Cemented or cementless THA in patients over 80 years with fracture neck of femur: a prospective comparative trial Early complications of anterior supine intermuscular total hip arthroplasty. A systematic review of psychological interventions in total hip and knee arthroplasty Early experience with dual mobility acetabular systems featuring highly cross-linked polyethylene liners for primary hip arthroplasty in patients under fifty five years of age: an international multi-centre preliminary study Robot‐assisted total hip arthroplasty: Clinical outcomes and complication rate Robot-assisted primary cementless total hip arthroplasty with a short femoral stem: a prospective randomized short-term outcome study. Robot-assisted primary cementless total hip arthroplasty with a short femoral stem: a prospective randomized short-term outcome study Internal fixation versus hemiarthroplasty versus total hip arthroplasty for displaced subcapital fractures of femur--13 year results of a prospective randomised study. A randomized pilot study of a comprehensive postoperative exercise program compared with usual care following primary total hip arthroplasty in subjects less than 65 years of age: feasibility, selection of outcome measures and timing of assessment Delta Ceramic-on-Alumina Ceramic Articulation in Primary THA: Prospective, Randomized FDA-IDE Study and Retrieval Analysis What Works Best, a Cemented or Cementless Primary Total Hip Arthroplasty?: Minimum 17-year Followup of a Randomized Controlled Trial A new short uncemented, proximally fixed anatomic femoral implant with a prominent lateral flare: design rationals and study design of an international clinical trial A randomized trial of ceramic-on-ceramic bearing versus ceramic-on-crossfire-polyethylene bearing in total hip arthroplasty: five-year outcomes. THA With Delta Ceramic on Ceramic: Results of a Multicenter Investigational Device Exemption Trial Component position following total hip arthroplasty through a miniinvasive posterolateral approach. Are Hip Precautions Necessary Post Total Hip Arthroplasty? A Systematic Review Thirteen-year wear rate comparison of highly crosslinked and conventional polyethylene in total hip arthroplasty: long-term follow-up of a prospective randomized controlled trial Dislocation of Primary Total Hip Arthroplasty with 36 and 40-mm Femoral Heads Causes for revision of dual-mobility and standard primary total hip arthroplasty A prospective, randomized study of cross-linked and non-cross-linked polyethylene for total hip arthroplasty at 10-year follow-up. Total hip arthroplasty through a minimally invasive lateral approach--our experience and early results. A randomised controlled trial of total hip arthroplasty versus resurfacing arthroplasty in the treatment of young patients with arthritis of the hip joint Time course and extent of functional recovery during the first postoperative year after minimally invasive total hip arthroplasty with two different surgical approaches--a randomized controlled trial.
Background Total hip arthroplasty is associated with a better long term outcome and lesser reoperation rates in the elderly but the risk of complications are beleived to be higher in very elderly patients . The study aims to compare the short-term results of cemented and cementless total hip arthroplasty ( THA ) in active patients > 80 years of age with femoral neck fractures . Methods Sixty-two consecutive patients underwent THA during the study period  ( cemented—31 and cementless—31 ) . The mean age was 84 years ( 81–94 years ) . Patients in both groups were comparable in their preoperative variables . Functional and radiological assessment s were carried out using vali date d outcome measures . Complications were recorded . Results Fifty-one patients were available for final analysis after accounting for deaths and cases lost in follow-up . Of the 51 patients , 25 ( 49 % ) regained their pre-injury mobility status and 36 ( 70 % ) were community ambulant . Cementless THA was associated with significantly less surgical time , blood loss , transfusion rates and hospital stay . The overall mortality rates , complications , functional and radiological results were similar in both groups though the number of deaths in the perioperative period was significantly high in patients undergoing cemented THA . ConclusionS atisfactory improvement in function with low reoperation rates can be achieved irrespective of the technique used . Complication rates are higher when compared to younger patients undergoing the procedure . Risks and benefits should be carefully assessed and explained before subjecting these patients to THA Anterior supine intermuscular total hip arthroplasty ( THA ) performed on a fracture table has been increasingly used for primary THA . Accurate cup placement , low incidence of dislocation , shorter hospital stay , and faster return of function are potential benefits of the technique . However , a high complication rate , particularly during a surgeon 's learning curve , has been reported . A retrospective analysis of 61 consecutive anterior supine intermuscular primary THAs with at least 6-month follow-up was performed . All procedures were performed using the anterior supine intermuscular approach with cementless implants under fluoroscopic guidance on a fracture table . Prospect ively collected data were retrospectively review ed to evaluate the early complication rate and radiographic accuracy of implant placement . Five ( 8.2 % ) intraoperative complications were observed : including 3 trochanteric fractures and 2 calcar fractures , 4 of which required cable fixation during the index procedure . One nondisplaced trochanteric fracture was treated conservatively . One patient sustained an injury of the lateral femoral cutaneous nerve . Postoperative complications included 1 anterior dislocation , 1 infected superficial hematoma , 1 stem subsidence , and 1 loose stem , with the latter 2 presenting as increasing thigh pain postoperatively and requiring stem revision . The overall complication rate was 16.4 % ( 10/61 ) . Overall , 3 patients ( 4 hips ; 6.5 % ) required reoperation . No femoral or sciatic nerve injuries occurred , and no patient was diagnosed with venous thromboembolism . All intraoperative fractures occurred during the first 32 cases , and none during the last 29 cases . A potentially high incidence of complications with the anterior supine intermuscular THA exists during a surgeon 's learning curve in an academic setting Background The current practice in elective orthopaedics does not routinely include psychological interventions despite evidence that psychological factors such as personality , anxiety , depression and negative thinking styles can influence outcomes and recovery from surgery . The objective of this paper was to review the effectiveness of psychological interventions used in conjunction with total hip ( THA ) and knee arthroplasty ( TKA ) , in improving patient reported joint outcomes . Methods An extensive literature search was conducted according to Preferred Reporting Items for Systematic review s and Meta-Analyses guidelines . Search terms included psychology , interventions , and orthopaedics . Articles were included if they were r and omised controlled trials ( RCTs ) of psychological interventions involving active patient participation measured with patient reported joint outcomes in patients undergoing hip or knee arthroplasty . Results A total of 19,489 titles were screened . Seven studies met the inclusion criteria and were included . Five of seven studies did not show improvements in patient reported outcomes after surgery . Specifically , psycho-education alone was not effective at improving patient reported joint outcomes in two out of two studies . Conclusion The current literature does not support routine psychological interventions for TKA and THA . However , it should be noted that the literature for psychological interventions in conjunction with TKA and THA is still in its infancy . This gap in the literature is surprising , considering the importance of the role of psychological factors in recovery . Further RCTs with long term follow ups , multidisciplinary involvement , and more comprehensive and focused interventions that go beyond educating patients are needed . Future studies should account for the dem and effect , include measures of psychological variables to determine whether psychological interventions are more beneficial for some patients compared to others , and compare the different modes of delivery and timing of interventions to determine the optimal nature and duration of psychological interventions for TKA and THA Purpose To evaluate early performance of contemporary dual mobility acetabular systems with second generation annealed highly cross-linked polyethylene for primary hip arthroplasty of patients under 55 years of age . Methods A prospect i ve observational five years study across five centers in Europe and the USA of 321 patients with a mean age of 48.1 years was performed . Patients were assessed for  causes of revision , hip instability , intra-prosthetic dissociation , Harris hip score and radiological signs of osteolysis .  Results There were no dislocations and no intra-prosthetic dissociations . Kaplan Meier analysis demonstrated 97.51 % survivorship for all cause revision and 99.68 % survivorship for acetabular component revision at five years . Mean Harris hip score was 93.6 . Two acetabular shells were revised for neck-rim implant impingement without dislocation and ten femoral stems were revised for causes unrelated to dual mobility implants . Conclusion Contemporary highly cross-linked polyethylene dual mobility systems demonstrate excellent early clinical , radiological , and survivorship results in a cohort of patients that dem and high performance from their implants . It is envisaged that DM and second generation annealed HXLPE may reduce THA instability and wear , the two most common causes of THA revision in hip arthroplasty BACKGROUND The purpose of this study was to report minimum 2-year outcomes and complications for robotic-arm-assisted total hip arthroplasty ( THA )  . METHODS Data were prospect ively collected and retrospectively review ed between June 2011 and April 2014 . Inclusion criteria were primary robotic-arm-assisted THAs treating idiopathic osteoarthritis with ≥ 2-year follow-up .  Demographics , operating time , complications , 2-year outcome scores and satisfaction , and subsequent surgeries were recorded . RESULTS There were 181 cases eligible for inclusion , of which 162 ( 89.5 % ) had minimum 2-year follow-up . At the latest follow-up , the mean visual analogue scale was 0.7 , satisfaction was 9.3 , Harris hip score was 91.1 and forgotten joint score was 83.1 . Six ( 3.7 % ) intraoperative complications and six ( 3.7 % ) postoperative complications were reported . No leg length discrepancies ( LLDs ) or dislocations were reported . CONCLUSIONS Robotic-arm-assisted THA demonstrates favourable short-term outcomes and does not result in a higher complication rate compared to non-robotic THA as reported by the literature BACKGROUND Recently , two topical issues in total hip arthroplasty ( THA ) have been robot-assisted surgery and use of a short stem . The purpose of this study was to evaluate the effects of robotic milling on the accuracy of short femoral stem positioning and on the short-term clinical outcome in THA using a prospect i ve , r and omized design . METHODS We r and omized 54 patients into two groups , either robotic milling group or manual rasping group .  The patients were assessed clinical ly and radiographically at 8 weeks , 5 months , 12 months , and 24 months . RESULTS Robotic milling group had a significantly longer operation time , requiring on average 8.9 min for registration and 11.2 min for milling . On the other h and , robotic milling group showed superior results in terms of stem alignment and leg length e quality . Two intraoperative femoral fractures occurred only in manual rasping group . Harris hip scores and WOMAC scores at 24 months postoperatively were similar in both groups . No complications including stem loosening , infection , nerve palsy , or dislocation were encountered in either group during the follow-up period . CONCLUSIONS The present study suggested that robot-assisted short stem THA could increase the accuracy of stem alignment , improve leg length e quality , and help reduce the risk of intraoperative femoral fracture as compared with manual rasping . However , the clinical outcome scores did not differ between the two groups at the time of short-term follow-up . Long-term follow-up is needed to determine whether there will be a long-term clinical relevance of robot-assisted implantation of short femoral stems in THA Abstract Background : Recently , two topical issues in total hip arthroplasty ( THA ) have been robot-assisted surgery and use of a short stem . The purpose of this study was to evaluate the effects of robotic milling on the accuracy of short femoral stem positioning and on the short-term clinical outcome in THA using a prospect i ve , r and omized design . Methods : We r and omized 54 patients into two groups , either robotic milling group or manual rasping group .  The patients were assessed clinical ly and radiographically at 8 weeks , 5 months , 12 months , and 24 months . Results : Robotic milling group had a significantly longer operation time , requiring on average 8.9 min for registration and 11.2 min for milling . On the other h and , robotic milling group showed superior results in terms of stem alignment and leg length e quality . Two intraoperative femoral fractures occurred only in manual rasping group . Harris hip scores and WOMAC scores at 24 months postoperatively were similar in both groups . No complications including stem loosening , infection , nerve palsy , or dislocation were encountered in either group during the follow-up period . Conclusions : The present study suggested that robot-assisted short stem THA could increase the accuracy of stem alignment , improve leg length e quality , and help reduce the risk of intraoperative femoral fracture as compared with manual rasping . However , the clinical outcome scores did not differ between the two groups at the time of short-term follow-up . Long-term follow-up is needed to determine whether there will be a long-term clinical relevance of robot-assisted implantation of short femoral stems in THA In this prospect i ve r and omised trial we compare the mortality , morbidity and functional results of patients following each of the three principal methods of treatment for displaced subcapital fractures of the femur . Two hundred and ninety patients over the age of 65 years were included and r and omly allocated to undergo closed reduction and internal fixation with a sliding compression screw plate or uncemented Austin Moore hemiarthroplasty or cemented Howse II total hip arthroplasty ( THA ) .  Nineteen patients were subsequently excluded . The 13 year results show that there was no statistical difference in the mortality between the three groups ( 81 , 85 and 91 % respectively ) . Internal fixation and hemiarthroplasty groups fared poorly with a revision rate of 33 and 24 % , respectively , compared with 6.75 % in the THA group . The dislocation rate was 13 % following hemiarthroplasty and 20 % following THA .  Average Harris hip scores were 62 , 55 and 80 , respectively , for the internal fixation , hemiarthroplasty and THA groups . In the long term , both internal fixation and hemiarthroplasty result ed in a poor outcome with respect to pain and mobility . Despite high early complications , THA result ed in least pain and most mobility both in the short and long-term and was encouraging with a revision rate of only 6.25 % . THA should be seriously considered in physiologically active patients with a displaced subcapital fracture of the femur Background Total Hip Arthroplasty ( THA ) is being used more commonly in younger higher dem and patients . The purpose of this r and omized pilot study was to explore a ) feasibility of comprehensive postoperative rehabilitation compared to usual care  following primary THA in subjects < 65 years , b ) appropriate outcome measures including performance-based measures and c ) timing of assessment s. Methods 21 subjects who underwent primary THA were r and omized to receive a three-month out-patient rehabilitation program ( Intervention ) or usual postoperative care ( Control ) . Subjects were assessed preoperatively , six-weeks postoperatively ( Pre-intervention ) and four and 12 months postoperatively ( Post-intervention ) . Self-report measures were the Western Ontario McMaster Osteoarthritis Index ( WOMAC ) and R and 36-Item Health Survey ( R AND -36 ) . Performance-based measures included lower extremity strength , walking speed and endurance , and gait laboratory assessment . Results Ten Control and 11 Intervention subjects with an average age of 53.4 ( SD9.3 ) years were r and omized . All Intervention subjects completed the program without adverse effects . Although no statistically significantly results were reported , four months postoperatively , Intervention subjects had clinical ly important differences ( CID ) in strength compared with Control subjects . Walking endurance , WOMAC and R AND scores improved significantly with no CID noted between groups . Ten ( 48 % ) subjects reported a ceiling effect on the WOMAC ( 9 ( 43 % ) subjects on Pain ; 1 ( 5 % ) subject on Function ) . No group CID were noted in gait measures . Conclusions Our recommendations would be that performance-based strength measures should be considered for the primary outcome in this younger cohort . Because of the ceiling effects with WOMAC Pain , a different pain measure is indicated . Other more challenging functional performance-based tests should be considered such as a more prolonged endurance test . There is merit in one-year follow-up as strength improved after four months in both groups Wear and osteolysis continue to be major reasons for revision surgery in THA .  Ceramic-on-ceramic bearings eliminate polyethylene wear debris . The newest generation of these bearings incorporate nanosized , yttria-stabilized tetragonal zirconia particles producing an alumina matrix composite . We asked whether this new material would perform as well as a conventional bearing in terms of functional hip scores , radiographic migration and osteolysis , complications and survival . As part of a US FDA investigational device exemption study ( G000075 ) , we conducted an initial prospect i ve safety study of 21 alumina matrix composite femoral heads articulating on alumina liners followed by a prospect i ve , r and omized study with 44 more of these articulations and 45 zirconia femoral heads on polyethylene liners .  The minimum followup for all patients was 26 months ( mean , 73 months ; range , 26–108 months ) . Harris hip scores and radiographic findings were similar in the two groups as was survivorship ( trial 95 % versus control 93 % ) . There were three reoperations in the trial group and three in the control group . A fractured head retrieval showed a 33 % monoclinic transformation with an increase in surface roughness from 3 to 5 nm at the main wear zone . While our numbers were insufficient to compare device-related complications , the trial device performed as well as the control device in terms of reoperation , and clinical and radiographic outcome . The alumina matrix composite femoral head on an alumina liner provided high survivorship . Level of Evidence : Level II , therapeutic study . See Guidelines for Authors for a complete description of levels of evidence Background  Total hip arthroplasty ( THA )  has been associated with high survival rates , but debate remains concerning the best fixation mode of THA . Questions / purpose sWe conducted a r and omized controlled trial ( RCT ) with 250 patients with a mean age of 64 years between October 1987 and January 1992 to compare the results of cementless and cemented fixation . Patients and Methods Patients were evaluated for revision of either of the components . One hundred twenty-seven patients had died ( 51 % ) and 12 ( 4.8 % ) were lost to followup . The minimum 17-year followup data ( mean , 20 years ; range , 17–21 years ) for 52 patients of the cementless group and 41 patients of the cemented group were available for evaluation . Results Kaplan-Meier survivorship analysis at 20 years revealed lower survival rates of cemented compared with cementless THA . The cementless tapered stem was associated with a survivorship of 99 % . Age younger than 65 years and male gender were predictors of revision surgery . Conclusions The efficacy of future RCTs can be enhanced by r and omizing patients in specific patient cohorts stratified to age and gender in multicenter RCTs . Including only younger patients might improve the efficacy of a future RCT with smaller sample sizes being required . A minimum 10-year followup should be anticipated , but this can be expected to be longer if the difference in level of quality between the compared implants is smaller . Level of Evidence Level I , therapeutic study . See Guidelines for Authors for a complete description of levels of evidence Background Anatomic short femoral prostheses with a prominent lateral flare have the potential to reduce stress-shielding in the femur through a more physiological stress distribution to the proximal femur . We present the design rationale of a new short uncemented , proximally fixed anatomic femoral implant and the study design of a prospect i ve multi-centre trial to collect long-term patient outcome and radiographic follow up data . Methods A prospect i ve surveillance study ( trial registry NCT00208555 ) in four European centres ( UK , Italy , Spain and Germany ) with a follow up period of 15 years will be executed . The recruitment target is 200 subjects , patients between the ages of 18 and 70 admitted for primary cementless unilateral THA will be included . The primary objective is to evaluate the five-year survivorship of the new cementless short stem .  The secondary objectives of this investigation are to evaluate the long term survivorship and the clinical performance of the implant , the impact on the subjects health related Quality of Life and the affect of the prosthesis on bone mineral density . Peri- and postoperative complications will be registered . Clinical and radiographic evaluation of prosthesis positioning will be done post-operatively and at 3 , 6 , 12 , 24 , 60 , 120 and 180 months follow up . Discussion Shortening of the distal stem can maximise bone and soft tissue conservation . New stem types have been design ed to improve the limitations of traditional implants in primary THA . A new , uncemented femoral short stem is introduced in this paper . A long-term follow up study has been design ed to verify stable fixation and to research into the clinical outcome . The results of this trial will be presented as soon as they become available This study determined how ceramic-on-ceramic bearing THA affected joint-specific pain , function and stiffness in the first five postoperative years compared with ceramic-on-highly-crosslinked-polyethylene bearing THA .  Subjects less than 61 years of age were r and omized  to ceramic-on-ceramic ( CERAMIC ) [ n = 48 ] or ceramic-on-highly-crosslinked-polyethylene ( POLYETHYLENE ) [ n = 44 ] bearing THA . Subjects were assessed using the Western Ontario McMaster Osteoarthritis Index ( WOMAC ) and the R AND 12-Item Health Survey ( R AND -12 ) preoperatively , and at one and five years postoperatively . 92 subjects(50 ( 54 % ) males ; average age = 52 ( SD 6.6 ) years ) were enrolled . 78 ( 85 % ) subjects returned five years postoperatively . All subjects reported improvements at one and five years in all measured indices with no group differences detected . Seven ( 8 % ) subjects experienced postoperative THA complications , none related to bearing surfaces ; two subjects ( POLYETHYLENE ) required revision for instability . Both bearing surfaces provided excellent short-term results in younger subjects Although the published studies on the outcomes of  total hip arthroplasty (  THA ) performed with currently available ceramic components show high survivorship and low bearing wear at midterm followup , concern over ceramic fracture and squeaking persist . For these reasons , the use of ceramic is limited . Recently , a new alumina matrix composite material ( Delta ceramic ) with improved material properties was developed to address these concerns . We report the early outcomes and complications of a prospect i ve , r and omized , multicenter trial of 263 patients ( 264 hips ) at eight centers , comparing a Delta ceramic-on-ceramic ( COC ) articulation with a Delta ceramic head-crosslinked polyethylene bearing combination ( COP ) . There were 177 COC hips and 87 COP hips . Complications  were reported for all patients , whereas  clinical and radiographic results were provided for the 233 patients with minimum 2-year followup ( average , 31.2 months ; range , 21–49 months ) . The Harris hip scores and clinical , radiographic , and survivorship outcomes were similar in both groups . There were four ( 2 % ) revisions in the COC group and two ( 2 % ) in the COP group . We encountered three intraoperative ceramic liner-related events . In addition , one patient receiving the COC underwent revision for chipping of the ceramic liner , and a second had ceramic fragmentation on followup radiographs but has not undergone revision . These liner related complications remain a concern . No patient reported squeaking in either group ; this leaves us hopeful the new material will lessen the frequency of squeaking . In the short term , the Delta COC articulation provided similar functional scores and survivorship and complication rates with the ceramic head mated with crosslinked polyethylene . Level of Evidence : Level I , therapeutic study . See Guidelines for Authors for a complete description of levels of evidence Implant malposition and poor fixation are potential risks of compromising long-term results after total hip arthroplasty performed with a minimally invasive technique . Between September 2000 and February 2002 , 120 cemented primary total hip arthroplasties were performed at the authors ' institutions in patients with primary osteoarthritis of the hip and with BMI lower than 35 . In 60 of these cases selected at r and om , a posterolateral incision no longer than 10 cm was used . The other 60 THA 's were performed through a st and ard posterolateral approach . The inclination and anteversion of the cup and the position of the femoral stem were assessed on radiographs and statistically evaluated . In the miniinvasive group , the average inclination angle of the cup was 42.3 degrees ( range : 36 to 52 degrees ) and the anteversion angle 13.6 degrees ( range : 6 to 29 degrees ) . The coronal alignment of the femoral component was within 3 degrees of neutral in 54 cases ( 90.0 % ) . Following conventional implantation in the other group , the average cup inclination angle was 42.4 degrees ( range : 35 to 50 degrees ) and the anteversion angle 13.6 degrees ( range : 8 to 24 degrees . A total of 53 stems ( 88.3 % ) were implanted optimally . Statistical analysis found no significant difference between the two groups regarding components position . These findings suggest that using a smaller posterolateral incision as was done in this study does not introduce a potential risk of compromising long-term results Purpose : Total hip arthroplasty ( THA ) is a common and effective treatment of hip osteoarthritis . Activity restrictions known as hip pre caution s are widely practice d in rehabilitation post THA , aim ing to foster healing and prevent hip dislocation . The focused clinical question was : Does the application of hip pre caution s in patients post THA versus unrestricted activities significantly decrease the risk of prosthetic dislocation ? Methods : A comprehensive literature search was conducted for r and omized controlled trials or cohort studies with a comparative group and minimum 6 months follow-up , with dislocation as an end point . Retrieved titles were assessed independently by 2 review ers for inclusion and underwent st and ardized data extraction . Results : Title search produced 80 potentially relevant articles . Five articles were retrieved for data extraction of which 2 met a prior eligibility criteria . No eligible studies were found that concerned posterior approaches to hip arthroplasty , so the results of this review concern only anterolateral approaches . Neither included study showed any benefit of hip pre caution s in preventing dislocation . Conclusion : The rate of dislocation after anterolateral THA is low and is not improved by hip pre caution s. Hip pre caution s are associated with a slower return to activities , significant expense , and decreased patient satisfaction . Existing studies risk being compromised by a type II error , but a definitive study may be prohibitively large and expensive Background The purpose of this study was to report the radiographic wear rates from a previous r and omized controlled trial of first-generation highly crosslinked versus conventional polyethylene in  total hip arthroplasty ( THA ) at a minimum of 13 years ’ follow-up . Methods Patients returned for radiographic imaging and radiostereometric analysis ( RSA ) .  Radiographs were review ed for the presence of osteolysis or component loosening . Femoral head penetration ( which includes both wear and creep ) was measured using RSA . We compared Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) , 12-Item Short Form Health Survey ( SF-12 ) and Harris Hip Scores ( HHS ) with preoperative values . Results There was 1 revision in each group . There was no difference in WOMAC , SF-12 , or HHS outcome scores  between the highly crosslinked and conventional polyethylene groups ( all p ≥ 0.13 ) . Wear rate was lower with crosslinked polyethylene than conventional polyethylene ( 0.04 ± 0.02 mm/year v. 0.08 ± 0.03 mm/year , p = 0.007 ) . Conclusion First-generation crosslinked polyethylene demonstrates greater wear resistance  than conventional polyethylene after 13 years of implantation . Crosslinked polyethylene continues to outperform conventional polyethylene into the second decade of implantation Some authors suggest the use of larger ( 36 and 40 mm ) femoral heads against highly cross-linked polyethylene acetabular liners will reduce the prevalence of early dislocation after primary total hip arthroplasty ( THA ) . We prospect ively followed 61 consecutive patients at high risk for dislocation to determine the prevalence of early dislocation after primary THA with 36 and 40 mm femoral heads .  We established specific indications for the use of these larger heads in primary arthroplasty . There were 65 hips in 61 patients with a minimum followup of 1 year ( mean 2 years , range 1 - 4 years ) . There were 55 36 mm heads and 10 40 mm heads . All arthroplasties were performed by the posterior approach with capsular repair . The prevalence of early dislocation was 4.6 % ( 3 of 65 ) . There was one patient with an anterior dislocation and two with posterior dislocation . No patient underwent reoperation for dislocation . There was no dislocation in the 10 hips that had a 40 mm head . We identified no complications related to the larger femoral heads . The use of larger femoral heads did not notably reduce the prevalence of early dislocation after primary THA in high risk patients compared to historical controls . Therapeutic study : Level IV , case series . See Guidelines for Authors for a complete description of levels of evidence Introduction The causes for revision of primary total hip arthroplasty ( THA ) are various and quite well known . The developing use of dual-mobility THA ( DM-THA ) seems a relevant option to decrease the risk of instability . Due to lack of long-term follow-up , this innovative retentive concept is suspected to increase the risk of polyethylene ( PE ) wear . the aim of the study was to analyse the causes for  DM-THA revision and assess whether or not its occurrence is different from that of fixed-st and ard ( FS ) THA , particularly for aseptic loosening or wear and /or osteolysis . Material s and methods The SoFCOT group conducted an observational prospect i ve multicentre study from 1 January 2010 to 31 December 2011 . Inclusion criteria comprised an exhaustive collection of 2044 first-revision THAs with 251 DM-THAs and 1793 FS-THAs . After excluding complications linked to patient factors ( infection and periprosthetic fractures ) , we performed a matched case – control study ( matching ratio 1:1 ) comparing two groups of 133 THAs . Results Revisions for aseptic loosening or osteolysis/wear were as frequent in DM-THA ( 58.7 % ) as in FS-THA ( 57.1 % ) ( p 0.32 ) ; 7.5 % of DM-THA were revised for dislocation versus 19.5 % of FS-THA ( p 0.007 ) . Discussion Revision for osteolysis/wear and aseptic loosening were as frequent in DM-THA as in FS-THA ;  revision for dislocation was less frequent in DM-THA . This confirms the efficiency of the DM concept regarding the risk of dislocation . Causes for revision were different between groups , and revisions for dislocation were less frequent in DM-THA . Only prospect i ve comparative studies could provide reliable information that may support broader use of the DM concept In 1999 , our institution initiated a prospect i ve study to compare the outcome of total hip arthroplasty patients r and omized to either non-cross-linked liners or polyethylene liners that were cross-linked with 5.0 Mrad of gamma-irradiation and heat treated to eliminate free radicals . Among 230 r and omized THAs , 13 have had reoperations , and 31 patients with 32 THAs died with less than 9-year follow-up . Follow-up for the remaining 185 THAs averaged 10.0 ± 1.8 years . There have been 9 wear-related liner exchanges among the non-cross-linked group and none among the cross-linked group . Using revision for wear-related complications as an endpoint , survivorship at 10-years was 94.7 ± 4.6 % for non-cross-linked and 100 % for cross-linked ( P = .003 ) . Among unrevised hips , the mean linear wear rate was 0.22 mm/yr for non-cross-linked and 0.04 mm/yr for cross-linked ( P < .001 ) . The incidence of clinical ly important osteolysis with an area of at least 1.5 square centimeters among unrevised hips was 22 % for non-cross-linked and 0 % for cross-linked ( P < .001 ) BACKGROUND AIMS Evaluation of : 1 . early clinical and radiographic results of  total hip arthroplasty ( THA ) through a st and ard lateral direct approach , 2 . early clinical and radiographic results of THA through a minimal lateral approach , 3 . comparison of the results of THA in these two groups . MATERIAL AND METHODS 120 THAs ( 60 cementless and 60 cemented ) done in 120 patients due to degenerative changes were evaluated prospect ively . 60 THAs were done through a minimal lateral approach and constituted a study group . 60 THAs were done through a direct lateral approach and constituted a control group . The mean age of the 120 patients ( 98 women and 22 men ) was 45 y.o . ( range : 32 - 67 y.o . ) . The duration of follow-up in the study group was from 6 to 12 months ( mean : 8.5 months ) . The duration of follow-up in the control group was from 10 to 16 months ( mean : 10.5 months ) . Mean preoperative functional status of the study group was 44.5 points according to the Harris hip score . Radiographic evaluation of the results was done according to the criteria of the Joint Committee of the Hip Society , AAOS and SICOT . RESULTS 6 months after THA , clinical results were 92 pts in the study group and 88 pts in the control group . Radiographic outcomes were very good in all 120 patients from both arms : there were no differences between the control and study group . The incidence of complications was similar in both groups . CONCLUSIONS Minimally invasive THA demonstrated its value in the treatment of  degenerative changes of the hip joint  with regard to short-term outcomes . The clinical and radiographic outcomes were comparable between the st and ard and minimally invasive approaches . Success with THA using a minimally invasive approach depends on excellent operative technique and experience with st and ard hip approaches rather than on the use of special instruments Background Hip replacement ( arthroplasty ) surgery is a highly successful treatment for patients with severe symptomatic arthritis of the hip joint . For older patients , several design s of Total Hip Arthroplasty have shown excellent results in terms of both function and value for money . However , in younger more active patients , there is approximately a 50 % failure rate at 25 years for traditional implants . Hip resurfacing is a relatively new arthroplasty technique . In a recent review of the literature on resurfacing arthroplasty it was concluded that the short-term functional results appear promising but some potential early disadvantages were identified , including the risk of femoral neck fracture and collapse of the head of the femur . The aim of the current study is to assess whether there is a difference in functional hip scores at one year post-operation between Total Hip Arthroplasty and Resurfacing Arthroplasty . Secondary aims include assessment of complication rates for both procedures as well cost effectiveness . Methods / design All patients medically fit for surgery and deemed suitable for a resurfacing arthroplasty are eligible to take part in this study . A r and omisation sequence will be produced and administered independently . After consenting , all patients will be clinical ly review ed and hip function , quality of life and physical activity level will be assessed through question naires . The allocated surgery will then be performed with the preferred technique of the surgeon . Six weeks post-operation hip function will be assessed and complications recorded . Three , six and 12 months post-operation hip function , quality of life and physical activity level will be assessed . Additional information about patients ' out-of-pocket expenses will also be collected . Trial registration Current Controlled Trials IS RCT N33354155UKCLRN portfolio ID UNLABELLED While others have reported short-term comparisons between various minimally invasive surgical ( MIS ) approaches to  total hip arthroplasty ( THA ) and their conventional analogues , longer-term data is lacking , as is information indicating whether MIS approaches to THA provide a biomechanically complete recovery . Furthermore , different MIS approaches have not been compared . Our approaches of interest were a one-incision modified Watson-Jones , and a two-incision approach . HYPOTHESES ( 1 ) There are significant differences in gait recovery patterns between the two surgical groups and ( 2 ) THA subjects have significant differences in function one year after surgery compared to control subjects . To test these hypotheses , THA c and i date s ( n=26 ) were r and omized to receive one of these MIS approaches and evaluated preoperatively , and postoperatively at 3 weeks , and at 3 , 6 and 12 months . Evaluations included three-dimensional gait analysis and 24-hour step-counts . The same data were obtained from 25 control subjects .  Recovery time-course was assessed using repeated measures ANOVA . T-tests were used to compare controls with the pooled group of THA subjects . We found no differences between the two THA surgical groups regarding the time-course of recovery ( p≥0.591 ) . Although recovery was statistically complete by 3 months postoperatively for all variables , there were significant differences from controls at 12 months . Most notably , the external hip adduction moment , which reflects hip abductor function , was more than one st and ard deviation below normal ( p<0.001 ) . THA subject inactivity could not explain the gait differences , since one year after surgery daily step counts were not significantly different from controls ( p=0.346 ) . More work is necessary to determine ways to improve biomechanical outcomes for today 's patients with high expectations for function and implant longevity
Conclusion Total hip arthroplasty in patients younger than 55 years provides reliable outcomes at up to 10 years .
Background Total hip arthroplasty ( THA ) is increasingly performed in younger patients despite the lack of comprehensive assessment of long-term outcomes .
We systematic ally review ed the contemporary literature to assess the 1 ) indications , 2 ) implant selection and long-term survivorship , 3 ) complication and reoperation rates and 4 ) radiographic and functional outcomes of primary THA in patients younger than 55 years .