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A reduction in femoral offset may decrease muscle tension and lead to spacer dislocations even though proximal femur, musculature and acetabulum remain intact. In this study, we aimed to determine whether postoperative lateral femoral offset (LFO) and modified vertical femoral offset (MVFO) values affect the risk of dislocation of a hip spacer.~Introduction~Background~We measured LFO and MVFO in properly centred, postoperative, anteroposterior radiographs of the pelvis in 66 patients (71 spacers). We then compared the operated and non-operated sides and recorded any dislocations.~Materials and Methods~Methods~Although LFO decreased (p<0.001), the reduction was not associated with dislocation (p = 0.471). MVFO remained unchanged after spacer implantation (p = 0.277) and was not associated with dislocation (p = 0.418).~Results~Results~In conclusion, the preformed spacer decreased LFO but not MVFO compared with the contralateral hip. The variations did not significantly affect the dislocation rate.~Conclusions~Conclusions [ABSTRACT FROM AUTHOR]

A retrospective study was performed to evaluate the cement mantle in two groups of patients treated with the acetabular components of cemented Exeter total hip arthroplasties (THAs). Two groups of 20 patients were compared: Group 1 received non-flanged acetabular cemented cups (Contemporary, Stryker) and Group 2 received flanged acetabular cemented cups (X3 Rim Fit, Stryker). Cups in Group 2 were implanted after using a rim cutter device. Group 2 showed better penetration of cement in zone 1 (10.76 mm compared with 2.93 mm; p = 0.008) and a thicker cement mantle in zone 1 (3.57 mm compared with 2.89 mm; p = 0.04). More cups in Group 2 had a cement mantle thickness less than 3 mm (30 % in Group 1 compared with 70 % in Group 2; p = 0.0039). No other radiological differences were observed. These results favor the use of a rim cutter device and flanged cup to improve the cement mantle for the acetabular components of cemented Exeter THAs. However, the improvements were less than expected. In view of the results of previous studies, further research is therefore needed to assess the value of this approach in improving the acetabular cement mantle. [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]

The prognosis associated with the DePuy ASR hip cup is poor and varies according to the series. This implant was withdrawn from use in 2010 and all patients needed to be assessed. We present the results of the assessment of our patients treated with this device, according to the Spanish Society of Hip Surgery (SECCA) algorithm published in 2011. This retrospective study evaluates 83 consecutive ASR cups, followed up at a mean of 2.9 years. Serum levels of chromium and cobalt, as well as the acetabular abduction angle, were determined in order to assess their possible correlation with failure, defined as the need for revision surgery. The mean Harris Hip Score was 83.2 (range 42-97). Eight arthroplasties (13.3%) required revision due to persistent pain and/or elevated serum levels of chromium/cobalt. All the cups had a correct abduction angle, and there was no correlation between elevated serum levels of metal ions and implant failure. Since two previous ASR implants were exchanged previously to the recall, the revision rate for ASR cups in our centre is 18.2% at 2.9 years. [ABSTRACT FROM AUTHOR]

Objective: To determine the accuracy of guided computed tomography aspiration in the detection of septic hip prosthesis before surgery.Materials and Methods: Sixty-three patients (35 women and 28 men; age range, 29-86 years; mean age, 71 years) with clinically suspected septic hip prosthesis were prospectively studied with independent review board (IRB) approval. Volume and microbiological cultures of aspirated fluid and several computed tomography imaging findings such as periprosthetic fluid collections, prosthetic acetabular malposition, and heterotopic ossification were analyzed. All patients underwent revision surgery and infection was finally diagnosed in 33 patients.Results: Statistical comparative analysis was performed comparing computed tomography aspiration and surgical findings (95% CI; level of significance at P=0.05 two-sided) with 70% sensitivity, 100% specificity, 84% accuracy, 100% positive predictive value, and 75% negative predictive value. Using Fisher's exact test, the presence of periprosthetic fluid collections (P=0.001), prosthetic acetabular malposition (P=0.025) and aspirated fluid volume (P=0.009) were significantly higher in infected than in non-infected prostheses, whereas heterotopic ossification was not (P=0.429).Conclusion: Computed tomography aspiration is accurate to preoperatively diagnose septic hip prosthesis on the basis of volume and bacterial cultures of aspirated joint fluid. Furthermore, imaging findings such as periprosthetic fluid collections and prosthetic acetabular malposition strongly suggest infected prosthesis. [ABSTRACT FROM AUTHOR]

Surgical navigation systems are offered to provide more precise implantation of the femoral component in hip resurfacing (HR), allowing to reduce the risk of malpositioning and of femoral neck fracture and notching. We conducted a retrospective analysis of 30 HR divided into two cohorts and compared the results of a nonnavigated group (15 hips) with those of a navigated group (15 hips). The BrainLAB Computer Navigation System was used in all cases. No notching occurred in either group. The femoral component did not show better positioning in the navigated group, but more outlier cases were observed in the nonnavigated group (7, versus 3 in the navigated group). Although there are no long-term studies showing that surgical navigation increases the survival of HR, the avoidance of outlier values justifies its use, especially during the surgical learning curve, which is a difficult and lengthy one. [ABSTRACT FROM AUTHOR]

KEY WORDS With the recent trend towards reducing hospital stay, it has become increasingly important to ensure that early patient discharge after total hip replacement is a safe practice. We evaluated complications and length of hospital stay associated with primary unilateral hip arthroplasty in 47 patients undergoing a new early discharge protocol consisting of at home based specialized care after hospital discharge. The mean length of stay (and standard deviation) in hospital was 4.59±0.68. The mean length of stay of home-based hospitalization was 3.7±1. The prevalence of postoperative complications was 12.8% and the readminssion rate was 6.4%. We saw a reduction of hospital stay with no difference in outcomes in comparison with previous data. On the basis of our findings we recommend the use of the early discharge protocol following elective primary total hip replacement and ongoing evaluation of the process. [ABSTRACT FROM AUTHOR]

Due to its advantages, ceramic-on-ceramic bearings have been widely used in young patients for almost 30 years. Long-term survivorship, low wear, and low biological reactivity to particles are some of its characteristics. Even though this material has had a lot of improvements, the risk of fracture is one of the concerns. There have been reports of fracture of ceramic in the acetabular liner and head but no fractures of both in the same patient. We report a case of a fracture in a sandwich type acetabular liner and the ceramic head in a patient involving ankylosing spondylitis. It occurred three years after the operation and with no history of direct trauma. We decided to change the bearing surfaces to metal polyethylene without removing the metal back. The patient is satisfied by the clinical results after a 5-year followup. [ABSTRACT FROM AUTHOR]