Search

Introduction: Instability accounts for 1/3 of revision total hip arthroplasty (rTHA) performed in the UK. Removal of well-fixed femoral stems in rTHA is challenging with a risk of blood loss and iatrogenic damage to the femur. The Bioball universal adaptor (BUA), a modular head neck extension adaptor, provides a mechanism for optimisation of femoral offset, leg length and femoral anteversion. This can avoid the need for femoral stem revision in selected cases. The aim of this study is to present the clinical results and rate of instability following revision with this BUA at a minimum of 2 years follow-up. Patients and methods: A review of our prospectively collected database was performed. All patients treated with the Bioball device were included. Clinical and radiologic review were performed pre- and post-surgery. Specific enquiry for instability was made. The Oxford Hip Score (OHS), EuroQol (EQ-5D) score and WOMAC scores were calculated pre-and post-operatively. Complications were recorded. Results: 32 rTHA procedures were performed using the Bioball device between 2013 and 2016. 4 patients did not wish to complete post-operative questionnaires. 2 patients (2/28, 7%) complained of recurrent dislocations following their rTHA procedure. 1 patient complained of instability but no dislocation. The median pre-operative EQ-5D was 0.195 (range −0.07–0.85), OHS was 20 (range 5–43) and WOMAC was 29.8 (range 15.5–52.3). The median EQ-5D was 0.85 (range 0.59–1), OHS was 39 (range 21–48) and WOMAC was 91.1 (range 44.5–99.2) at final follow-up. There were significant improvements in the EQ-5D ( p = 0.0009), OHS ( p = 0.0004) and WOMAC ( p = 0.0001). Conclusion: The BUA is associated with significant functional improvement and relatively low dislocation rates in revision THA. It is a viable option for use in the revision setting.

Background: Polycarbonate urethane (PCU) is a bearing surface with a lower modulus of elasticity than polyethylene or ceramic and is thought to more closely replicate the tribology of native hyaline cartilage. The purpose of this study was to determine the clinical outcomes with the use of PCU in elective total hip arthroplasty (THA). Methods: We carried out a prospective observational study in which 157 patients underwent elective THA with a metal-on-PCU hip system. Patients had radiographic follow-up at 6 months and 3 years after surgery. Oxford Hip Scores and EuroQol scores were obtained annually and Harris Hip Scores were obtained at 6 months and 3 years after surgery. Results: 180 hips were implanted, of which, 149 hips reached 3-year review with no revisions. There was an increase in Harris Hip Scores, Oxford Hip Scores and EuroQol scores ( p < 0.001). 12 patients (12 hips) reported painless hip squeaking. There were no dislocations and no other adverse events were reported. Conclusion: Our results showed satisfactory survivorship and improvements in patient reported outcomes with metal on PCU THA. Long-term data are still being collected to confirm these findings. We recommend further tribological research into the squeaking phenomenon we observed.

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

Surgeons undertaking total hip arthroplasty (THA) routinely perform a distal femoral neck resection. It has been argued that retaining the femoral neck during THA can provide mechanical and biological advantages.The objectives of this study were to review: (1) the current evidence on the advantages of femoral neck preservation during THA and (2) the clinical and radiological outcome of neck-preserving femoral stems.A search of the English-language literature on neck-preserving THA and on the individual neck-preserving implants was performed using PubMed, Ovid SP and Science Direct.Studies have indicated that neck preservation offers superior tri-planar implant stability and allows more accurate restoration of the hip geometry and biomechanics. The trend towards tissue sparing surgery has contributed to the development of bone-conserving short-stem implants that offer variable levels of neck preservation. Despite an initial learning curve, these implants have generated promising early clinical results, with low revision rates and high outcome scores. However, radiological evaluation of some neck-preserving implants has detected a characteristic pattern of proximal femoral bone loss with distal cortical hypertrophy. The long-term implications of this finding are not yet known.Preserving the femoral neck during THA has biomechanical advantages. However, long-term outcome data are needed on neck-preserving femoral stems to evaluate on-going bone remodelling and assess implant performance and survival.

We present a novel arthroscopic-assisted technique to graft chondral defects and subchondral cysts of the acetabular socket using a synthetic osteochondral plug. Four patients with groin pain, solitary cysts in the roof of the acetabulum and radiographic evidence of early osteoarthritis were treated. A bone tunnel was prepared from the region of the iliac crest to the acetabular articular surface. A synthetic osteochondral plug was inserted in an ante-grade fashion and positioned flush with the lunate articular cartilage. The minimum follow-up from surgery was 8 months (mean 10 months, range 8 to 11 months). There were no peri-operative complications related to the procedure. All patients reported an improvement in symptoms and function at the latest follow-up. One of the patients underwent a re-look arthroscopy at 5 months for persistent dull groin and buttock pain. Capsular adhesions of the labrum were identified and released. The mean non-arthritic hip score improved from 53.8 (range 43.8 to 70) pre-operatively to 84.6 (range 78.8 to 87.5) at 6 months. Computed tomography and magnetic resonance imaging at 6 months confirmed the stability of the osteochondral plugs and on-going healing. This procedure offers an arthroscopic means to treat patients with solitary acetabular cysts and may prove effective for chondral grafting of denuded acetabular areas in early to moderate degenerative hip disease.

We describe a hip condition with a recognisable pattern of clinical signs and radiological findings thought to result from chronic capsular injury. Between June 2006 and October 2009, ten patients (11 hips), four men and six women, were identified with an abnormality of external rotation at the hip joint. A detailed history and clinical examination was undertaken for each patient. Dynamic magnetic resonance imaging of symptomatic and control hips were evaluated for bony and soft tissue appearances. The relative positions of the femoral head and the acetabulum were assessed through a range of hip rotation. In affected hips, a loss of normal log roll recoil was observed. Three distortions of the iliofemoral ligament were identified on axial MR images; thinning at the lateral insertion of the ligament, attenuation of the iliofemoral ligament most noticeably on maximum external rotation (60°) and the appearance of laxity despite full external rotation. Stability of the hip is dependent on the interaction of bony and soft tissue structures. Hip instability is recognised in dysplasia and is known to lead to premature degeneration of the joint. Chronic capsular injury may destabilise previously asymptomatic hips with subsequent development of pain in young, active patients.

Acetabular component extraction following intra-pelvic migration of a total hip replacement can be hazardous to pelvic tissues, vessels and organs. Acetabular component removal is usually performed using an abdominal retroperitoneal approach. We describe a closed reduction of the acetabular component using a traction/manipulation technique. This manoeuvre can be used in cases of intra-pelvic acetabular component migration where the surface contour of the acetabular component is uncomplicated and an interposition membrane separates the implant from adjacent intra-pelvic structures.