Introduction: We analysed the long-term outcome of revision hip arthroplasty using the novel BioBall adapter system in multimorbid patients with THA instability.

Materials and methods: 19 multimorbid patients undergoing THA revision surgery with novel BioBall adapters were followed-up for maximum 12 years using standard hip scores and statistical analyses with Kruskall-Wallis and Kaplan-Meier analyses.

Results: The patients achieved a median of 17 points in the Merle d` Aubigné in 2004 and of 18 points in 2011 and 2015. Harris Hip Score evaluation showed comparable results and patients had a median Barthel index of 90 in 2004, 100 in 2011 and 90 in 2015.
Due to the small patient numbers the results were constant over long-term observation but statistically not significant.

Conclusions: In multimorbid patients with THA dislocation BioBall adapters proved to result in good long-term clinical outcome without impairment of quality of life.

Introduction: Use of ceramic bearings in total hip replacement is increasing, especially in younger patients but there are still reports of Ceramic failures and dealing with the revision surgeries in these cases is challenging. Material and Methods: We present our experience of 10 hips (9 patients) who underwent revision for ceramic failures between 2008-2012.Seven patients reported squeaking. There were 8 head and 3 ceramic liner fractures. Seven patients had a small head (28mm) with short neck. All patients had revision with titanium sleeve with ceramic bearing with revision of the socket to a uncemented cup. One patient was lost to follow up and 1 deceased. Eight hips (7 patients) were followed up clinically and radiologically. Post-operative Oxford Hip Scores were obtained, and the radiographs were accessed for osteolysis, loosening, subsidence and osteo-integration. Results: All patients had good to excellent function and Oxford Hip Score except one patient who had periprosthetic fracture and regained the function after the healing of the fracture. There were no Re-revisions for bearing wear, osteolysis. Radiological follow up did not show any osteolysis or loosening in any of the hips. Discussion: There are limited follow up results of revision hips following ceramic failures. Our Study highlights the importance of early diagnosis, prompt surgery with extensive debridement and use of appropriate titanium sleeve with revised ceramic bearing couple can yield satisfactory mid-term results. Conclusions: Our study shows good clinical and radiological mid-term results of ceramic failure revision hip replacements.

Revision Total Hip Replacement for recurrent dislocation is a difficult task. Medical and orthopaedic comorbidities increase the risk of recurrent instability.
Correction of component malposition with the use of Dual Mobility systems seem appropriate in most cases. In the absence of component malposition and/or after multiple attempts of revision, the use of a constrained liner can be useful. Medical comorbidities and abductor mechanism deficiency are important factors to take into consideration. We propose a treatment algorithm for recurrent dislocation of the hip.
We also report on the 4- to 14-year follow-up of 13 revisions with the use of a fully constrained liner in the treatment of recurrent dislocation with no previous component malposition. All cups were uncemented and fixed with a minimum of 3 screws. All patients had either medical comorbidities, abductor insufficiency or multiple previous revision attempts that had failed. The success rate was 85% for eradication of instability. No implant loosening was reported. This limited series confirms that fully constrained liners can be a useful tool in the treatment of difficult instability cases. The locking mechanism of the constrained liner could be improved, since failure was limited to liner dissociation.

Introduction:
For total hip arthroplasty in Dysplastic hips specially crowe type 2 and 3, there may be deficient dome. Cup may be uncovered. For covering the cup it is possible to use structural graft. But, union of graft to ilium and strength of graft is in doubt. Acetabuluplasty with augment is an option istead of bone graft.

Materials and methods:
From 2010 to 2019 , every case of Total hip in dysplastic cases which need acetabuloplasty were stud-ied. Loosenong of cup was considered the end point of successful arthroplasty in these cases.In one group bone graft and in the other group augment were used for acetabuloplasty.

Results:
42 cases need acetabuloplasty. Bone graft was used in 31cases and augment in 11 cases. There were 4 cup loosening in the graft group and no loosening in augment group.

Discussion:
Augment can be used for acetabuloplasty in dysplastic cases with good and reliable results. It gives immediate stable fixation to the cup. Cup loosening may be happened if bone graft is not united to ilium or if it is resorbed. These complications are noot seen with augment. On the other hand, augment in-ceases the cost of arhroplasty.

Background. Aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL) development (including pseudotumors) secondary to metal debris generation around total hip arthroplasties is a well recognized histopathologic phenomenon. The complexity of treatment of such condition lies in periprosthetic osteolysis, which compromise the stability of the revision implant.
Objectives. Aim was to report results of complex revision surgery in patients suffering from “pseudotumor”, analyzing 1) implants survival, 2) incidence of complications and 3) functional results.
Material and Methods. We retrospectively analyzed patients 14 patients (3 males, 11 females, mean age of 68 years) treated between June 2016 and May 2019. Revision surgery was performed using standard or custom-made 3D-printed prostheses. Complications classified as acute (intra-operative), early (within 6 months), late (after 6 months). The functional results were assessed using the Harris Hip Score.
Results. At a mean follow-up of 30 months (range, 18-54 months), four patients (28%) reported as early complications a wound dehiscence requiring surgical debridement without implant removal. Survival rate to all complications was of 71%. Functional results were excellent in all patients. Mean pre-operative Harris Hip Score was 35 (range 18-45) and post-operative score was 74 (range 60-89).
Conclusions. Prosthetic revision associated with pseudotumor excision is the key of treatment; it can be performed in a single or in two stages surgery. The prosthetic revision can be performed with standard revision prostheses or custom-made prostheses, depending on the type of bone defect. The use of custom-made 3D-printed prostheses is increasing and, in such a case, two-stage revision is advisable.

Purpose: To compare the accuracy and the inter- and intra-observer reliability of preoperative digital 2D templating in prosthesis size prediction for the planning of cemented or uncemented THA. Methods: This study was registered in the NIHR PROSPERO database (ID: CRD42020216649) and conducted according to the PRISMA guidelines. A search of electronic databases in March 2021 found 29 papers overall. The quality of evidence was assessed using the IHE Quality Appraisal of Case Series Studies Checklist and the CASP Randomised Controlled Trials Checklist. A meta-analysis was conducted and the accuracy was presented as proportions and the inter- and intra-observer reliability was measured using intraclass correlation coefficients (ICC). Results: Accuracy within one prosthesis size (+/-1) for cemented stems was 0.89 (95% confidence interval (CI95): 0.83-0.95), cemented cups 0.78 (CI95 0.67-0.89), uncemented stems 0.74 (CI95 0.66-0.82) and uncemented cups 0.73 (CI95 0.67-0.79) (test of group differences: p = 0.010). Inter-observer reliability (ICC) for uncemented cups was 0.88 (CI95 0.85-0.91), uncemented stems 0.86 (CI95 0.81-0.91), cemented stems 0.69 (CI95 0.54-0.84) and cemented cups 0.68 (CI95 0.55-0.81) (test of group differences: p=0.004). Due to lack of data, intra-observer reliability (ICC) could only be calculated for uncemented prostheses, which for the stems was 0.90 (CI95 0.88-0.92) and for the cups was 0.87 (CI95 0.83-0.90) (test of group differences: p = 0.124). Conclusion: The accuracy of preoperative digital templating is greater for cemented prostheses, but the inter-observer reliability is greater for uncemented prostheses. The intra-observer reliability showed a high level of agreement for uncemented prostheses.

Introduction: There is limited literature evaluating the impact of ESRD on long-term outcomes after THA surgery. Methods: Using New York State’s Statewide Planning and Research Cooperation System, patients admitted from 2009 to 2011 with diagnoses of ESRD who underwent THA with a minimum 2-year follow-up surveillance were retrospectively reviewed. A 1:1 propensity score-match by age and gender was performed before analyzing data. Univariate analyses evaluated demographics and postoperative outcomes. Multivariate binary logistic regression models were also conducted to identify correlations between ESRD and postoperative outcomes, controlling for sex and age. Results: A total of 456 propensity score-matched patients were identified (ESRD: n = 290; no-ESRD: n = 290). Patients with ESRD incurred higher total charges across THA surgery-related visits ($78,045 vs. $47,582, P<0.001) and had longer total length of stay (8.43 days vs. 4.29 days; p <0.001). Two years post-operatively, patients with ESRD compared to non-ESRD patients had higher rates of adverse postoperative outcomes (p>0.05). These outcomes were surgical complications (wound complications, nonunion of fracture, and transfusion of blood), medical complications (acute myocardial infarction, pneumonia, acute renal failure, sepsis), postoperative readmission, and in-hospital mortality (all, p<0.05). Conclusion: Patients with ESRD incurred higher hospital charges and experienced higher overall complication, readmission, and mortality rates than patient without ESRD from New York State undergoing THA. These results can support management of postoperative expectations and concerns in this patient cohort.

Introduction: Cemented hip arthroplasty is associated with an entity known as bone cement implantation syndrome characterised by hypoxia, hypotension or both and/or unexpected loss of consciousness. There is a lacuna on studies amongst the Indian population. Methods: 40 consecutive elderly patients undergoing cemented stem hip arthroplasty were enrolled. The heart rate, systolic arterial pressure, diastolic arterial pressure and saturation were recorded at base line and after implantation of bone cement. Patient data analysed based on Donaldson criteria.
Results: Study depicted an incidence of 32.5%. The incidence of grade1,2,3 was 22.5%,7.5% and 2.5% respectively. There was no correlation drawn between comorbidities of the patients and presence of the condition. However, all the patients with history of dementia, myocardial infarction and stroke developed the syndrome. A significant correlation was drawn with patients of left ventricular failure (p-value 0.03). The severity of bone cement implantation syndrome was associated with a significant increase in pre-operative neutrophils (p-value 0.037) and hyponatremia (p-value 0.042) compared to patients with mild condition. Significant decrease in systolic blood pressure was found in patients with presence of the condition at 5,10 and 15 minutes after cementing, with highly significant decrease in systolic blood pressure at 5 minutes after cementing. Furthermore significant decrease in oxygen saturation was found 5,10,15 minutes after cementing with highly significant decrease in saturation at 5 minutes after cementing.
Conclusion: Thus bone cement implantation syndrome is a commonly occurring phenomena in elderly which is fairly under-reported leading to significant intra-operative findings

Introduction: Certain types of femoral stems have proven to increase the risk of subsidence. For example, Clair et al. found that modular femoral stem implants result in significantly greater subsidence in comparison to monoblock or nonmodular implants (3.9 vs. 2.3 mm, p < 0.001) in patients who underwent revision total hip arthroplasty (THA). To our knowledge, no study to date has examined subsidence in relation to the degree of the femoral stem taper. The purpose of this study was to compare the subsidence of 2° and 3° tapered femoral stems in patients who underwent revision THA. Methods: A retrospective study of patients who underwent revision THA within the past 12 years at the Rothman Orthopaedic Institute was performed. Patients’ post-operative radiograph immediately after surgery and the 6 month post-operative radiograph were compared to determine the amount of subsidence by the femoral stem. Subsidence measurements were based on a technique described by Ilchmann et. al. Results: Two degree tapered femoral stems resulted in greater subsidence compared to three degree tapered femoral stems. Eight percent of the two degree tapered fluted femoral stems subsided. Conclusion: When considering tapered fluted femoral stems for a revision situation, the orthopaedic surgeon should consider the degree of the taper of femoral stem when selecting the implant. A relatively large percentage of two degree tapered fluted stems were found to subside postoperatively.