Introduction: Despite the importance of infection eradication after the 1st stage of RHA (revision hip arthroplasty), some specialists ignore the necessity of PJI examination before the 2nd stage of RHA. The goal was to compare the diagnostic accuracy before the second stage of revision hip arthroplasty in patients with hip joint spacer. Methods: In our prospective study from 2018-2023 we examined 107 patients with the hip joint spacer to exclude reinfection/recurrence of PJI. The patients were divided into two groups. In the 1st group (prospective) were included 55 patients with extended diagnostic protocol: hip joint aspiration, blood tests for ESR, CRP. In the 2d group (retrospective) were 52 patients with only preoperative ESR, CRP blood tests. Results: The reinfection among patients in both groups according to the results of intraoperative microbiological examination during the RHA 2d stage was identified in 40% of cases: in the 1st – 9 cases, in the 2d group – 31 cases. The diagnostic accuracy of serum markers level in both groups demonstrated weak results. In the 1st group - 55.5% and 65.5% (for ESR and CRP, respectively) and 53.2% and 64.7% (for ESR and CRP, respectively) in the 2d group. The diagnostic accuracy level of preoperative aspiration in the 1st group patients demonstrated 82.6%. Conclusion: The extended preoperative protocol with aspiration allows to reduce the risk of PJI by 3.44 times during the RHA 2d stage. The highest diagnostic accuracy marker was the hip aspiration – 82.6%, which allow to changed treatment tactics in 9%.

Revision total hip arthroplasty is becoming more and more popular. The surgical approach can vary based on anatomy, patient position, experience, and surgeon habits. Surgeons often choose the posterior incision, while the current literature has very few articles on revision total hip arthroplasty using anterior incision. In this paper, we present 3 cases of revision total hip arthroplasty using minimally invasive anterior incision technique for those who had been treated the primary total hip replacement combined with the disaster complications to emphasize the feasibility of this approach and re-evaluate the clinical, X-ray imaging, and patient satisfaction. These cases highlight that total hip replacement can be successfully performed through anterior incision with a minimally invasive procedure that offers many advantages such as minimizing soft tissue damage, early rehabilitation, improve mobility rapidly.

Aim: Evaluation of the results of using the modified anterior approach developed by us - without dissection and damage to muscles, blood vessels, and lateral cutaneous nerve during hip replacement.
Materials and methods: A comparative analysis of two groups of patients.The control group consisted of 185 people who underwent total hip replacement using the Anterior Approach (Smith-Petersen) technique in the supine position. The experimental group consisted of 200 patients who underwent surgery through modified anterior lateral access. The analysis of the frequency of damage to anatomical structures in the area of intervention was carried out.
Results: In the Experimental group, damage to the tensor fascia latae was noted in 5%, and in the control group – in 87%. When performing the classical anterior access on the back, coagulation of the vessels encircling the femur was performed in all cases, and with a modified anterior access on the side – in 7%. Postoperative neuropathy of the lateral cutaneous nerve of the femur in the experimental group was diagnosed in 1%, in the control group in 12.4% of cases. Conclusion: Performing hip replacement through our modified anterior approach, the risk of damage to the lateral cutaneous nerve of the thigh, lateral vessels encircling the femur, and muscle fibers decreases; the severity of pain syndrome decreases, which contributes to earlier activation of the patient and acceleration of rehabilitation.

Introduction: This study assessed adherence to national guidelines for managing distal femur and pathological fractures at a London district general hospital. As these fractures become more prevalent, adherence to evidence-based guidelines become crucial for optimal outcomes. Methods: A retrospective cohort study including distal femur, pathological, and peri-prosthetic fractures. Data collected at 6 months and 1 year postoperatively. Results: 44 patients, 16 had distal femur fractures DDF (average age 81), 12 had pathological fractures PF (average age 75), and 5 had peri-prosthetic fractures PPF (average age 85). 3 patients were non-operative due to comorbidities, and 8 patients deceased before 6-month review. The average length of stay was 22 days for DDF, 6 days for PF, and 61 days for PPF. Wait times for surgery were 3, 18, and 32 days, respectively. 9 distal femur patients were allowed full weight-bearing postoperatively, compared to 2 pathological femur fracture patients; none of the peri-prosthetic fracture patients were permitted full weight-bearing. Patients permitted full weight-bearing had shorter stays (average 13 days FWB vs. 23 days NWB). At 6 months, 8 patients had non-union (39%), and 11 were wheelchair-bound (52%). Discharge destinations varied. Discussion: Standardized protocols and multidisciplinary collaboration are crucial in fracture management. Addressing gaps in adherence to guidelines, particularly in post-operative care and rehabilitation, helps improve patient care. Conclusion: This audit provides insights into current practices and areas for improvement in managing distal femur and pathological fractures. Enhancing adherence to evidence-based guidelines, especially in post-operative care, can improve patient outcomes.

This study aims to evaluate the implementation of a day-case pathway for total hip (THR), total knee (TKR) and unicompartmental knee (UKR) arthroplasty within an NHS hospital. The primary outcome was the rate of successful same day discharge (SDD). Secondary outcomes included length of hospital stay, post-operative pain scores, opioid consumption, time to mobilisation, performance during physical therapy, Oxford Hip/Knee Scores and 30-day re-admission rate. A consecutive series of 47 cases was studied comprising patients undergoing THR (19/47), TKR (20/47) and UKR (8/47).

The overall rate of SDD discharge was 25/47 (53%). Reasons for failure included delay in physiotherapy assessment, pain management and hypotension. The 30-day re-admission rate was 2/47 (4%). The rate of SDD for THR patients was 11/19 (58%). Their mean length of hospital stay was 9 hours and time to mobilisation was 206 minutes. The mean pre- and post-operative Oxford Hip Scores were 23 and 42, respectively. The mean visual analogue scores (VAS) for pain were 4/10 (immediate), 5/10 (6 hours) and 5/10 (24 hours).

The rate of SDD for TKR patients was 11/20 (55%) and for UKR patients was 3/8 (38%). Their mean length of hospital stay was 8 hours and time to mobilisation was 191 minutes. The mean pre- and post-operative Oxford Knee Scores were 24 and 34, respectively. The mean post-operative VAS for pain were 4/10 (immediate), 5/10 (6 hours) and 5/10 (24 hours).

Our experience highlights the feasibility of employing a day-case pathway for hip and knee arthroplasty within an NHS hospital.

Background: Whether the direct anterior approach (DAA) for total hip arthroplasty (THA) is associated with improved outcomes compared to other approaches in patients with lumbar spine stiffness is uncertain. Methods: We conducted a systematic review and meta-analysis comparing DAA versus other surgical approaches in patients with lumbar spine stiffness undergoing THA. PubMed, Embase and Cochrane Central databases were searched for cohort studies and randomized controlled trials. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated to assess dislocation rates. Results: In an analysis of 11 nonrandomized studies involving 2,505 patients, 738 patients (29.4%) underwent DAA. Patients who underwent THA via DAA had reduced rates of dislocations (RR 0.31, 95% CI 0.14–0.67, P=0.003, I²=0%) compared to other surgical approaches. Subgroup analysis demonstrated significantly lower dislocation rates in DAA patients compared to the posterior approach (RR 0.22, 95% CI 0.10–0.52, P=0.001, I²=0%), while no statistically significant difference was observed compared to the lateral approach (RR 0.53, 95% CI 0.19–1.47, P=0.22, I²=0%), despite a lower numerical rate. Conclusions: In patients with lumbar spine stiffness undergoing THA, DAA was associated with lower dislocation rates compared to other surgical techniques.

Background: Heterotopic ossification (HO) can occur after hemiarthroplasty (HA) for femoral neck fractures (FNF). The present study aimed to investigate the frequency of and factors contributing to the development of HO after HA. Methods: Data from 92 (26 male, 66 female) of 183 patients who sustained FNF and underwent HA between April 2019 and January 2022, were included in the present study. HO was identified on postoperative radiographic images, which in turn were the basis for calculating the incidence of HO. Patient background, operative duration, blood loss, and the presence of free bone fragment(s) immediately after surgery identified on radiographic images were compared between the HO and non-HO groups. Statistical analysis included the independent-sample t-test for continuous variables and the chi-squared test for categorical variables. Multivariate analysis using logistic regression analysis was performed with HO as the objective variable. Results: HO occurred in 47 of 92 (51%) patients. There were no statistical differences in patient backgrounds. Univariate analysis revealed that mean operative duration and blood loss were significantly greater in the HO group. Free bone fragments in the immediate postoperative period were observed in 25 of 47 (53%) patients in the HO group and in 5 of 45 (11%) in the non-HO group, a difference that was statistically significant. Logistic regression analysis revealed that the presence of free bone fragments was an independent explanatory factor for the development of HO. Conclusion: The presence of free bone fragments immediately after surgery may be significantly associated with the development of HO.

Introduction: Fast track elective arthroplasty (FTS) is well defined opiod sparing orthopedic procedure.
Methods: The first aim of this study was to determine is it possible to do FTS into the general orthopedic and trauma hospital. The second aim was to compare clinical outcome between standard and fast track elective hip procedures.
Study was last for 2 years and follow up was at least one year. Including criteria for the study was hip osteoarthritis foreseen to primary elective total arthroplasty from single surgeon. Patients were randomly distributed from surgeon's elective list into „Fast track“ and „Standard“ group.
Total number of 295 patients were mobilized for the study. Inhospital lenght of stay (LOS) was recorded, laboratory values during hospitalization and up to 3 months, average pain in intervals, Harris hip score (HHS) and overall complications during the follow up.
Results: There was significantly shorter LOS in FT group. There was no blood transfusion in FT group and 7 (5.1%) in S group. CRP level was significantly less elevated in FT patients and comes faster to normal values in both check points postoperatively. Average VAS in FT group was lower, HHS was higher in FT group in control intervals. There was 4 readmissions in FT group and 5 in S group.
Conclusion: This study showed that elective hip FTS is safe and efficient orthopedic procedure applicable into standard hospital organisational settings. FTS brings beneffits to patients itself for faster recovery. Overall complications was not different in both groups.

Introduction: Total Hip Arthroplasty(THA) is procedure of choice hip arthritis. But this procedure can become technically challenging in presence of a deformed proximal femur. A proximally deformed femur may necessitate corrective osteotomies and there is a need to use special custom made stems. Little is known about the outcomes of THA in proximally deformed femur. We carried out this systematic review of literature to determine the most common causes of proximal femur deformity and to look for outcomes and survivorship of the THA implants in this scenario. Methods: A literature search was conducted in databases like PubMed, EMBASE, SCOPUS and Cochrane. A total of 21 studies out of 882 studies met our inclusion criteria. A total of 819 THA were included in study in which the average age of 39 years with a mean follow up of 7.26 years. Results:Most common cause of proximal femur deformity included Development dysplasia of hip and post traumatic deformity of proximal femur. 8 studies reported the use of corrective osteotomies for deformity correction with the subtrochanteric osteotomy being the most commonly employed technique. The most commonly used stem was the non-modular stem (57.14%) followed by modular stem like S-ROM and custom made stems. Modified Harris Hip Score remains the most commonly used tool to assess the functionality which increased in all the cases with final scores being in the range of 74-89. Femoral canal perforation is the most common complication. Stem survivorship ranged from 76% to 94% with 9 studies reporting revision THA .

Introduction: Heterotopic Ossification (HO) is one of the commonest complications after Total Hip Arthroplasty (THA) with incidence ranges from 15-90%. As per recent studies, HO can be attributed to immune cell infiltration and inflammation involving cytokines and Interleukin (IL). Tranexamic Acid (TXA) is a synthetic derivative of lysine which is mainly used as a fibrinolysis inhibitor in THA to prevent excessive bleeding. Recent studies have shown TXA modulates inflammatory response by reducing levels of CRP, IL-6, TNF-α, reactive oxygen species and MMP-9. Another study showed that TXA reduces the recurrence of HO after excision in elbow injury. There are currently no studies demonstrating effect of local TXA on HO after THA. Methods: Patients undergoing elective primary THA at district hospital in Wales from 2017-2023 were selected and divided into two groups depending on whether they received TXA capsular infiltration during the time of closure. Their immediate post op and follow up X rays were then evaluated based on Brooker classification for evidence of HO. Results: There were 90 patients in Group A (No TXA) and 45 patients in Group B (TXA). About 55.56% patients in Group A developed HO, with 10% having Grade 3or4. In Group B, 18.7% patients developed HO with 3.125% having Grade 3. There was no significant difference between cemented and uncemented implants. Conclusion: Local infiltration of TXA significantly reduces incidence of HO after THA due to its anti-inflammatory properties. However, there is a need of further studies with a larger patient population to support these findings.

Background:
The efficacy of total hip arthroplasty (THA) for patients with minimal or no radiographic signs of osteoarthritis (OA) is unclear. We aimed to evaluate their outcomes, identify predictive factors (comorbidities, CT or MRI findings), and compare their results with to the expected outcome of THA for hip OA.

Methods:
Adults undergoing THA for hip pain without significant radiographic features of OA (Tönnis grading scale ≤1) were selected from 1,925 consecutive THAs. Exclusion criteria included inflammatory arthritis, femoral head osteonecrosis, and patients lacking ≥1-year follow-up or patient-reported outcome measures (PROMs). Primary outcome: Oxford Hip Score (OHS). Secondary outcomes: EQ-VAS, UCLA scale, and validated patient satisfaction assessment (‘better’, ‘same’, ‘worse’).

Results:
107 patients (median age 41, range 18-73) were included with mean follow-up 6.0 ± SD 3.1 years. All received a diagnostic hip injection as decision aid. Median postoperative Oxford Hip Score (OHS) was 34 (IQR 28-42); 33% achieved OHS ≥ 42—lower than typical THA patients in international registries. Secondary outcomes: UCLA 6 (4-8), EQ-VAS 73 (51-80); 89% felt ‘better’ and would ‘undergo surgery again.’ Patients with chronic pain syndrome or hypermobility had lower OHS (-6 points, p < 0.01). 84 had CT, 34 had MRI. Those with subchondral cysts (OHS 42, 37-45 vs. 35, 26-36; p=0.01) or joint space narrowing on CT (OHS 42, IQR 37-44 vs. 35, 26-36, p=0.02) had higher function.

Conclusion:
Despite high satisfaction, THA patients without radiographic OA had lower postoperative function. We recommend obtaining CT imaging and a diagnostic hip injection to aid decision-making.

Background: Acetabular revision surgery is challenging due to the occurrence of bony defects that complicate the fixation of implants. Poor bone quality in geriatric patients makes it even more difficult. The MUTARS® RS cup system is a cementless revision cup with an integrated polyethylene cup. It offers the option for a tripolar head in unstable conditions. The aim of this study was to evaluate the clinical and radiographic results after revision arthroplasty with the MUTARS® RS cup system in geriatric patients (age > 70 years). Methods: From 2019 to 2023, 22 geriatric patients, 10 males, 12 females, with a mean age of 79.2 years (range 70-94 years) were provided with the MUTARS® RS cup system (implantcast GmbH, Buxtehude, Germany). After a mean follow-up of 2.5 years (range 1-4 years), the Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Oxford Hip Score (OHS), EQ-5D-5L, and radiographs (AP and axial view) were analyzed. Results: A total of 17 patients (77.3%) remained. Two patients died. One patient was revised for reinfection (4.5%), and 2 (9%) for recurrent instability. The average HHS was 71.8 (range 52-93), the average OHS was 32.4 (range 27-40), and the average WOMAC was 12.6 (range 4-20). According to EQ-5D-5L there were 10 patients (58.8%) with slight problems, 6 patients (35.3%) with moderate problems, and 1 patient (5.9%) with severe problems. The x-ray showed no migration of the components, in 15 cases (88.2%) radiolucent lines around the caudal flap in the os ischii were seen.

Introduction:
The Direct Anterior Approach (DAA) has garnered attention as a surgical technique for total hip arthroplasty due to enhanced patient outcomes. However, its application in complex primary and revision cases remains a subject of exploration and investigation. We share insights from our experience with the DAA in the context of 15 complex primary and revision total hip replacements, focusing on early outcomes and an extensile approach tailored to revision cases.

Methods:
We followed 15 cases involving intricate primary and revision total hip replacements, all carried out using the Direct Anterior Approach. These cases were selected based on the complexity of hip pathologies, including severe osteoarthritis, prior failed hip surgeries, and challenging anatomical variations. The documentation involved patient demographics, intraoperative findings, implant selection, and postoperative outcomes.

Results:
Our analysis revealed DAA approach is compatible with THA for complex hip pathologies and revision surgeries. Early outcomes from our series indicate favourable early functional recovery and pain relief, accompanied by a low incidence of complications. The length of hospital stay was an average of 2.7 days. Additionally, we will demonstrate an extended application of the DAA for revision cases, facilitating access to the acetabulum and femoral components while minimizing disruption of the abductor mechanism

Conclusion:
The Direct Anterior Approach holds promise as an option for complex primary and revision total hip replacements. The present study offers insights gained from 15 cases, emphasizing surgical techniques tailored for complex primary cases and an expanded approach to revision procedures.