Internal fixation compared with total hip replacement for displaced femoral neck fractures in the elderly. A randomised, controlled trial. The management of intracapsular hip fractures in the 'young elderly' internal fixation or total hip replacement? Incidence and natural history of deep-vein thrombosis after total hip arthroplasty. A prospective and randomised clinical study. A prospective randomised controlled trial comparing three alternative bearing surfaces in primary total hip replacement. The impact of treatment with hylan G-F 20 on progression to total hip arthroplasty in patients with symptomatic hip OA: a retrospective study [Minimally invasive vs. transgluteal total hip replacement. A 3-month follow-up of a prospective randomized clinical study]. Cemented versus cementless stems: a verdict is in. Does reduced movement restrictions and use of assistive devices affect rehabilitation outcome after total hip replacement? A non-randomized, controlled study. Total hip replacement rate in a cohort of patients affected by symptomatic hip osteoarthritis following intra-articular sodium hyaluronate (MW 1,500–2,000 kDa) ORTOBRIX study Comparison of total hip replacement with and without cement in patients younger than 50 years of age: the results at 18 years. Prostaglandin E2 level in tissue surrounding aseptic failed total hips Exercise therapy may postpone total hip replacement surgery in patients with hip osteoarthritis: a long-term follow-up of a randomised trial Long-term comparison of Charnley and Stanmore design total hip replacements. Leg length discrepancy, dislocation rate, and offset in total hip replacement using a short modular stem: navigation vs conventional freehand. Tackling the learning curve: comparison between the anterior, minimally invasive (Micro-hip®) and the lateral, transgluteal (Bauer) approach for primary total hip replacement Predicting the cost-effectiveness of total hip and knee replacement: a health economic analysis. The total costs of a displaced femoral neck fracture: comparison of internal fixation and total hip replacement Treatment of femoral neck fractures with total hip replacement versus cemented and noncemented hemiarthroplasty. Questionnaire on the perceptions of patients about total hip replacement. Predictive factors of total hip replacement due to primary osteoarthritis: a prospective 2 year study of 505 patients. Preoperative gait adaptations persist one year after surgery in clinically well-functioning total hip replacement patients. Randomised controlled trial to evaluate a physiotherapy-led functional exercise programme after total hip replacement. Leisure time physical activity and the risk of hip or knee replacement due to primary osteoarthritis: a population based cohort study (The HUNT Study)
The treatment algorithms for displaced fractures of the femoral neck need to be improved if we are to reduce the need for secondary surgery . We have studied 102 patients of mean age 80 years , with an acute displaced fracture of the femoral neck . They were r and omly placed into two groups , treated either by internal fixation ( IF ) with two cannulated screws or total hip replacement ( THR ) . None showed severe cognitive dysfunction , all were able to walk independently , and all lived in their own home . They were review ed at four , 12 and 24 months after surgery . Outcome measurements included hip complications , revision surgery , hip function according to Charnley and the health-related quality of life ( HRQoL ) according to EuroQol ( EQ-5D ) . The failure rate after 24 months was higher in the IF group than in the THR group with regard to hip complications ( 36 % and 4 % , respectively ; p < 0.001 ) , and the number of revision procedures ( 42 % and 4 % , p < 0.001 ) . Hip function was significantly better in the THR group at all follow-up review s regarding pain ( p < 0.005 ) , movement ( p < 0.05 except at 4 months ) and walking ( p < 0.05 ) . The reduction in HRQoL ( EQ-5D index score ) was also significantly lower in the THR group than in the IF group , comparing the pre-fracture situation with that at all follow-up review s ( p < 0.05 ) . The results of our study strongly suggest that THR provides a better outcome than IF for elderly , relatively healthy , lucid patients with a displaced fracture of the femoral neck There is a lack of consensus about how to treat intracapsular hip fractures in the ' young elderly ' ( 50 - 75 years ) . Evidence for older more mobile patients seems to point towards Internal Fixation ( IF ) for undisplaced fractures and Total Hip Replacement ( THR ) for displaced fractures . Radiographs of 263 patients from the Norfolk and Norwich University Hospital , who have suffered an intracapsular hip fracture between 2000 - 2009 were review ed . The complication and mortality rates were noted . A Hip function question naire ( Oxford hip score ( OHS ) ) and Numeric pain score ( NPS ) were sent out to patients , then methods of treatment ( IF and THR ) were compared . In displaced fractures THR compared favourably to IF , OHS ( 16.0 vs. 20.0 p 0.029 ) , NPS ( 2.0 vs. 4.0 p 0.007 ) , complications ( Odds Ratio ( OR ) 2.90 ; p 0.006 ) and death rate ( OR 3.61 ; p 0.007 ) . Although not statistically significant when stratified for age , the youngest age group ( 50 - 60 ) still achieved better function with a THR ( 13.0 vs. 18.0 ; p 0.129 ) . There was little difference in the results for undisplaced fractures . This retrospective cross-sectional study showed IF is associated with a much higher complication rate than THR for patients who sustained a displaced hip fracture . THR also showed a better functional outcome and reduced pain .  IF should be used in undisplaced fractures as there was no difference in functional outcome or complication rate . A large r and omised controlled trial is needed to confirm these results There are many reports concerning the aetiology and prophylaxis of deep-vein thrombosis ( DVT ) but little is known about its natural history . The purpose of our study was to identify the incidence and site of DVT , the risk factors for pulmonary embolism and the natural history of DVT  after total hip replacement ( THR ) in patients who do not receive any form of prophylactic or therapeutic treatment for DVT . Two hundred patients who had a primary THR were included : 100 had one-staged bilateral THR and 100 had unilateral THR and 150 implants were cemented and 150 cementless .  Coagulation assays , a full blood count , blood typing and serum chemical profile tests were performed for all patients on three separate occasions . Bilateral simultaneous or unilateral venograms were performed on the sixth or seventh postoperative day and perfusion lung scans preoperatively and on the seventh or eighth postoperative day . Further venograms were performed in all patients who had thrombi six months later . In the patients with bilateral THR , 52 ( 26 % ) venograms were positive for thrombi , while in the patients with unilateral THR 20 ( 20 % ) were positive ( p = 0.89 ) . In the patients with a cemented THR , 31 venograms ( 20.7 % ) were positive for thrombi , while in those with a cementless THR 41 ( 27.3 % ) were positive ( p = 0.654 ) . Further venograms in all 72 patients who had thrombi at six months after operation showed that they resolved completely and spontaneously regardless of their site and size . No patients had symptoms of pulmonary emboli and none were seen on the perfusion lung scans . Two patients died from unrelated causes . Although the prevailing opinion is that patients with proximal venous thrombosis should be treated with anticoagulants , our study has shown that all thrombi regardless of their site and size resolve spontaneously without associated pulmonary embolism The ideal bearing surface for young patients undergoing total hip replacement ( THR ) remains controversial . We report the five-year results of a r and omised controlled trial comparing the clinical and radiological outcomes of 102 THRs in 91 patients who were < 65 years of age . These patients were r and omised to receive a cobalt-chrome on ultra-high-molecular-weight polyethylene , cobalt-chrome on highly cross-linked polyethylene , or a ceramic-on-ceramic bearing . In all , 97 hip replacements in 87 patients were available for review at five years . Two hips had been revised , one for infection and one for peri-prosthetic fracture . At the final follow-up there were no significant differences between the groups for the mean Western Ontario and McMaster Universities osteoarthritis index ( pain , p = 0.543 ; function , p = 0.10 ; stiffness , p = 0.99 ) , Short Form-12 ( physical component , p = 0.878 ; mental component , p = 0.818 ) or Harris hip scores ( p = 0.22 ) . Radiological outcomes revealed no significant wear in the ceramic group . Comparison of st and ard and highly cross-linked polyethylene , however , revealed an almost threefold difference in the mean annual linear wear rates ( 0.151 mm/year versus 0.059 mm/year , respectively ) ( p < 0.001 ) Abstract Introduction : There is scarce data available on intra-articular hyaluronan ’s ability to modify the progression of osteoarthritis ( OA ) . Objective : The purpose of this retrospective pilot study was to assess the impact of treatment with hylan G-F 20 on progression to total hip replacement ( THR ) in patients with symptomatic hip OA . Research design and methods : The records of patients presenting with symptomatic hip OA and treated with hylan G-F 20 were analysed . Endpoints were the number of THRs performed and the survival time ( in months ) between commencement of treatment and THR , if performed . Endpoints were evaluated for the entire study population and for those sub-groups of patients which were , or were not , defined as c and i date s for THR prior to intra-articular treatment . Predictive factors of progression to THR were also assessed . Results : A total of 850 patients ’ records were evaluated and 224 patients ’ data were included in the study and evaluated . Eighty-four patients ( 37.5 % ) progressed to THR , 206 patients ( 92.0 % ) achieved 12 months survival , 170 patients ( 75.9 % ) achieved 24 months survival , and 69 patients ( 30.8 % ) achieved 5 years survival . Mean survival time was 36 months . Classification as a THR c and i date , Lequesne score , ultrasound pattern and the presence of diabetes were predictive factors for progression to THR . Conclusions : These results suggest that hylan G-F 20 could be included in the management of symptomatic hip OA before recommendation for THR , particularly in patients presenting with milder symptoms , or in patients where , due to comorbidities or personal choice , THR is not a feasible option . Limitations of this study include the retrospective study design and the lack of a control group to determine any placebo effect of hylan G-F 20 . Further prospect i ve studies are therefore needed to corroborate these results BACKGROUND The aim of this prospect i ve r and omized study was to compare the results after total hip replacement ( THR ) using an MIS approach  versus a regular transgluteal approach ( Bauer approach ) . METHOD We compared 20 THRs using a modified Watson-Jones minimally invasive approach ( MIS group ) with 20 conventionally performed THRs using a Bauer approach ( control group ) .  In all cases , the same implants ( Trilogy cup , MAYO stem ) were used . The Harris Hip Score ( HHS ) , the visual analogue scale , myoglobin level , and creatinine kinase level were measured preoperatively and up to 3 months postoperatively . RESULTS Advantages of the MIS group were evaluated using the HHS in the categories of activity and range of motion 6 weeks postoperatively . In terms of function , gait , and total HHS , we found benefits in the MIS group 6 and 12 weeks postoperatively . Up to 48 h postoperatively , patients in the MIS group had lower myoglobin blood levels . No differences were found in creatinine kinase levels , pain sensation as measured by visual analogue scale , or implant positioning . CONCLUSION Use of the minimally invasive Watson-Jones approach shows advantages compared with the transgluteal Bauer approach 6 and 12 weeks postoperatively . Up to now there has been no prospect i ve r and omized clinical study that has definitely shown the superiority of the minimally invasive procedure . For that reason , the conventional approaches in THR are still the gold st and ard The purpose of this r and omized clinical trial was to compare the > 20-year outcomes of cemented ( n=124 ) versus cementless ( n=126 )  total hip replacements ( THRs ) in patients with end-stage , unilateral hip osteoarthritis . At 20 years , 168 patients ( 67 % ) were available for follow-up , 78 ( 31 % ) had died , and 4 ( 2 % ) were lost . A power analysis was performed to determine the number of patients needed in each study cohort . Patients were assessed pre- and postoperatively by vali date d disease-specific Western Ontario McMaster Osteoarthritis Score , patient-specific McMaster Arthritis Score , global health ( sickness impact profile ) , functional capacity ( 6-minute walk ) , and cost utility ( cost-to- quality adjusted life years ) . Patients were followed every 2 years clinical ly and radiographically . The cementless THR outperformed its cemented counterpart in terms of overall ( P=.01 ) , socket ( P=.009 ) , and stem ( P<.0001 ) Kaplan-Meier survivorships . Patients younger than 65 years had significantly poorer cemented and cementless socket survivorships , and male sex adversely affected cementless socket survivorship . The cementless tapered stem had 100 % survivorship with aseptic loosening as the endpoint at 20 years . Although this study has demonstrated the superiority of the cementless THR over its cemented counterpart , care must be taken in generalizing these results to other cemented and cementless THRs BACKGROUND Improvements in surgical techniques and increase of femoral head size might have changed the rationale for movement restrictions after total hip replacement ( THR ) . AIM To evaluate the influence of movement restrictions and assistive devices on rehabilitation after fast track THR . DESIGN Non-r and omized , controlled study . SETTING Inpatient . POPULATION 365 consecutively included THR patients . METHODS Patients included the 3 initial month of the study underwent rehabilitation with restrictions in hip movement and a st and ard package of assistive devices ( restricted group ) . This group was compared to patients included the following 3 months with less restricted hip movement and use of assistive devices according to individual needs ( unrestricted group ) . Question naires on function , pain , quality of life ( HOOS ) , anxiety ( HADS ) , working status and patient satisfaction were completed before THR , 3 and 6 weeks after . RESULTS The HOOS function score at the 3 measurement times was ( mean ± SD ) ; unrestricted group : 46 ± 17 - 76 ± 9 - 83 ± 14 compared to restricted group : 43 ± 16 - 81 ± 14 - 83 ± 13 . Changes over time was significantly higher in the restricted group ( P=0.004 ) . Return to work 6 weeks after THR for the unrestricted group compared to restricted group was : 53 % versus 32 % ( P=0.045 ) . No significant differences between groups in pain , symptoms , quality of life , anxiety/depression , hip dislocations and patient satisfaction . CONCLUSION This study showed slightly slower recovery in patient-reported function after reduction in movement restrictions and use of assistive devices , but the difference was eliminated after 6 weeks . Reduced movement restrictions did not affect the other patient-reported outcomes and led to earlier return to work . CLINICAL REHABILITATION IMPACT It is possible to reduce movement restrictions and use of assistive devices considerably . More research on safety issues is needed to eluci date the effect of unrestricted rehabilitation on hip dislocation Hip osteoarthritis is very common and costly . The European League Against Rheumatology Committee agenda asks for research to investigate treatments able to slow down the progression of hip osteoarthritis ( OA ) , to delay joint replacement , and to determine the comparative effectiveness and cost-effectiveness of non-surgical and surgical treatment modalities as well as criteria relating to the indications for and timing of total hip replacement ( THR ) . After publishing the results of a r and omized controlled trial and a cohort study on the efficacy of Intra-articular sodium hyaluronate ( MW 1,500–2,000 kDa ) on symptomatic hip OA , we performed this retrospective study in patients suffering from hip OA treated with ultrasound-guided intra-articular injections of HyalOne ( Hyalubrix 60 Italian br and name ) involving a group of THR expert orthopedic surgeons to appraise whether or not considered eligible for THR and the frequency and timing of THR . Six orthopedists , not routinely performing hip intra-articular injections , each independently assessed whether 176 patients suffering from hip OA and treated with ultrasound-guided intra-articular injections of sodium hyaluronate ( MW 1,500–2,000 kDa ) were c and i date s for THR according to the clinical data ( age , body mass index , Pain Visual Analog Scale , Lequesne Algofunctional Index , global patient assessment , global physician assessment , nonsteroidal anti-inflammatory drug intake , and hip X-ray ) collected at the first intra-articular sodium hyaluronate injection visit and provided as anonymous electronic data . At 24 months , 159 out of 76 ( 90 % ) patients did not undergo to THR . At 48 months , 82 % ( N = 144 ) of the study population treated with intra-articular hyaluronic acid avoided THR . In the group of 93 patients considered c and i date s for THR ( that is , in which 4 , 5 , or 6 orthopedic surgeons agreed that the patient was a suitable c and i date for THR ) , only 17 had undergone THR , with survival results of 82 % at 24 months . At 48 months , this percentage reduced to 66 % in this group . In the other groups of patients ( in which respectively 3 , 2 , 1 or no surgeons were in agreement that the patient was a c and i date for THR ) arthroplasty is not recorded . Sodium hyaluronate ( MW 1,500–2,000 kDa ) given by ultrasound-guided injection seems to delay THR in the real context of actual overall management of symptomatic hip OA patients . Although further studies are necessary to confirm these data and to identify outcome predictors , hip viscosupplementation should be considered as conservative treatment to perform before proposing patients for THR There have been comparatively few studies of the incidence of osteolysis and the survival of hybrid and cementless total hip replacements ( THRs ) in patients younger than 50 years of age . We prospect ively review ed 78 patients ( 109 hips ) with a hybrid THR having a mean age of 43.4 years ( 21 to 50 ) and 79 patients ( 110 hips ) with a cementless THR with a mean age of 46.8 years ( 21 to 49 ) . The patients were evaluated clinical ly using the Harris hip score , the Western Ontario and McMaster Universities ( WOMAC ) osteoarthritis score and the University of California , Los Angeles ( UCLA ) activity score .  Radiographs and CT scans were assessed for loosening and osteolysis . The mean follow-up was for 18.4 years ( 16 to 19 ) in both groups . The mean post-operative Harris hip scores ( 91 points versus 90 points ) , the mean WOMAC scores ( 11 points versus 13 points ) and UCLA activity scores ( 6.9 points versus 7.1 points ) were similar in both groups . The revision rates of the acetabular component ( 13 % versus 16 % ) and the femoral component ( 3 % versus 4 % ) , and the survival of the acetabular component ( 87 % versus 84 % ) and the femoral component ( 97 % versus 96 % ) were similar in both groups . Although the long-term fixation of the acetabular metallic shell and the cemented and cementless femoral components was outst and ing , wear and peri-acetabular osteolysis constitute the major challenges of THR in young patients Summary Production of inflammatory mediators ( IM ) by cells and specifically macrophages around loosened implants may be responsible for their loosening . Our hypothesis was that different material s give rise to different amounts of these IM . It is thought that alumina/alumina for total hip replacement ( THR ) , which has been used for 15 years in our orthopedic department , may produce less IM than other systems . We initiated a clinical prospect i ve study to measure the level of prostagl and in E2 ( PGE2 ) in tissue surrounding loosened prostheses to quantify PGE2 production regarding the types of material involved in the friction couple , i.e. , alumina/alumina versus metal/polyethylene , and the type of fixation , i.e. , cemented versus cementless . A total of 29 THR revisions were performed in 28 patients . Four implant groups were identified : alumina/alumina cemented , alumina/alumina cementless , metal/polyethylene cemented , and metal/polyethylene cementless . For each revision , tissues surrounding the failed implants were harvested and processed , and the PGE2 was measured in a blind manner using an immunoassay technique . As the measuring technique was difficult , at least three determinations for each sample were necessary . Some sample s were excluded from the analysis for various reasons , for example , second or further revisions involving many different material s in the past , conjunction of metallic and alumina debris and sample s taken from nonloosened components . Finally , 15 sample s were considered adequate for inclusion in this study . Two groups were analyzed and compared : the alumina/alumina couple and the metal/polyethylene couple . Tissue surrounding the first group demonstrated a PGE2 level of 69 ± 56 fmol/mg wet weight compared to 202 ± 156 fmol/mg for the second . The Wilcoxon test was applied , and there was a statistical difference ( P < 0.05 ) . When the alumina/alumina cemented group was compared to the alumina/alumina cementless group , there was a tendency to less PGE2 with the cemented , but the difference was not statistically significant . Results thus demonstrate that alumina/alumina produces less IM than metal/polyethylene . However , these results do not indicate whether this is related to the type of debris , the amount , or both . This remains a preliminary study . Further studies with more sample s , other mediators and growth factors , and a precise comparison to histological findings are still necessary Background Exercise treatment is recommended for all patients with hip osteoarthritis ( OA ) , but its effect on the long-term need for total hip replacement ( THR ) is unknown . Methods We conducted a long-term follow-up of a r and omised trial investigating the efficacy of exercise therapy and patient education versus patient education only on the 6-year cumulative survival of the native hip to THR in 109 patients with symptomatic and radiographic hip OA . Results regarding the primary outcome measure of the trial , self-reported pain at 16 months follow-up , have been reported previously . Results There were no group differences at baseline . The response rate at follow-up was 94 % . 22 patients in the group receiving both exercise therapy and patient education and 31 patients in the group receiving patient education only underwent THR during the follow-up period , giving a 6-year cumulative survival of the native hip of 41 % and 25 % , respectively ( p=0.034 ) . The HR for survival of the native hip was 0.56 ( CI 0.32 to 0.96 ) for the exercise therapy group compared with the control group . Median time to THR was 5.4 and 3.5 years , respectively . The exercise therapy group had better self-reported hip function prior to THR or end of study , but no significant differences were found for pain and stiffness . Conclusions Our findings in this explanatory study suggest that exercise therapy in addition to patient education can reduce the need for THR by 44 % in patients with hip OA . Clinical Trials.gov number NCT00319423 ( original project protocol ) and NCT01338532 ( additional protocol for long-term follow-up ) We review ed the records of the long-term outcome of 208 Charnley and 982 Stanmore total hip replacements ( THR ) performed by or under the supervision of one surgeon from 1973 to 1987 . The Stanmore implant had a better survival rate before revision at 14 years ( 86 % to 79 % , p = 0.004 ) , but the difference only became apparent at ten years . The later Stanmore implants did better than the early ones ( 97 % to 92 % at ten years , p = 0.005 ) , the improvement coinciding with the introduction of a new cementing technique using a gun . Most of the Charnley implants were done before most of the Stanmore implants so that the difference between the results may in part be explained by improved methods , but this is not the complete explanation since a difference persisted for implants carried out during the same period of time . We conclude that improved techniques have reduced failure rates substantially . This improvement was much greater than that observed between these two design s of implant . Proof of the difference would require a very large r and omised controlled trial over a ten-year period We present a match-paired study between computer-assisted and freeh and techniques using a short modular femoral stem ( Metha ; B. Braun Aesculap , Tuttlingen , Germany ) in  total hip replacement ( THR ) .  Surgical time , clinical outcome , dislocation rate , limb length , and offset in 44 patients with ideal indication for this more conservative implant were assessed . Despite both longer surgical time and similar early outcomes , the results showed how computer-assisted techniques allow easier management of limb length discrepancy and offset restoring . We believe that navigated short modular stems are safe for less invasive THR Background and purpose There is still conflicting evidence about the true benefit of minimally invasive ( MI ) techniques in total hip replacement ( THR ) . The aim of this prospect i ve study was to evaluate the safeness of a MI approach during the learning curve of a single surgeon . Second , clinical and radiographic results among the  MI THR group were compared with the results using a st and ard transgluteal ( Bauer ) approach . Methods 86 primary unilateral total hip arthroplasties ( THAs ) through a MI , anterior ( Micro-hip ® ) approach were performed by a single senior surgeon ( ES ) , representing a consecutive series of patients after beginning with the MI technique . Cases were compared to a matched cohort of patients who were treated with a st and ard transgluteal ( Bauer ) approach .  Operation time , incision length , perioperative blood loss , haemoglobin level and blood transfusions were monitored . Complications were documented and followed up 1 year postoperatively . The Harris Hip Score ( HHS ) , range of motion , use of analgetics , the Trendelenburg sign , sensibility of the lateral femoral cutaneous nerve and the acetabular/femoral component placement as well as potential heterotopic ossifications were analysed in both the groups after 12 months postoperatively . Results 74 MI THR patients and 60 st and ard THR patients were available for the one year follow-up . Operative time was significantly longer in the MI group , reduction in the haemoglobin level during the first 24 h was significant and the length of skin incision was significantly shorter . No significant differences were found for HHS , range of motion , use of analgetics , the Trendelenburg sign , and the acetabular/femoral component placement , heterotopic ossifications and intra- and postoperative complications . Sensibility of the lateral femoral cutaneous nerve was affected in three patients in the MI group . Radiographic evaluation revealed no component migration , implant subsidence or radiolucency signs in both the groups . DicussionConsistent with recent meta- analysis we found reduced blood loss , similar clinical /radiographic outcome and similar complication rates compared to st and ard THA . Our study shows , that MI THR is a safe procedure during the learning curve of an experienced surgeon The aim of this study was to perform a cost-utility analysis of  total hip ( THR ) and knee replacement ( TKR ) .  Arthritis is a disabling condition that leads to long-term deterioration in quality of life . Total joint replacement , despite being one of the greatest advances in medicine of the modern era , has recently come under scrutiny . The National Health Service ( NHS ) has competing dem and s , and re source allocation is challenging in times of economic restraint . Patients who underwent THR ( n = 348 ) or TKR ( n = 323 ) between January and July 2010 in one Scottish region were entered into a prospect i ve arthroplasty data base . A health-utility score was derived from the EuroQol ( EQ-5D ) score pre-operatively and at one year , and was combined with individual life expectancy to derive the quality -adjusted life years ( QALYs ) gained . Two-way analysis of variance was used to compare QALYs gained between procedures , while controlling for baseline differences . The number of QALYs gained was higher after THR than after TKR ( 6.5 vs 4.0 years , p < 0.001 ) . The cost per QALY for THR was £ 1372 compared with £ 2101 for TKR . The predictors of an increase in QALYs gained were poorer health before surgery ( p < 0.001 ) and younger age ( p < 0.001 ) . General health ( EQ-5D VAS ) showed greater improvement after THR than after TKR ( p < 0.001 ) . This study provides up-to- date cost-effectiveness data for total joint replacement . THR and TKR are extremely effective both clinical ly and in terms of cost effectiveness , with costs that compare favourably to those of other medical interventions We r and omised 143 patients –age 75 years or older – with displaced femoral neck fracture to either internal fixation or total hip replacement ( THR )  and compared the socio-economic consequences . In the internal fixation group , 34 of 78 hips underwent secondary surgery . In the THR group , 12 of 68 hips dislocated , the majority in mentally impaired patients . We calculated the total hospital costs for two years after operation . When secondary surgery was included , there was no difference in costs between the internal fixation and THR groups , or between the mentally impaired and lucid subgroups .  The costs to the community were calculated comparing the baseline cost before surgery with the average cost per month during the first postoperative year . No difference was found between the treatment groups . The Harris hip scores were higher in the THR group , and pain was more common in the internal fixation group . In lucid patients , THR gives a better clinical result at the same cost . RésuméNous avons r and omisé 143 malades-âgés de 75 ans ou plus– avec une fracture du col fémoral déplacée traitée par fixation interne ou remplacement totale de la hanche et avons comparé les conséquences socio-économiques . Dans le groupe de la fixation interne , 34/78 hanches ont subi une chirurgie secondaire . Dans le groupe PTH , 12/68 hanches se sont luxées , la majorité chez des malades mentalement affaiblis . Nous avons calculé les coûts totaux d’hospitalisation jusqu’à deux années postopératoires . Qu and la chirurgie secondaire a été incluse , il n’y avait aucune différence dans les coûts entre la fixation interne et le groupe PTH , ou entre les sous-groupes mentalement affaibli et lucides . Les coûts municipaux ont été calculés en comparant le coût de base avant chirurgie avec le coût moyen par mois pendant la première année postopératoire . Aucune différence n’a été trouvée entre les groupes de traitement . Le score de hanche de Harris étaient supérieur dans le groupe PTH et la douleur était plus fréquente dans le groupe de la fixation interne . Chez les malades lucides , la PTH donne un meilleur résultat clinique au même coût A prospect i ve study of displaced femoral neck fractures was conducted with patients r and omized into three groups :  cemented total hip replacement ( THR ) , cemented hemiarthroplasty ( UHR-C ) , and noncemented hemiarthroplasty ( UHR-NC ) .  Eighty-nine patients were treated for displaced ( Garden type 3 or 4 ) fracture with a prosthesis ; 39 patients had THR , 37 had UHR-C , and 13 had UHR-NC .  No difference was found in the level of pain , ambulation , or aids required between the THR group and the UHR-C group , except for active community ambulators , who demonstrated decreased endurance capability when treated with UHR-C. The patients treated with UHR-NC had increased pain and decreased ambulation and required assistive devices . The most significant complication was dislocation , which occurred in 7 patients with THR and 2 with UHR-C. The mortality rate at 2 years was 18 % ; all but two of the deaths were in patients with one of five different medical diseases : clinical ly significant cardiac or pulmonary disease , cancer , alcoholism , or psychosis . The mortality rate was insignificant in patients younger than 70 years of age . Roentgenographic review showed only 2 of 76 cemented stems with progressive cement-bone demarcation , with one patient requiring revision for a loose prosthesis . No evidence of protrusio was seen with the use of the bipolar cap . The uncemented hemiarthroplasties demonstrated lucency between the metal and bone in the proximal femur in 9 of 13 stems . The authors make recommendations regarding hip replacement We developed a 12-item question naire for completion by patients having total hip replacement ( THR ) . A prospect i ve study of 220 patients was undertaken before operation and at follow-up six months later . Each completed the new question naire as well as the SF36 , and some the  Arthritis Impact Measurement Scales ( AIMS ) . An orthopaedic surgeon assessed the Charnley hip score . The single score derived from the question naire had a high internal consistency . Reproducibility was examined by test-retest reliability and was found to be satisfactory . The validity of the question naire was established by obtaining significant correlation in the expected direction with the Charnley scores and relevant scales of the SF36 and the AIMS . Sensitivity to change was assessed by analysing the differences between the preoperative scores and those at the follow-up . The st and ardised effect size for the new question naire compared favourably with that for the SF36 and the AIMS . The new question naire provides a measure of outcome for THR which is short , practical , reliable , valid and sensitive to clinical ly important changes OBJECTIVES To determine the 2 year total hip replacement ( THR ) rate and to identify factors predictive of THR due to primary osteoarthritis ( OA ) . METHODS A 2 year prospect i ve cohort study . Inclusion criteria were primary hip OA , with a history of pain for 6 months , and patients ' pain assessment of > or = 30 mm on a visual analogue scale ( 0 - 100 mm ) . Predictive factors of THR were identified by univariate then multivariate analysis using logistic regression . Potential predictors considered were demographic , radiographic ( localisation and severity of OA ) , and patients ' assessment of symptomatic severity of OA . RESULTS Of the 741 patients enrolled , 505 ( 68.2 % ) patients , mean ( SD ) age 64.0 ( 10.1 ) years , mean ( SD ) disease duration 4.7 ( 5.2 ) years , had complete 2 year data . There was no difference between the completer and non-completer groups . During follow up , 189/505 ( 37.4 % ) patients had a first THR . By multivariate analysis , predictors of THR were Kellgren-Lawrence radiographic grade ( grade III : odds ratio ( OR ) = 3.3 ( 95 % confidence interval ( 95 % CI ) 1.7 to 6.4 ) ; grade IV : OR = 5.3 ( 95 % CI 2.6 to 10.8 ) ) , high mean patient global assessment during the first 6 months ( OR = 2.2 ( 95 % CI 1.4 to 3.2 ) ) , and previous non-steroidal anti-inflammatory drug ( NSAID ) intake ( OR = 1.5 ( 95 % CI 1.0 to 2.4 ) ) . For two of these factors together , OR = 3.0 ( 95 % CI 1.6 to 5.9 ) , for three factors together , OR = 5.6 ( 95 % CI 2.6 to 12.2 ) . CONCLUSION The 2 year rate of THR was high in this group of patients with painful hip OA : 37.4 % . Radiological grade , mean patient global assessment , and the need for NSAIDs were predictive of THR The purpose of this study was to evaluate whether preoperative gait adaptations persist one year after THR in the same set of subjects . The hypothesis tested was that hip dynamic range of motion and peak external moments during walking return to normal after THR .  Hip kinematics and kinetics were measured for 28 subjects before and one year after THR  and compared to those of 25 subjects with radiographically normal hips . All THR subjects improved clinical ly after surgery with Harris hip scores improving from 33 - 85 ( average 53 ) to 61 - 100 ( average 95 ) ( sign test p<0.001 ) . Preoperatively dynamic hip range of motion ( ROM ) , and all peak external moments were reduced compared to normal ( Mann-Whitney p < or = 0.040 ) . Improvement was seen in the ROM and all but the frontal plane , and external rotation peak moments ( Friedman p < or = 0.023 ) . The preoperative and postoperative values of the ROM , and peak flexion , abduction and external rotation moments were all significantly correlated ( Spearman p<0.020 ) indicating a possible learned effect from before THR surgery . Postoperative THR subjects continued to have a significantly lower than normal ROM , and peak adduction and peak internal rotation moments ( Mann-Whitney p < or = 0.003 ) . Despite good to excellent clinical functional outcome , gait in THR patients does not return to normal by one year after surgery . Aggressive muscle strengthening is currently not emphasized after THR surgery . Some THR patients may benefit from more intensive rehabilitation before and after surgery BACKGROUND At present , there is an insufficient evidence base to evaluate the effectiveness of physiotherapy following total hip replacement ( THR ) . This study evaluated the effectiveness of a physiotherapy-supervised functional exercise programme between 12 and 18 weeks following THR . These time-points coincide with increased functional dem and in patients . DESIGN Adequately powered assessor-blinded r and omised controlled trial . SETTING Patients were recruited at a pre-operative assessment clinic and r and omised following surgery . PARTICIPANTS Sixty-three subjects were r and omised to either the  usual care group (  control , n=31 ) or the functional exercise+usual care group  ( n=32 ) . INTERVENTIONS Patients in the functional exercise group attended a physiotherapy-supervised functional exercise class twice weekly from 12 to 18 weeks following THR . Patients in the control group followed the usual care protocol with no exercise intervention . MAIN OUTCOME MEASUREMENT The main outcome measurement tool was the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) question naire , and the secondary outcomes included walking speed , hip abduction dynamometry , Short Form 12 physical and mental health scores , and visual analogue pain scale score . RESULTS At 18 weeks post surgery , WOMAC function and walking speed improved significantly more in the functional exercise group [ mean difference -4.0 , 95 % confidence interval ( CI ) -7.0 to 1.0 ( P<0.01 ) ; mean difference 21.9 m , 95 % CI 0.60 to 43.3 ( P<0.04 ) ] than the control group , but there was no significant difference in hip abductor strength . CONCLUSION This study demonstrated that patients who undertake a physiotherapy-led functional exercise programme between 12 and 18 weeks after THR may gain significant functional improvement compared with patients receiving usual care . Clinical trial registration number NCT01683201 Background The relationship between leisure time physical activity ( LPA ) and hip and knee OA and subsequent joint replacement has not yet been clearly defined . Some studies have found the risk of knee replacement ( TKR ) to increase with high levels of LPA , while others have found no overall relationship to either TKR or hip replacement ( THR ) . The aim was to investigate the association between LPA and the risk of severe end-stage OA  , defined as THR or TKR due to primary OA , in a large population -based cohort . Methods Participants in the Nord-Trøndelag Health Study ( HUNT ) were followed prospect ively to identify THR and TKR using the Norwegian Arthroplasty Register . Self-reported LPA was classified as inactive , low , moderate or high . The Cox proportional hazards model was used to calculate hazard ratios ( HRs ) according to levels of LPA with adjustments for confounding variables . Analyses were performed by age ( < 45 , 45–59 and ≥60 years ) and sex . Results A total of 66 964 participants ( mean age 46.8 years ( SD 16.3 ) were included in the analyses . We identified 1636 THRs and 1016 TKRs due to primary OA during 17.0 years ( median ) of follow-up . High LPA was significantly associated with THR for women < 45 years ( HR 1.78 , 95 % CI 1.08–2.94 ) and men between 45–59 years ( HR 1.53 , 95 % CI 1.10–2.13 ) at baseline . A significant trend was found only among women < 45 years at baseline ( p = 0.02 ) . We found that LPA was significantly associated with TKR for women only ( HR 1.45 , 95 % CI 1.03–2.04 ) . No measures of LPA were associated with TKR for men . Conclusion In this population -based study , high level of LPA was associated with increased risk of THR where a significant trend of LPA was seen among women < 45 years at baseline . For TKR , high LPA was associated with increased risk only in women . In contrast to previous studies , this study shows a possible association between high LPA and the risk of THR
Patients experienced significant post-THR improvements in Harris Hip scores , but this did not differ between impact types .
Recipients of cross-linked vs. conventional polyethylene cup liners experienced reduced femoral head penetration and revision .
There was no impact of femoral stem fixation and cup shell design on implant survival rates .
Evidence on mortality and complications ( aseptic loosening , femoral fracture ) was inconclusive .
BACKGROUND Evolvements in the design , fixation methods , size , and bearing surface of implants for  total hip replacement ( THR ) have led to a variety of options for healthcare professionals to consider .
The need to determine the most optimal combinations of THR implant is warranted .
This systematic review evaluated the clinical effectiveness of different types of THR used for the treatment of end stage arthritis of the hip .