. Messages were continually updated to address the evolving situation and to resonate with local values. Messages were disseminated via advertisements, local news media, and directly to PWID, people experiencing homelessness, and providers. The response supplemented CHHD's assets, including strong relationships and community knowledge, with staff capacity and expertise from state and federal agencies. This collaborative approach is a useful model to address communication needs., (© 2021. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.)

Introduction: In January 2019, the West Virginia Bureau for Public Health detected increased HIV diagnoses among people who inject drugs in Cabell County. Responding to HIV clusters and outbreaks is 1 of the 4 pillars of the Ending the HIV Epidemic in the U.S. initiative and requires activities from the Diagnose, Treat, and Prevent pillars. This article describes the design and implementation of a comprehensive response, featuring interventions from all pillars., Methods: This study used West Virginia Bureau for Public Health data to identify HIV diagnoses during January 1, 2018-October 9, 2019 among (1) people who inject drugs linked to Cabell County, (2) their sex or injecting partners, or (3) others with an HIV sequence linked to Cabell County people who inject drugs. Surveillance data, including HIV-1 polymerase sequences, were analyzed to estimate the transmission rate and timing of infections using molecular clock phylogenetic analysis. Federal, state, and local partners designed and implemented a comprehensive response during January 2019-October 2019., Results: Of 82 people identified in the outbreak, most were male (60%), were White (91%), and reported unstable housing (80%). In a large molecular cluster containing 56 of 60 (93%) available sequences, 93% of inferred transmissions occurred after January 1, 2018. HIV testing, HIV pre-exposure prophylaxis, and syringe services were rapidly expanded, leading to improved linkage to HIV care and viral suppression., Conclusions: Evidence of rapid transmission in this outbreak galvanized robust collaboration among federal, state, and local partners, leading to critical improvements in HIV prevention and care services. HIV outbreak response requires increased coordination and creativity to improve service delivery to people affected by rapid HIV transmission., (Published by Elsevier Inc.)

Objective: To develop and validate a deep convolutional neural network (CNN) method capable of (1) selecting a specific shoulder sagittal MR image (Y-view) and (2) automatically segmenting rotator cuff (RC) muscles on a Y-view. We hypothesized a CNN approach can accurately perform both tasks compared with manual reference standards., Material and Methods: We created 2 models: model A for Y-view selection and model B for muscle segmentation. For model A, we manually selected shoulder sagittal T1 Y-views from 258 cases as ground truth to train a classification CNN (Keras/Tensorflow, Inception v3, 16 batch, 100 epochs, dropout 0.2, learning rate 0.001, RMSprop). A top-3 success rate evaluated model A on 100 internal and 50 external test cases. For model B, we manually segmented subscapularis, supraspinatus, and infraspinatus/teres minor on 1048 sagittal T1 Y-views. After histogram equalization and data augmentation, the model was trained from scratch (U-Net, 8 batch, 50 epochs, dropout 0.25, learning rate 0.0001, softmax). Dice (F1) score determined segmentation accuracy on 105 internal and 50 external test images., Results: Model A showed top-3 accuracy > 98% to select an appropriate Y-view. Model B produced accurate RC muscle segmentations with mean Dice scores > 0.93. Individual muscle Dice scores on internal/external datasets were as follows: subscapularis 0.96/0.93, supraspinatus 0.97/0.96, and infraspinatus/teres minor 0.97/0.95., Conclusions: Our results show overall accurate Y-view selection and automated RC muscle segmentation using a combination of deep CNN algorithms.

In October 2018, the Centers for Disease Control and Prevention was notified of a cluster of Legionnaires' disease cases in workers at a racetrack facility. The objective of the resulting investigation was to determine the extent of the outbreak and identify potential sources of exposure to halt transmission. Case-finding and interviews were conducted among symptomatic racetrack workers who were known to be at the facility within 14 days prior to symptom onset. An environmental assessment of the facility and surrounding area was conducted for sources of potential Legionella exposure. In total, 17 legionellosis cases were identified. The environmental assessment revealed a poorly maintained hot tub in the jockey locker room as the most likely source. Further investigation identified deficiencies in the facility's ventilation systems, which suggested a transmission mechanism for workers who never entered the locker room floor. Considering indirect exposure routes via air handling systems can be useful for source identification and case-finding in legionellosis outbreaks.

Nursing homes are high-risk settings for outbreaks of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) (1,2). During the COVID-19 pandemic, U.S. health departments worked to improve infection prevention and control (IPC) practices in nursing homes to prevent outbreaks and limit the spread of COVID-19 in affected facilities; however, limited resources have hampered health departments' ability to rapidly provide IPC support to all nursing homes within their jurisdictions. Since 2008, the Centers for Medicare & Medicaid Services (CMS) has published health inspection results and quality ratings based on their Five-Star Quality Rating System for all CMS-certified nursing homes (3); these ratings might be associated with facility-level risk factors for COVID-19 outbreaks. On April 17, 2020, West Virginia became the first state to mandate and conduct COVID-19 testing for all nursing home residents and staff members to identify and reduce transmission of SARS-CoV-2 in these settings (4). West Virginia's census of nursing home outbreaks was used to examine associations between CMS star ratings and COVID-19 outbreaks. Outbreaks, defined as two or more cases within 14 days (with at least one resident case), were identified in 14 (11%) of 123 nursing homes. Compared with 1-star-rated (lowest rated) nursing homes, the odds of a COVID-19 outbreak were 87% lower among 2- to 3-star-rated facilities (adjusted odds ratio [aOR] = 0.13, 95% confidence interval [CI] = 0.03-0.54) and 94% lower among 4- to 5-star-rated facilities (aOR = 0.06, 95% CI = 0.006-0.39). Health departments could use star ratings to help identify priority nursing homes in their jurisdictions to inform the allocation of IPC resources. Efforts to mitigate outbreaks in high-risk nursing homes are necessary to reduce overall COVID-19 mortality and associated disparities. Moreover, such efforts should incorporate activities to improve the overall quality of life and care of nursing home residents and staff members and address the social and health inequities that have been recognized as a prominent feature of the COVID-19 pandemic in the United States (5)., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Competing Interests: All authors have completed and submitted the ICMJE form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

In January 2014, a chemical spill of 4-methylcyclohexanemethanol and propylene glycol phenyl ethers contaminated the potable water supply of approximately 300,000 West Virginia residents. To understand the spill's impact on hospital operations, we surveyed representatives from 10 hospitals in the affected area during January 2014. We found that the spill-related loss of potable water affected many aspects of hospital patient care (eg, surgery, endoscopy, hemodialysis, and infection control of Clostridium difficile). Hospital emergency preparedness planning could be enhanced by specifying alternative sources of potable water sufficient for hemodialysis, C. difficile infection control, and hospital processing and cleaning needs (in addition to drinking water). (Disaster Med Public Health Preparedness. 2017;11:621-624).

Study Design: Retrospective case series., Purpose: To report a novel approach to open posterior sacroiliac (SI) joint arthrodesis using a threaded titanium cage containing rhBMP--2., Materials & Methods: Twenty consecutive patients with a mean age of 57.7 years (range: 33--84) underwent posterior SI joint fusion. Two closely related novel posterior oblique approaches were employed. Enrolled subjects included 17 females and three males. The mean follow--up time for CT to assess fusion was 27 months (range: 17--45 months). Insurance included a mixture of public and private payers. One of the patients (patient 19) was on worker's compensation. During follow--up, patients were assessed radiologically for radiographic bony union and asked to rate their satisfaction with the procedure. The Oswestry Disability Index (ODI) was applied on a one-time basis upon follow-up. All patients were diagnosed with sacroiliac joint pain based primarily on a positive response to fluoroscopically guided injections into the sacroiliac joint., Results: Out of 20 patients, 33 SI joints were considered symptomatic and operated, and 32/33 joints successfully fused radiographically (a 96.9% fusion success rate). The average procedure satisfaction rating (PSR) was 7.25 out of a maximum 10 (range 1--10). Seventeen patients responded to post-surgery -follow-up questions, and 13 patients (76%), indicated they would elect to have the surgery again as well as recommend it to others. Average estimated blood loss was less than 50 mL, and average length of stay was one day., Conclusions: Preliminary experiences with these novel posterior approaches to the SI joint described here seem to be safe and effective. The novel posterior approaches to the SI joint described here appear, preliminarily, to have many advantages over previously described procedures including markedly reduced surgical morbidity.

Purpose: Acetabular component malalignment in total hip arthroplasty can lead to potential complications such as dislocation, component impingement and excessive wear. Computer-assisted orthopaedic surgery systems generally use the anterior pelvic plane (APP). Our aim was to investigate the reliability of anatomical landmarks accessible during surgery and to define new potential planes of reference., Methods: Three types of palpations were performed: virtual, on dry bones and on two cadaveric specimens. Four landmarks were selected, the reproducibility of their positioning ranging from 0.9 to 2.3 mm. We then defined five planes and tested them during palpations on two cadaveric specimens., Results: Two planes produced a mean orientation error of 5.0° [standard deviation (SD 3.3°)] and 5.6° (SD 2.7°)., Conclusions: Even if further studies are needed to test the reliability of such planes on a larger scale in vivo during surgery, these results demonstrated the feasibility of defining a new plane of reference as an alternative to the APP.

Polyelectrolyte multilayers (PEMs), formed by alternating layer-by-layer deposition of polyanions and polycations, are an ideal substrate for controlling cellular adhesion and behavior. In the present study we propose a simple mechanism for the controlled detachment of C(2)C(12) myoblasts cell sheets from PEMs consisting of poly(l-lysine) and hyaluronic acid with a topmost layer of fibronectin. The multilayers were deposited on two standard cell culture surfaces: glass and polystyrene. Adding a low concentration of nontoxic ferrocyanide to the cell culture medium resulted in erosion of the polyelectrolyte multilayer and rapid detachment of viable cell sheets. Additional Quartz Crystal Microbalance and Atomic Force Microscopy measurements indicated that the detached cells retained their extracellular matrix and that no polyelectrolyte molecules remained bound to the cell sheets. The dissolution of polyelectrolyte multilayers by multivalent ions is a promising approach to cell sheet engineering that could potentially be used for regenerative medicine., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

We observed the spontaneous formation of vesicle-multilayers on top of a polyelectrolyte multilayer (PEM). By varying the thickness of underlying PEM (uPEM) it was possible to tailor the amount of adsorbing liposomes. Thereby, the loading capacity could be increased up to 17 times with respect to a monolayer of vesicles for an uPEM of 50.5 bilayers. We, furthermore, proved that the formation of the vesicle multilayer is due to the ability of poly-L-lysine to diffuse within the uPEM. This method could be interesting for applications in sensors and drug delivery systems where the increase in loading capacity is highly desired.

The electrochemically triggered dissolution of noncontinuous polyelectrolyte assemblies presenting distinct nanomorphologies and its tuning by chemical cross-linking were monitored locally, in situ, by electrochemical atomic force microscopy. Poly-l-lysine and hyaluronic acid deposited layer-by-layer on indium tin oxide electrodes at specific experimental conditions formed well-defined nanostructures whose morphologies could be easily and precisely followed along the dissolution process. In addition to shrinkage of polyelectrolyte nanodroplets, ecAFM images revealed the faster dissolution of coalesced structures compared to droplet-like complexes, and the readsorption of dissolved polyelectrolytes onto slower dissolving neighboring structures. Covalently cross-linked PLL/HA assemblies dissolved only partially, and exhibited slower dissolution rates compared to native multilayers, with a clear dependence on the cross-link density. Tuning the electrochemical dissolution of polyelectrolyte multilayers through chemical cross-linking opens new prospects for future biomedical applications, such as the development of advanced drug or gene delivery platforms allowing for tightly controlled releases of different compounds at specific rates.

Promising results have made the Exeter technique a valuable alternative in hip replacement revision. However, even with this technique, subsidence remains a difficult problem because it may lead to additional revision if it is not mild and self-limited. We propose a technical modification that achieves primary stability by cementing the distal portion of the stem directly to the host bone. We conducted a prospective study on 45 hips. After an average of 46 (range, 18-72) months of follow-up monitoring, no hips required or underwent revision for aseptic loosening of the prosthesis. Four stems subsided <5 mm. In each case, distal cementation was only fair, so implant strength was decreased. Allograft transformation occurred in 36 hips and was associated with host bone remodeling in 11. This technical modification appears to be reliable, as satisfactory distal cementation was achieved in 41 hips (91%), and the modification did not interfere with allograft transformation.

Revision hip surgery now constitutes 10-30% of all joint procedures. The morbidity and associated with this demanding operation are not well established. The goal of this paper is to determine these rates and to identify some predictive factors., The complication rate ranges from 31,5 to more than 77% in the literature. Life threatening complications represent 1,8 to 8% of these, leading to death in about 1,6%. ASA score and age above 75 appear to be correlated with medical complications. The injection rate varies from 1 to 5,8%, and may be as high as 14% in cases with a past history of infection. Heterotopic ossification occurred in 13 to 65%, reaching severity in 3,3 to 8,3%., Surgical complications include dislocation and femoral injuries. Dislocations occur in almost 10%, leading to revision in1-4,2%. Age and the number of previous surgical operations appear to be significant risk factors. Femoral injuries (perforations or femoral fractures) occur in 6-37%, especially in impaction grafting technique and when uncemented implants are used. Age over 75 years and femoral defects appear to be significant risk factors for femoral fractures., The rate of complications in revision hip surgery continues to be high, but successful clinical outcome can be attained even in elderly patients. Attentive preoperative exams, good prevention of technical pitfalls, the experience of the surgeon and the use of specific tools may decrease these complications and make this demanding procedure safer.,