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➤ Dual mobility (DM) refers to a now widely available option for total hip articulation. DM implants feature a small inner head, a hard bearing, that connects via a taper fit onto the femoral trunnion. This head freely rotates but is encased inside a larger, outer polyethylene head that articulates with a smooth acetabular component. ➤ DM acetabular components are available in the form of a monoblock shell or as a liner that is impacted into a modular shell, providing a metal articulation for the polyethylene outer head. ➤ DM is designed to increase hip stability by providing the arthroplasty construct with a higher jump distance, head-to-neck ratio, and range of motion prior to impingement. ➤ The use of DM in total hip arthroplasty continues to increase in the United States for both primary and revision arthroplasty. Surgeons should be aware of the potential benefits and pitfalls. ➤ Long-term data are lacking, especially for modular DM implants. Points of concern include a potential for accelerated polyethylene wear, intraprosthetic dislocation, and modular backside fretting corrosion. [ABSTRACT FROM AUTHOR]

➤: The primary means of femoral fixation in North America is cementless, and its use is increasing worldwide, despite registry data and recent studies showing a higher risk of periprosthetic fracture and early revision in elderly patients managed with such fixation than in those who have cemented femoral fixation.➤: Cemented femoral stems have excellent long-term outcomes and a continued role, particularly in elderly patients.➤: Contrary to historical concerns, recent studies have not shown an increased risk of death with cemented femoral fixation.➤: The choice of femoral fixation method should be determined by the patient's age, comorbidities, and bone quality.➤: We recommend considering cemented femoral fixation in patients who are >70 years old (particularly women), in those with Dorr type-C bone or a history of osteoporosis or fragility fractures, or when intraoperative broach stability cannot be obtained. [ABSTRACT FROM AUTHOR]

The article offers information on the femoral stem fixation in hybrid total hip arthroplasty (THA). Topics discussed include debate concerning cemented versus cementless versus hybrid THA; perspective of high-volume centers; cementless femoral fixation; and risk of periprosthetic fracture using an uncemented femoral implant in patients.

Unlabelled: Combined segmental and cavitary deficiencies of the acetabulum (American Academy of Orthopaedic Surgeons Type III) are a difficult problem that revision arthroplasty surgeons must tackle with increasing frequency. Porous-coated bilobed acetabular components are a reconstruction option that allows for increased host bone-prosthesis contact with restoration of the anatomic hip center without the use of a structural bone graft. Eleven consecutive Type III acetabular defects in 11 patients were revised with a porous-coated bilobed cup without a structural bone graft between January 1999 and January 2001 and prospectively followed. Average Harris hip scores improved from 36 preoperatively to 85 postoperatively. Radiographic analysis showed improvement in the average vertical displacement of the hip center. Average leg length discrepancies decreased from 34 mm preoperatively to 7 mm postoperatively. There have been no revisions performed or planned. Porous-coated bilobed acetabular components can provide good clinical and radiographic results at intermediate followup for treatment of Type III acetabular deficiencies. Bilobed components offer a viable option for reconstruction of Type III defects without the use of a structural bone graft or cement while maximizing the host bone-implant contact and restoring the native hip center.Level Of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: The decision as to whether to revise a well-fixed femoral component in hips requiring isolated ac-etabular revision is challenging. The purpose of the present study was to determine the long-term results of, and the complications associated with, retention of a stable and well-fixed femoral component during isolated acetabular revision. Methods: We retrospectively reviewed the clinical and radiographic results for thirty-one patients (thirty-two hips) who underwent isolated revision acetabuloplasty without removal of a well-fixed femoral component. The reason for acetabular revision was aseptic loosening in thirty-one hips and malposition in one hip. Of the thirty-two femoral components, twenty-one were cemented and eleven were cementless. The average duration of follow-up from the time of the index revision was 8.1 years (range, 6.4 to 12.5 years), and the average duration of total service of the femoral component was seventeen years (range, seven to twenty-five years) from time of the initial implantation. The average age of the patients at the time of the index revision was sixty-six years (range, twenty-nine to eighty-seven years). Results: Thirty-one (97%) of the primary femoral components were judged to be stable and well fixed at the lat-est follow-up evaluation. One femoral component (3%) was revised because of aseptic loosening, eight years after the index acetabular revision and seventeen years after the initial total hip arthroplasty. Radiographic eval-uation of the thirty-one femoral components that were not revised demonstrated no evidence of loosening or subsidence. There were no dislocations, nerve palsies, or intraoperative fractures associated with retention of the femoral component. Twenty-seven (84%) of the acetabular components were judged to be stable at the lat-est follow-up evaluation. Conclusion: In hips treated with isolated acetabular revision, a well-fixed femoral component can be retained successfully witho [ABSTRACT FROM AUTHOR]

The article comments on the study "Outpatient Total Knee Arthroplasty Is Associated with Higher Risk of Perioperative Complications" by Armin Arshi and colleagues. Topics discussed include safe and effective implementation of outpatient arthroplasty in highly selected patients, increased risk of postoperative complications such as surgical site infections and stiffness; and duration of antibiotic therapy.

The article focuses on improving the accuracy of acetabular component orientation. The use of larger femoral head sizes in primary total hip arthroplasty has increased in recent years with the introduction of alternative bearings and reduced short-tern dislocation. Many factors can negatively impact acetabular component positioning.