Introduction: As the clinical burden of revision total hip arthroplasty (THA) and periprosthetic fracture (PPF) continues to increase, it has been suggested that use of anatomical stems may facilitate more uniform cement mantles and improve implant survival. The primary aim of this study was to determine the long-term survivorship and PPF rate of the anatomical Lubinus SP II 170 mm femoral stem in a single UK centre. Methods: Between 2000 and 2002, 80 consecutive THAs were performed using the 170 mm Lubinus SP II femoral stem in our institution. Patient demographics and operative details were collected in a prospective arthroplasty database. Patient records and national radiographic archives were then reviewed at a minimum of 20 years following surgery to identify occurrence of subsequent revision surgery, dislocation or periprosthetic fracture. Results: Mean patient age at surgery was 66.1 years (SD 12.2, 25-88 years). There were 40 women (52%). Osteoarthritis was the operative indication in 67 patients (86%). At mean 21.1 year follow-up (SD 0.7) there were 2 revisions in total (2 for acetabular loosening with original stems retained) and 6 dislocations (7.7 %). Analysis of all cause THA failure demonstrated a survivorship of 98.1% (97.7%-98.5%) at 10 years and 95.5% (94.9%–96.1%) at 20 years. Stem survivorship at 20 years was 100%. There were no periprosthetic fractures observed at mean 21.1 year follow-up. Conclusions: The Lubinus SP II stem demonstrated excellent survivorship and negligible PPF rates over 20 years following primary THA.

Introduction: Increasing life expectancy and patients' expectations are contributing to an ever-increasing need for long-term survival of total hip arthroplasty (THA) prostheses. The primary aim of the study is to evaluate the survival of Furlong Hydroxyapatite ceramic (HAC) coated femoral stems in primary THA, in addition to clinical evaluation using patient-reported outcome measures (PROMs). Methods: Retrospective cohort study for 385 patients (442 hips) underwent primary THA between (June 2008-December 2018). During the follow-up, 23 patients died and 36 patients (38 hips) were lost to follow-up. Prospective data collection for 326 patients (381 hips) to evaluate the stem survival using Kaplan-Meier method using aseptic loosening or revision for any reason as the endpoint. Clinical evaluation was done using the EQ-5D (EuroQol five dimension) score and PROMs using Oxford Hip Score (OHS) and Merle D’Aubigne Postel (MDP) score. Radiological assessment was done using the Engh radiological criteria for osteo-integration. Results: Survival of the Furlong stem after 14 years was 100% (95% CI 96.7-100%) with aseptic loosening as the end point, and 98.9% (95% CI 96.7- 100%) for any revision. Cup survival at 14 years was 99.41% (95%CI 95.2-100%) using aseptic loosening as the end point, and 97.6% (95%CI 95.2-100%) for any revision. The mean OHS was 44.5 (30-48) and the mean MDP score was 15.87 (10-18). Radiological evaluation has shown full osteo-integration of all stems. Conclusion: Furlong HAC stem gives excellent survival rates with full osteo-integration at 14 years of follow-up and minimal stress shielding with comparable results to other HA-coated stems.

Introduction: Metal-on-metal (MoM) total hip replacements (THR) were introduced to avoid the problems associated with polyethylene liner wear. It is well known that they are prone to Adverse Reactions to Metal Debris and subsequent failure, and they are no longer recommended for use. It is recommended that those patients who received them are regularly reviewed to detect these complications. All patients received an uncemented Corail femoral stem and an uncemented Pinnacle femoral head. Methods: local ethical approval was received for a retrospective review of the departmental database for all patients who received a MoM THR when they were 55 years old, or younger. Electronic patient records were reviewed for clinic letters, operation notes, and serum chromium and cobalt ion levels. Patients were contacted by telephone to gain consent to send them a paper Oxford Hip Score (OHS) questionnaire. Data was analysed using SPSS. Results: 109 procedures on 90 patients with a mean follow-up of 15 years. Sixteen patients have died, and at last review three have been lost to follow-up. Twelve prostheses (11%) required revision; 1 for subsidence, 2 for infection, 6 for metallosis, 3 for femoral loosening. Mean time to revision was 7.4 years. We are awaiting analysis of OHS scores and they will be included in the final presentation. Conclusion: MoM THR are no longer recommended for use, and they should receive long-term follow-up. However, this data can reassure those patients and their healthcare professionals that the majority of MoM THR continue to perform satisfactorily.

Introduction: Long-term survival rates are one of the main requirements in total hip arthroplasty (THA). Subsequent aseptic loosening of the cup due osteolysis and stress-shielding of the surrounding bone remains main reasons for complications. In revision cases, good bone stock is mandatory for sufficient anchorage of the cup. The design of the acetabular cup most likely to preserve a good bone stock is still controversial. Methods: This matched-pair study analysed 98 THA cases treated with two different cementless cups. In group A, the RM Pressfit vitamys cup was implanted. This is an isoelastic titanium coating cup with vitamin E-infused highly-crosslinked polyethylene. In group B, the Fitmore cup was implanted. This is a modular metal-back cup with a titanium shell and two sharp-edged fins. The polyethylene is made of highly-crosslinked polyethylene. Acetabular cup migration and wear were measured using the "Einzel-Bild-Röntgen-Analyse" (EBRA) software.Results: Mean follow-up time was 73.2 months in group A and 60.5 months in group B. HHS showed a major improvement in both groups without significant differences. In group A the mean cup migration was 1.67mm and the mean wear rate was 0.37mm. In group B the mean cup migration was 1.24mm and the mean total wear rate was 0.35mm. Conclusion: Our results could not support the hypothesis that monoblock cup can prevent acetabular stress shielding with reduced wear rates and cup migration compared to modular cup. Long-term data will be useful to determine the effect of modularity, isoelasticity and vitamin E stabilisation on cup loosening and survival rates.

Introduction: Dorr classification of proximal femur is based on cortical thickness and medullary canal morphology. Thicker cortices reduce risk of periprosthetic fracture or femoral stem subsidence. The purpose of this study was to compare complication rates between cemented and cementless femoral stems in Dorr type A in over 71–79-year-olds who have undergone THR. Methods: During the period 2016-17, we identified 71–79-year-olds who underwent THR. Exclusion criteria were previous hip surgery, complex primary THR, indications for THR other than primary osteoarthritis. All pre-operative radiographs were assessed for Dorr type. Femoral stem used was identified. Electronic patient records, radiographs, blood tests etc were analysed to identify any femoral stem related complications, to a minimum of 5 years post THR. Age, sex, BMI, American Society of Anaesthetists (ASA) grade and co-morbidities were compared. Chi-squared test to compare type of stem used and complications. Results: During the period 2016-17, we identified 593 THRs of which 157 were 71–79-year-olds. After exclusion criteria, 32/57 cementless stems and 37/81 cemented stems were Dorr A type femora. There were 2 fractures in cementless stems and 1 fracture in cemented stems. There were no revisions for loosening of femoral stems. Chi squared test showed no difference in complication rate. There were 11 deaths unrelated to THRs in this time. Conclusions: Dorr type A femora have similar incidence of complications for both cemented and cementless femoral stems at 5 years following THR in 71–79-year-olds.

Introduction: The decision to do a total hip arthroplasty(THA) or a hemiarthroplasty(HA) in an elderly with a fracture neck of femur(FNOF) is commonly based upon the surgeon’s preference, pre-anesthetic fitness, hospital setup, and intensive care backup. Sharma’s risk assessment score (SRAS) based on common factors, that affect the surgical outcomes following FNOF in the elderly. Methods: SRAS is based upon 10 parameters with each parameter having a max score of 4 and a minimum score of 1. It was hypothesized that a patient with FNOF with a preop SRAS score > 20 if subjected to a (HA) and a patient with a preop SRAS score< =20 if subjected to a (THA) would have better outcomes and low complications. Eighty-eight patients with FNOF were followed since May 2018 till date . Results: Average follow-up was 2.6 yrs (6 months to 4.8 years). The average SRAS was an average 25.7(21-32) in the HA group and 16.2 (11-20) in the THA group. Complications were seen in 12.7% of the THA group and 17.6 % in the HA group. We had a 2.1% 90-day mortality in the THA group and 2.9% 90-day mortality in the HA group. One year mortality in THA was 2.1% and it was increased to 5.8% in the HA group. Conclusion: SRAS is a useful decision-making tool that would guide surgeons to decide between THA or HA as a treatment option for elderly FNOF and would help minimize post-operative complications and reduce mortality

Introduction: Dislocation after elective THA is a well-known complication and a common reason for revision surgery. Whilst registers report on revisions for dislocation, a true dislocation rate following THA is difficult to ascertain. In this study, we explored the dislocation rate, the association between bearing size/type, approach and dislocation, recurrent dislocation, and revision. Material and methods: We designed a longitudinal cohort study linking the Swedish Arthroplasty Register with the National Patient Register, including patients with a unilateral elective THA from 1999 to 2014. The total dislocation rate, proportion of patients having reoccurring dislocations, revision rate, and revision rate for instability were recorded. Kaplan-Meier survival analyses and Cox multivariable regression models were fitted to calculate hazard ratios(HR) for the complete cohort and following stratification for approach. Results: 145,062 patients with elective unilateral THA and complete data were available for analysis. The dislocation rate was 2.0% after 1 year, while the revision rate due to dislocation was 0.3%. The dislocation rate was higher for posterior(PA) compared to lateral approach(LA)(2.6%versus1.3% at 1-year). Among patients with PA, a lower risk of dislocation was associated with bearing sizes >32 mm(HR=0.62,CI0.48-0.80) and dual mobility THA(DMC-THA)(HR=0.22,CI0.11-0.42). 11.6% of patients with a confirmed dislocation were revised within 1 year with female and younger patients as well as those operated through LA were more likely to be revised. Discussion: The dislocation rate after elective THA was expectedly considerably higher than the revision rate for this reason. When using PA, a bigger bearing size and DMC-THA might be better choices.

Background: Dislocation following total hip replacement (THR) remains a significant clinical problem and can occur even with optimal implant alignment. We hypothesized that different patterns of pelvic flexion/extension (PFE) during daily activities may influence acetabular alignment and contribute to impingement and instability following THR. Recently, there has been an increased interest in spinopelvic alignment and its impact on THR. Therefore, this study aimed at identifying different patterns of PFE that could be predictive of instability following THR.
Methods: A range of motion (ROM) simulator was used to demonstrate the effects of different patterns of PFE on ROM and impingement. The findings were applied to PFE measurements obtained from 84 patients in standing and sitting positions.
Results: Three different categories of PFE were identified: normal, hypermobile, and stiff. ROM simulator revealed that changes in PFE had affected ROM and impingement significantly. Patients in the stiff pelvis category, even with “optimal” implant alignment, were more susceptible to implant impingement.
Conclusion: The different patterns of PFE during daily activities could affect acetabular alignment and stability following THR. We propose a classification system that can identify different types of PFE and predict their effects on the stability of prostheses following THR. Consequently, we believe that patients with unfavorable PFE may require modified cup alignment.

Background: Development of Coxa Magna is one of the complications of DDH management by either open or closed reduction. Correction of hip dysplasia in the presence of an enlarged head requires re-directional osteotomies, such as Ganz osteotomy, to avoid reduction of the acetabular size. Such osteotomies are technically demanding and have a higher risk of complications. Patients and methods: Augmentation acetabuloplasty was performed in 13 patients with hip dysplasia, associated with Coxa Magna. There were three boys and ten girls. The average age was 6 years and 8 months. The postoperative function was assessed by Modified Mackay score. LCEA (lateral center edge angle) and AI were used to assess the radiological outcome. Results: According to the Modified Mackay score, four patients had excellent result, five had good, five had fair, and no one had poor outcome. The average Postoperative AI was 21.75 degrees. The Average Postoperative LCEA was 25 degrees. The average follow-up period was 18.5 months. Only one patient had significant postoperative stiffness which improved with physiotherapy. Conclusion: The short term functional and clinical outcomes of using augmentation acetabuloplasty to obtain coverage of dysplastic hips with coxa magna were satisfactory, and had low complications rate

Introduction:As the incidence of revision total joint arthroplasties continues to rise, it becomes increasingly important to understand the impact of individual medical comorbidities on perioperative outcomes. The purpose of this study was to identify risk factors for in-hospital mortality after revision total hip arthroplasty.
Methods: A single-institution retrospective study conducted on 210 patients who underwent aseptic revision total hip arthroplasty (rTHA) between March 1996 and March 2016. A total of 70 patients who died during hospitalization were analyzed. The control group was matched semi-randomly by surgical procedure (n =140; 1:2 ratio) who did not die during hospitalization. The two groups were evaluated in terms of patient and surgery related risk factors such as age, Charlson Comorbidity Index (CCI) and number of previous operations on the same hip. Results: Comparing the two groups, the deceased group had a significantly higher proportion of diabetes mellitus, as well as number of previous operations, need for blood transfusion, myocardial infarction (MI) and an increased CCI with an average of 4.1. Binominal logistic regression analysis showed that the probability of in-hospital death following rTHA increased 1.639-fold with each additional point of CCI, 1.861-fold with each additional point to the number of previous operations, and 4.035-fold with an additional history of MI. Conclusion:
High rate of CCI and number of previous operations, and also history of MI are the main risk factors for in-hospital mortality after rTHA. Therefore, we recommend that patients with these characteristics should be screened and selected carefully prior revision arthroplasty

The purpose of this study is to investigate the prevalence of unexpected positive cultures (UEPC) in hip and knee periprosthetic fracture (PPF) and its clinical significance.
This is a retrospective review of patients admitted to our spezialized arthroplasty center with hip and knee PPF, during the period December 2010 - 2021. Data collection included patients' demographics, patients' related factors predisposing to infection, preoperative investigations to rule out infection, postoperative microbiology or histology results of infection, and how patients with UEPC were treated. In all cases, 3-5 samples were taken for culture.
220 patients were admitted during the study period. The average age was 70 years (range 32-93 years). Female to male ratio was 1.3:1. 61 presented with knee PPF and 159 with hip PPF. Of the 220 patients, 15 patients (6.8%) had unexpected positive cultures diagnosed postoperatively on cultures and/or histopathology. Of those, 5 (3.1%) had two or more positive cultures of the same organism and were consequently diagnosed as infected. The most prevalent organisms were Staphylococcus epidermidis (35.0%), Cutibacterium acnes (15.0%), and Staphylococcus aureus (10.0%). The infected patients required a single-stage revision during the same stay, the other patients were treated conservatively. None of the patient-related risk factors were found to be associated with an increased risk of UEPC.
We propose routine preoperative aspiration for patients admitted with periprosthetic fracture, especially if the pre-test risk analysis of infection is elevated. Larger series are required to investigate the clinical significance of this rare situation.

The organism profile for peri-prosthetic joint infection caused by hematogenous seeding or direct inoculations is changing. The organisms that cause prosthetic joint infections range from normal skin colonizers to highly virulent pathogens. The pathogens continue to evolve. While staphylococcus aureus continues to be the leading organism, gram-negative bacilli account for approximately 7% of cases and that incidence is increasing. Methicillin-resistant S. aureus(MRSA) accounts for approximately 10% of all infections occurring in the community setting and 20% of those in the health care setting. The list of organisms causing PJI has expanded in recent years. It is important to have an understanding of which organisms may be causing a periprosthetic joint infection based on where the patient contracted it and their recent medical history. Also recent technology has expanded rapidly and new methods to detect the pathogen and why we failed in detected it. There are a number of explanations for the latter finding, perhaps with the most important reason being liberal use of antibiotics that interferes with isolation of the infective organism.

Mechanical failure due to spacer dislocation or spacer fracture are the main complications associated with the use of hip spacers in the treatment of periprosthetic joint infections. In this context, we have developed a novel custom-made spacer to reduce the risk of spacer related complications. We here present our mid-term results using the spacer technique. In this current study, we have enrolled a total of 73 patients, who have received the novel spacer technique in the management of periprosthetic joint infection of the hip. This technique involves the combination of a dual-mobility liner with a stainless cemented stem with the use of antibiotic-loaded bone cement. The primary outcome measure was the overall spacer complication rate. Furthermore, we have analyzed the eradication rate after reimplantation and the functional outcomes using the Harris Hip Score (HHS). Reimplantation could be performed in all patients. At latest follow-up (24 to 60 months), the reinfection after reimplantation was less than 7%. The overall complication rate was less than 10 %, while the spacer dislocation rate was 5%. Functional outcomes improved measured by the HHS. The novel spacer technique shows excellent results in the treatment of PJI with a low dislocation rate and excellent infection control after reimplantation.

Purpose: The purpose of this study is to evaluate the results of Combined subtrochanteric femoral valgus osteotomy and greater trochanter epiphysiodesis for cases of post-perthes proximal femoral deformity. Patients and Methods: In this prospective study, 16 legs in 14 patients with proximal femoral deformity secondary to perthes disease were included and treated in Tanta university hospitals between June 2020 and June 2022. The deformity was bilateral in two patients, and unilateral in 12 patients. Age of patients ranged between 10 and 16 years. Proximal femoral valgus osteotomy was performed and fixed by dynamic hip screw (DHS), follow by screw epiphysiodesis of the greater trochanter. Functional evaluation was done using Harris hip score (HHS). Results: The mean Harris hip score improved significantly from 63.5 to 86.5 points (p < 0.001), and the mean limb length discrepancy improved from 2.3 to 0.8 cm (p < 0.001). The mean neck-shaft angle increased from 115.6° to 128.7°, and the articulo-trochanteric distance has improved from −7.7 to 18.8 mm. Conclusion: Combined proximal femoral valgus osteotomy and greater trochanter epiphysiodesis in patients with post-perthes coxa vara, breva and trochanteric overgrowth, yielded good results, with relatively low complications. Keywords: Perthes disease. Proximal femoral osteotomy. Guided growth. Dynamic hip screw. Coxa brevis.

Introduction:Intertrochanteric fractures are one of the most common fractures among elderly population. These fractures are mainly classified into stable and unstable fractures.In unstable fracture patterns like involvement of lateral wall there is a controversy whether in addition to cephalomedullary nailing an augmentation procedure is required or not.In our study we intend to evaluate whether lateral wall fracture extension affects functional and radiological outcomes following single screw cephalomedullary nailing without any augmentation in Intertrochanteric fractures. Materials and methods:A retrospective observational study involving 100patients with Intertrochanteric fracture fixed with single screw cephalomedullary nail without augmentation was done. In postoperative X rays position of the screw and medial beak are noted.Follow up was done at 1,3 months and every6weeks till radiological fracture union.At the end of 3months or fracture union radiologically,functional outcome was assessed by Harris hip score. Result:Out of 100patients included in the study 83patients were available for follow up. Lateral wall fracture was found to be present in 78%based on X ray and CT scans.At final followup 2.4%patients had varus collapse and 2.5%had screwpenetration. Fracture union was noted in all patients at 3months follow up.90%patients had fair to excellent functional outcome based on Harris hipscores. Conclusion:In our study we had good radiological and functional outcomes with cephalomedullary nailing. No significant differences were noted in the outcomes of patients with and without lateral wall fractures. Achieving good reduction with either positive or neutral medialcortical support and position of screw in centralcentral or inferiorcentral position were more important than augmentation with additional implants.