Our study aimed to compare clinical and radiological outcomes of Total Hip Arthroplasty (THA) via Direct Anterior Approach (DAA) versus Posterior Approach (PA) in a South-east Asian population, particularly in India. We included 40 patients with unilateral symptomatic hip arthritis, evenly split between the two approaches. Follow-ups were conducted at intervals up to one year postoperatively. Muscle fatty atrophy and soft tissue damage were assessed using muscle damage and inflammatory markers (ESR, CRP, LDH, Creatine Kinase, Myoglobin, Creatinine) and MRI scans preoperatively, at 3 months, and 1 year postoperatively. Functional outcomes were evaluated using gait analysis, Harris Hip Scores, and Forgotten Joint Score-12. Radiographs and EOS™ scan evaluated implant positioning and leg length. Return to activities of daily living was tracked using a milestone diary. Results showed higher postoperative muscle damage and inflammatory markers in the PA group, notably elevated CRP levels at POD 1-2(p=0.035) and 2 weeks(p=0.020). MRI scans revealed significant differences in fatty atrophy: Gluteus medius, Gluteus minimus, Piriformis, Obturator Internus, Obturator Externus, and Quadratus femoris had higher incidences in the PA group, while the Tensor Fasciae Latae exhibited a higher incidence in the DAA group. DAA patients demonstrated superior gait parameters postoperatively, with significant improvements in mean velocity(p=0.023) and stride length(p=0.013). Acetabular cup positioning fell within the safe zone for both groups, with no complications or dislocations. In summary, our findings suggest that DAA may offer advantages over PA in terms of reduced muscle damage, inflammation, and improved early gait parameters in patients undergoing THA.

Purpose: This systematic review and meta-analysis aimed to compare the outcomes of cemented collared composite beam (CB) and collarless taper slip (TS) femoral stems in Total hip arthroplasty (THA).
Methods: Four databases were searched from inception until August 2023 for original studies that compared the outcomes of cemented CB and TS femoral stems following THA. The primary outcome was the aseptic loosening; the secondary outcomes were periprosthetic fractures, instability, dislocation, revision, survivorship, and periprosthetic infection (PJI). This review was conducted in line with PRISMA guidelines.
Results: A total of 11 studies with 730,769 hips were included, with a mean follow-up period of 8.48 ± 6.07 years and average MINORS score of 17.36 ± 1.86. There was a statistically significant difference in aseptic loosening (OR, 0.28; 95% CI, 0.19–0.43; p < 0.001), and PJI rate (OR, 0.61; 95% CI, 0.53–0.71; p < 0.001) between the CB and TS groups in favor of the latter. However, periprosthetic fracture, revision rate, survivorship, instability, and dislocation were all similar across both groups (P=NS).
Conclusion: This study demonstrated a significantly higher aseptic loosening and PJI in the CB group compared to the TS stem type. However, other outcomes were comparable. These results must be interpreted in context due to confounding effects.
Level of Evidence: III
Keywords: Total hip arthroplasty; Charnley; Exeter; Composite beam; Taper slip

INTRODUCTION:
Management of severe acetabular bone defect in the setting of revision Total hip replacement (rTHA) poses a challenge in achieving good bone stock with stable and durable fixation of component, and restoration of center of rotation of hip joint. We report the clinical, radiological results and complications using prefabricated porous coated flanged acetabular cup for type II/III Paprosky acetabular bone loss.
MATERIAL AND METHODOLOGY:
This retrospective study included 20 patients with paprosky type II/III acetabular bone loss who underwent rTHA using morselized femoral head graft and prefabricated porous coated flanged acetabular cup. Clinical assessment included Harris hip score (HHS) and radiological assessment comprised of graft incorporation, centre of rotation of hip. Complications like infection, dislocation, migration of cup, loosening were also recorded.
RESULT:
This study comprised of 20 cases which includes 10 cases of type II and 15 cases of type III paprosky acetabular bone loss. The mean age is 45.6 years (range:28-74 years). The HHS improved significantly at the last follow-up. Superficial infection was found in 2 cases which was amenable to debridement and antibiotics. None of our patients had any evidence of cup loosening and migration. All patients had graft incorporation by last follow-up.
CONCLUSION:
Prefabricated porous coated flanged acetabular cup having caudal hook for obturator foramen and lugs for ilium fixation provides a durable and stable method of fixation with good to excellent functional outcome with minimal complication rate in the setting of revision total hip arthroplasty.

Introduction: The clinical outcomes of total hip arthroplasty (THA) in neglected or failed acetabular fractures are not often studied. THA is a reliable procedure following failed treatment of acetabular fractures. The aim of our study was to evaluate the influence of the acetabular fracture leading to posttraumatic arthritis between the arthritis and instability groups on the clinical and radiological outcomes of conversion THA. Methods: Between January 2011 and January 2020, 128 patients underwent conversion THA after failed acetabular fractures. After exclusions, 121 patients were included in the final cohort, with 85 patients in the arthritis group and 36 patients in the instability group. Intraoperative measures and preoperative and follow-up clinical, radiological, and functional outcomes were compared between the arthritis and instability groups. Any complications and revision surgery noted in the follow-up. Results: There was a significant improvement in Harris Hip Scores (HHS) post-surgery in both groups. However, a significant difference in the mean HHS was not observed between the two groups (p = 0.16). The time interval between the index surgery to THA was significantly shorter in the instability group. The vertical offset was significantly higher in the instability group (p = 0.03), and vertical offset and inclination were not statistically significant (p = 0.69). Conclusion: Conversion THA after posttraumatic arthritis due to acetabular fractures yields good to excellent outcomes. THA for the instability group gives equally good outcomes compared to the arthritis group. However, the instability group, associated with acetabular bone defects, requires more reconstructive options.

ABSTRACT BACKGROUND: 3D-printed implants are one of the options for acetabulum reconstruction. The popularity of this technique is increasing every year.AIM: To evaluate the early clinical, radiological and functional results of revision arthroplasty using individual acetabular components in patients with acetabulum bone defects.MATERIALS AND METHODS: Revision endoprosthetics was performed in 64 patients. There were 50 female and 14 male patients. The patients’ mean age was 60.4±13.4 (23–89) years. According to the Paprosky classification, the defects in 1 case corresponded to type IIC, in 15 cases to type IIIA, in 48 cases to type IIIB, including 8 cases with violation of the acetabulum discontinuity . Hip joint function was assessed using the Harris Hip Score (HHS), pain severity using the Visual Analogue Scale (VAS), and social adjustment using the Western Ontario and McMaster Universities Arthritis Index (WOMAC).RESULTS: Significant improvement was obtained on all assessment scales. The HHS score improved on average from 33.6 to 87.1 points, the VAS scale from 78.1 to 4.7 points, and the WOMAC from 75.8 to 11.6 points. There were 8 cases (12,5%) with complications in total. In one case with a violation of the acetabulum integrity we observed migration of the sciatic bone from the lower flange of the construct. CONCLUSION: Thus, the results of the acetabulum reconstruction using individually fabricated acetabular components are promising

Sickle cell anemia is a hereditary condition when a mutation occurs where negatively charged glutamine is replaced by a neutral Valine at the sixth position of the beta-globin chain. The mutation is transmitted via Mendelian genetics and is inherited in an autosomal dominant fashion. Sickle cell anemia brings about a change in the shape of RBC from circular to sickle shape on exposure to hypoxia which clog end arteries and in femur bring about AVN.

Material and Methods:
12 hips with sickle cell AVN of the femoral head with grade 1 to 3 AVN and with good hip motion were selected for live autologous cultured osteoblast Concentrate implantation following core decompression. The concentrate was certified to be having 48 million osteoblasts in a volume of 4 ml of DMEM transport media and without any antigens of infection. In making this concentrate from bone marrow cold chain and asepsis was maintained throughout the 4-week procedure.

Results:
The short term results of the procedure has given comparable results to that of patient with idiopathic AVN of the femoral Heads. All these patients were permitted weight bearing at 3 weeks.

Conclusion:
Autologous Live cultured osteoblasts concentrate remains a viable option in treating early Grade 1 and 2 AVN in Femoral head affected by Sickle cell AVN.

Concerns of THA in younger patients less than 35 years is high failure rate due to higher activity level and increased life expectancy. Present study is based on clinico-radiological outcome with minimum 5 years follow up.

A prospective analytical study of 110 patients (160 hips) operated between July 2004 and June 2012. Functional outcome analysis and satisfaction level assessed by HHS, SF-36 score and WOMAC scores. Radiological parameters were assessed. Student’s t-test was used for analysis.

Sixty (54.5%) were unilateral while fifty (44.5%) were bilateral. Mean follow-up 8.16 years (5-12 years). Mean age 28.96 years. 61.8% were male, 38.2% females. Common causes were AVN (50%) followed by ankylosing spondylitis (22%). 92.8% (n=148) cementless implants with 70.7% (n=113) ceramic on ceramic, 24.6% Ceramic on Poly and 3% metal on poly. The average acetabular inclination was 40.43deg±6.0, anatomical anteversion was in 82% (n=131). Mean vertical offset was 5.72+ 0.26cm and horizontal offset was 3.77+0.29cm. The radiological limb length discrepancy was 0.6±0.15cm shortening (n=64) and lengthening was 0.59±0.15 (n=32). The femoral stem position was in neutral in 55.6% (n=89) patients. Harris hip score, SF-36 and WOMAC score showed significant improvement (p<0.0001). Neither infection nor loosening was observed. Incidentally, ninety patients were able to sit cross legged and squat during latest followup.

Based on the acceptable radiological parameters studied and the functional outcome scores assessed the outcome was excellent among the young requiring no revision till date. First of its kind studied in Indian scenario with radiological parameters results with minimum 5 years follow-up.

Introduction: We present only the difficult cases of THR in high dislocated hip. Femoral canal is frequently distorted in severe cases of DDH. Starting from this idea we have developed an original classification of femoral defect. Materials and Methods: We have operated 122 patients with DDH. First 61 cases were operated using a cemented femoral stem with trochanterotomy, femoral shortening osteotomy and trochanteroplasty Kerboull-Postel. The others 61 cases were operated with uncemented femoral stem with femoral subtrochanteric triple osteotomy - shortening, correction of valgus and rotation. Results: The non-union of greater trochanter in 5 cases has leaded us to adopt the technique of triple femoral osteotomy, using a non-cemented femoral component functioning as a centromedulary nail. The lengthening obtained varied from 4,5 to 6 cm and we did not record any case of palsy, neither total nor partial, of the sciatic nerve. No septic complications or nonunion of femoral osteotomy did not occur. Conclusion: The femoral dysplastic vice is present in DDH. The femoral torsion with sever helitorsion angle – is a good indication for femoral triple osteotomy. The prosthetic replacement in cases of hips with congenital dysplasia is difficult in the high, unstable dislocations, but surgery offers the satisfaction of achieving a stable and mobile hip as well as an equal length of the limbs in patients of an average age of 42 years. The triple femoral osteotomy and uncemented femoral prostheses, seems to be attractive, femoral complications have not been yet noticed.

Introduction: The incidence of total hip revision surgery is increasing, with acetabular failure being the most common cause. Management of acetabular defects is complex and challenging. The development of Porous Metal Augments (PMA) is shown to be an effective option, with less morbidity and improved function. Methods: Single-center retrospective study of patients treated between 2014-2023. Inclusion criteria: Acetabular revision, use of PMA and follow-up >6 months. Demographic, clinical and radiological parameters were analyzed. Results: 44 patients were included. 22 were females. Median age was 73 years (38-92). 24 right and 20 left hips. The reason for the revision was aseptic loosening in 40 hips, infection in 3 hips, and instability in 1 hip. Femoral revision was performed in 21 hips. Based on Paprosky classification, 7 defects were classified as IIB, 2 as IIC, 18 as IIIA, and 17 as IIIB. The median surgery time was 159 minutes (72-309) and estimated blood loss was 800mL (250-2400). Two patients developed complications requiring new surgery (1 periprosthetic infection and 1 fixation failure with intra-pelvic cup migration). 42 hips showed good osteointegration as identified by absence of radiolucent lines. In 38 hips, the final hip center was lower than preoperatively. All patients demonstrated improvement in pain, satisfaction and HOOS scores. Discussion: PMA demonstrated good osteointegration, providing reliable fixation and recovery of the hip center, improving overall patient satisfaction, with a low complication rate. Conclusion: PMA constitute a proven solution for acetabular defects in revision hip arthroplasty.

Introduction: Robotic-arm-assisted surgery (MAKO, Stryker) is helpful in THA by improving the accuracy of implant placement. However, there are few reports on their accuracy in cases with complex pelvic morphology, such as after pelvic osteotomy, using 3D image analysis software. We examined the accuracy of the cup position of patients who underwent THA after pelvic osteotomy using MAKO, compared with that of a control group. Methods: Post-pelvic osteotomy cases of patients who underwent THA using MAKO between 2021 and 2023 at our hospital were included in the study (PO). The control group was selected using propensity score matching from cases of osteoarthritis without previous pelvic surgery, who had undergone THA using MAKO with a similar technique (Control). Age, gender, and BMI were selected as covariates. Preoperative planning and postoperative CT images were imported into 3D image analysis software (ZedHip, LEXI), and the pelvic coordinate system was matched. Finally, the accuracy of cup placement was calculated, evaluating the absolute values of displacements in radiographic inclination, radiographic anteversion, Anterior-Posterior, Medial-Lateral, and Superior-Inferior directions (ΔRI, ΔRA, ΔAP, ΔML, ΔSI). Results: Control and PO included 24 patients each. The accuracy was significantly inferior in PO than in Control for ΔRI (1.4° vs. 0.6°; P value=0.038). However, no significant difference was observed for ΔRA, ΔAP, ΔML, and ΔSI (1.6° vs. 1.4°; P value=0.944, 1.1mm vs. 1.2mm; P value=0.734, 1.8mm vs. 1.3mm; P value=0.226, 1.6mm vs. 1.2mm; P value=0.103). Conclusion: THA with MAKO can be performed with high accuracy, even in patients with previous pelvic osteotomies.

Introduction: While technology in total hip arthroplasty (THA) is generally developed by experienced surgeons, particular difficulties in surgical steps and technical demands experienced by early-career surgeons remain important. This study queried the challenges early-career surgeons currently face in THA, to obtain insights into how they perceive future innovative technologies might reduce the difficulties and complications associated with THA. Methods:The American Association of Hip and Knee Surgeons Young Arthroplasty Group was surveyed. The perceived degree of difficulty with key THA surgical steps (scale 1-10, from No difficulty to Very difficult), and utility of adjunctive technology (scale 1-10, from Not important to Very important) were recorded. Results: Membership response rate was 16.1%. The most common THA approach was direct anterior (67.4%), followed by posterior (25.5%). Four out of the top five most difficult surgical steps were associated with cup preparation/placement. Fluoroscopy was the current most used technology (56.7%), followed by no technology use (21.2%) and robot-arm assistance (12.1%). With respect to the importance of technology, accurate cup placement ranked first (mean score 7.5 points). Dislocation and stem subsidence were the top two complications for which technologic advances were thought to be most beneficial. Conclusion: This is the first survey to reveal data about perceived difficulties in THA surgical steps, from the perspective of early-career arthroplasty surgeons in the United States, and the role of technology in mitigating these complications. Future technological developments may take these needs of early-career surgeons into account.

Objective: To evaluate the accuracy of the cup placement angle of the Hip navigation system (Stryker), a CT-based navigation system, and the Naviswiss (Kyocera), a portable navigation system.
Subjects and Methods: Patients underwent total hip arthroplasty for developmental dysplasia of the hip (Crowe type I/II) between April 2020 and December 2022 in our hospital. All patients were treated with a posterior approach in the lateral decubitus position, with group C using a CT-based navigation system and group N using a portable navigation system (Naviswiss). The target angles of radiographic inclination (RI) and radiographic anteversion (RA) were 40° and 20°, respectively. 38 patients in group C and 63 patients in group N were matched 1:1 for propensity score by logistic regression analysis with age, sex, and BMI as explanatory variables. The study items were operative time, navigation error (absolute value of the error between the displayed navigation value and the actual insertion angle), and complications.
Results: After matching, there were 32 cases in group C and 32 cases in group N. The navigation errors were RI 2.8±2.1° and RA 3.4±2.1° for group C and RI 2.5±1.7° and RA 3.8±3.6° for group N. The RA error was significantly larger in group P. The operative time was 104.34±32.5 minutes for group C and 94.9±25.5 minutes for group N. The operative time for group C was longer.
Conclusion: The accuracy of navigation was better with CT-based navigation due to differences in registration methods and other factors. However, CT-based navigation tended to increase operative time.

Arthroscopic hip surgery effectively addresses femoroacetabular impingement and related conditions but may lead to postoperative complications like capsulo-labral adhesions and heterotopic ossification (HO). Losartan, inhibiting TGFβ-1, aims to reduce fibrosis risk, while NSAIDs like naproxen or celecoxib assist in decreasing HO incidence. This study aims to identify unsuitable candidates, quantify adherence, and report treatment adverse effects of postoperative Losartan and NSAID protocols in hip arthroscopy patients.

A prospective multicenter study enrolled 48 eligible patients (M=22, F=26) aged 16-60 (Mean=36.41, SD=13.93). Following surgery, patients followed the Losartan protocol (12.5mg orally on the second post-operative evening, then 12.5mg orally twice a day for two weeks) and NSAID protocol (Naproxen 500mg orally twice a day or Celecoxib 100mg orally twice a day for two weeks). At the routine six-week follow-up, patients completed a questionnaire regarding treatment compliance and reported side effects.

One patient did not initiate Losartan due to low blood pressure, while two patients avoided NSAIDs due to allergies. No major adverse events were recorded. Among those on Losartan (n=47), one missed a dose, whereas among Celecoxib/Naproxen users (n=43), three discontinued early due to perceived ineffectiveness, stomach issues, or unspecified reasons. Side effects were reported by 5 patients taking Losartan (tiredness, nausea & vomiting) and 5 taking NSAID (dizziness).
Postoperative employment of Losartan and NSAIDs in hip arthroscopy patients showed robust adherence, and safety. Consideration must be made for patients with preexisting dyspepsia. These protocols have been embedded into NAHR (Non-Arthroplasty Hip Registry) minimal dataset to report prescribing practice in the UK.

Introduction: Ceramic-on-ceramic (CoC) bearings offer superior wear characteristics and a low coefficient of friction, yet their use is limited due to reported risks of ceramic fractures in the literature. We assessed our series of patients undergoing total hip arthroplasty (THA) with 36mm CoC bearings. Methods: Prospective evaluation of 385 patients (442 hips) undergoing primary THA between 2008 and 2018 was conducted. Twenty-three patients deceased and 36 patients (38 hips) were lost to follow-up. Data were prospectively collected for 326 patients (381 hips) who had uncemented THA with 36-CoC bearings. Kaplan-Meier analysis was used to assess survival with ceramic fracture or revision as endpoints. Clinical evaluation was done using EQ-5D and Oxford Hip Score (OHS). Incidence of squeaking and ceramic-related complications, dislocation, and infection were recorded. Results: Survival of CoC bearings was 100% (95% CI 96.7-100%) at 14 years with ceramic fracture, failure, or revision due to squeaking as the endpoint. Mean OHS was 44.5 (30-48). Occasional squeaking was reported by 28 patients (7.3%), without pain or revision surgery due to squeaking. Squeaking correlated significantly with younger age (<60 years; P=0.002). Dislocations occurred in 2 cases (0.5%) and prosthetic joint infection in 1 (0.3%). Conclusion: THA with CoC bearings using 4th generation BIOLOX delta ceramic heads yielded excellent 14-year results, with no ceramic fractures or squeaking-related revisions. The optimal position of the bearing surface is crucial to mitigate fracture risk, while larger heads reduce dislocation risk. The observed low infection rate may be attributed to reduced biofilm formation on ceramic surfaces.