Introduction: Bone preservation is the main challenge in total hip arthroplasty (THA). The cementless titanium-coated, isoelastic monoblock cup with vitamin E-blended highly cross-linked polyethylene (VEPE) was introduced to the market in 2009 to increase the implant survival rate and decrease the aseptic loosening. The aim of the present study was to obtain long-term clinical follow-up data of vitamys cup (Fa. Mathys, Bettlach, Switzerland).
This single-centre prospective study investigated 101 primary THA cases in 96 patients treated with a RM Pressfit vitamys cup. Clinical follow-up was performed using the Harris Hip Score (HHS), pain and satisfaction on a visual analogue scale (VAS). Radiological acetabular bone alterations and complications were documented.
At minimum 10 years follow-up (mean 129.3 months, range: 126.1-148.9) 70 cases were analyzed. 24 cases were deceased with implants in situ. 7 cases were lost to follow-up. The mean HHS was 96.4, VAS satisfaction was 9.9, VAS rest pain was 0.0, and VAS load pain was 0.2. Radiographic analysis revealed one case with osteolysis without clinical symptoms. Two patients had trauma-related periprosthetic fractures after 5 and 10 years. One patient had a persistent femoral nerve palsy. None of the patients required cup-related revision due to aseptic loosening, mechanical failure, or any other reason after 10 years.
After using VEPE in cementless isoelastic monoblock cups, there were no obvious signs of aseptic loosening occurred. No patients required revision surgery after 10 years follow-up. A survival of 100% indicates reliable and encouraging long-term results for the titanium-coated RM Pressfit vitamys cup.

The principal idea of developing short stem hip implants was to create short stems that are favorable for minimally invasive implantation with improved osteointegration. A historical overview describes successes and failures. The comparatively good results of various registers from Europe and Australia are presented. Special cases in patients with different short-stem implants outside of the considered indication are presented, especially in dysplasia, femoral head necrosis and in very young patients. The implantation allows soft and bone-preserving techniques and has shown good individual results since 2005 in more than 2000 cases operated by the author and his team mainly with an anterolateral MI approach and the neck-sparing Nanos stem. The experience from more than 200 instructional operations and training courses is brought in. Biomechanical studies have shown that anatomically curved, neck-preserving hip stems are favorable for MI implantation due to a minimal entry with low unfavourable stress. The femoral neck can be partially preserved and serves as an anchoring area that facilitates primary stability.

Background

The aims of this study were to compare the revision rate and the long-term survivorship between two generations of DMC in primary intention.

Methods
This retrospective monocentric study included 150 primary total hip arthroplasties (THA) performed with uncemented DMC of first and second generations between 2006 and 2012. The mean follow-up was 14.2 years ±1.1 [10-16]. The mean age was 77±10 years old. Complications and revisions have been researched retrospectively. Ten-years Kaplan-Meier survival was calculated based on the following endpoints: implant removal for any reason or cup removal for any reason.

Results
At the last follow-up, the revision rate was 9.1% in the 1st DMC group and 1.6% in the 2nd DMC group (p=0.10). In the 1st DMC group, the two revisions were performed for early aseptic loosening of the cup at one et six years postoperatively. There was no revision for cup loosening at a minimum follow-up of 10 years in the 2nd DMC group (p=0.021). The global survival rates at 10 and 15 years were 90.4% in the 1st DMC group and 98.1% in the 2nd DMC group (p=0.06). The cup revision-free survival rates at 10 and 15 years were 90.4% in the 1st DMC group and 98.9% in the 2nd DMC group (p=0.009).

Conclusion
The 2nd generation of DMC with a double coating of plasma spray titanium and hydroxyapatite had a lower risk of aseptic loosening than the previous generation with an excellent survival rate at minimum 10-year follow-up without specific complications.

The relationship between sagittal spinal alignment and total hip arthroplasty (THA) attract significant research including hip-spine relationship. However, literature regarding the coronal spinal alignment (CSA) in patients undergoing THA remains sparse, particularly regarding its links with leg length discrepancy.

The aim of the present study is to evaluate the variations of coronal radiographic spinopelvic parameters following total hip arthroplasty. acetabular inclination and intra-articular length discrepancy.
Methods: Among 241 THA, 183 who underwent a Mako robotic-arm assisted THA between 2019 and 2022 were selected and 58 excluded. Preoperative, postoperative and difference of intra-articular length discrepancy (IALD), Cobb angle, pelvic obliquity, and coronal balance, were recorded as well as acetabular inclination (AI) for every patient.
Results: Of the 183 patients selected, 107 were balanced, 76 were unbalanced, including 35 THA in the convexity and 41 in the concavity. In the general population, between pre and postoperative the THA significantly improves coronal balance (12.6mm+/-10.4 to 6.2mm +/-13 ; p<0.0001) but with no change in Cobb angle and pelvic obliquity. The unbalanced group improves the Cobb angle compared to the balanced group (-0.95 vs 0.08 ; p=0.008) and the opposite is found for the coronal balance (-0.16 vs -12 ; p<0.0001).

THA respecting the IALD of the opposite side decreases the coronal balance, but does not influence the Cobb angle and pelvic obliquity. Finally, the smaller difference in IALD, the greater improvement in Cobb angle and pelvic obliquity.

Introduction:

The latest 3D planning of total hip arthroplasty (THA) makes it possible to take into account the lumbopelvic adaptability and flexibility during extreme position of the everyday life. The objective of this work was to compare the modeled mobility of a robotic THA between several fixed femoral anteversions (FA) and a personalized one.

Material and methods:

This was a retrospective study of 53 patients operated on for THA using the Mako system (Mako Total Hip 4.0 software; Stryker, USA). For each, a CT-scan planning has been carried out. The planning goals of the acetabular cup were: minimum diameter according to the simulated bone resection, absence of anterior overhang, displacement of the center of rotation ≤5 mm medially and ≤3 mm superior
Results :
The percentage of minimal mobility obtained with AFp compared to fixed AFs of 0°, 10°, 20° and 30° was:
- EXT ≥ 40°: 100% versus 100% (p=1), 94.3% (p=0.08), 77.4% (p=0.0002) and 35.9% (p<0, 0001),
- RE ≥ 30°: 100% versus 100% (p=1), 96.2% (p=0.153), 73.6% (p<0.0001) and 43.4% (p<0.0001),
- FLEX ≥ 130°: 92.5% versus 58.5% (p<0.0001), 81.1% (p=0.09), 86.8% (p=0.339) and 100% (p= 0.04),
- Minimum IR ≥ 50°: 86.8% versus 39.6% (p<0.0001), 69.8% (p=0.033), 92.5% (p=0.339) and 100% (p=0.006 ).

Conclusion :
Optimization of maximum mobility before impingement of a THA must include personalized femoral anteversion while taking into account static and dynamic lumbopelvic parameters.

Background: Patients with ankylosing spondylitis often have fusions in the spine and sacroiliac joints, such that it is difficult to compensate for the difference in length of the lower extremities.
Methods: We retrospectively measured the difference in lower extremity length after total hip arthroplasty(THA) in 89 patients with ankylosing spondylitis from June 2004 to February 2021 at Our institute. Patients were divided into two groups based on a difference in lower extremity length of 5 mm or 10 mm. Clinical outcomes were investigated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Harris Hip Score (HHS). In addition, these points are investigated : patient satisfaction with the operation; whether there was a current difference in leg length; and whether there was a limping gait.
Results: The group with a leg length difference of 5–10 mm rather than <5 mm had significantly worse WOMAC pain and stiffness. The survey revealed statistically significant differences in patient satisfaction with the operation, limping gait, and whether back pain had improved.
Conclusion: For patients with ankylosing spondylitis, reducing the difference in length of the lower extremities to <5 mm, which is more accurate than the current standard of <10 mm, may produce greater improvement in clinical outcomes after hip arthroplasty.

Background: the reconstruction of acetabular bone defects encountered during revision hip arthroplasty is a challenging task for surgeons especially in large defects; Paprosky type II and III. By reviewing the literature, no single gold standard method for reconstruction of these defects was found. Trabecular metal augments have gained a lot of momentum in the management of moderate to severe acetabular bone defects as it is variable in size and shape allowing a customized reconstruction of the bony defect. Aim: to evaluate early functional and radiological outcomes in patients undergoing revision total hip arthroplasty with acetabular defects using trabecular metal augments. Patients and methods: a prospective cohort study was conducted between April 2019 and March 2023 in Benha university hospital including twenty patients underwent revision total hip arthroplasty with acetabular defects using trabecular metal augments. According to Paprosky classification, 9 patients had Paprosky type IIB defect (45%), 6 patients had type IIA defects (30%) and 5 patients had type IIIA defect (25%). Results: the mean age of patients was 59 years old with mean follow up of 16 months. The average of short form 12 health survey results has increased from 29.5 preoperative to 50.5 postoperative. Oxford Hip Score had improved from 12.85 (5-20) preoperatively to 38.9 (27-46) at the latest follow up visit. Conclusion: porous metal augments are considered a valuable method in the management of acetabular defect due to its modularity and the ability to reconstruct different types of defects with no fear of bone resorption.

Femoral stem fracture following total hip arthroplasty (THA) is an infrequent but nevertheless devastating complication. The aim of this study was to perform a systematic review and meta-analysis of risk factors for femoral stem fracture to help identify at risk patients.

A systematic search was conducted on EMBASE, MEDLINE and AMED to identify relevant studies. Data extraction was performed using Cochrane recommended methodology and analysis of risk factors completed.

A total of 402 stem fractures in 12 396 THAs were identified. The median time from index procedure to stem fracture was 68 months (IQR 42.5 – 118) whilst mean age at surgery was 61.8 years (SD 6.9). Male gender (OR = 3.27, 95 % CI = 2.59 – 4.13, p < 0.001), patient weight >80 Kg (OR = 3.55, 95 % CI = 2.88 – 4.37, p < 0.001), age <63 years (OR = 1.22, 95 % CI = 1.01 – 1.49, p < 0.001), varus stem alignment (OR = 5.77, 95 % CI = 3.83 – 8.7, p < 0.001), use of modular implants (OR = 1.95, 95 % CI = 1.56 – 2.44, p < 0.01) and revision arthroplasty (OR = 3.33, 95 % CI = 2.70 – 4.1, p < 0.001) were significant risk factors for prosthetic stem fracture.

Patient weight, younger age, male gender, varus stem alignment and revision arthroplasty are significant risk factors for femoral stem fracture. Modifying these risk factors where possible may help reduce incidence of femoral stem fracture in at risk patients.

As the burden of peri-prosthetic fractures (PPFs) continues to increase, it has been suggested that use of anatomical femoral stems may help reduce risk of PPFs and risk of revision. The primary aim of this study was to determine the long-term survivorship and PPF rate of the Lubinus SP II anatomical femoral stem in a UK centre. 1000 consecutive THAs performed using the Lubinus SPII femoral stem were identified from a prospectively collected arthroplasty database. Patient records and radiographs were reviewed finally at a mean of 12.4 years (SD 1.3) following surgery to identify occurrence of revision surgery, dislocation or PPF. Mean patient age at surgery was 68.8 years. There were 634 women. Osteoarthritis was operative indication in 946 patients. At mean 12.4 year follow-up analysis of all-cause THA failure demonstrated survivorship of 99.1% (95 % confidence interval, 99.0-99.3%) and 97.9 % (97.8 – 98.0 %) at 15 years. 10-year stem survivorship was 99.6% (99.5-99.7%) and at 15 years was 98.2% (98.1–98.3%). Implant survivorship was not significantly (p > 0.05) impacted by patient demographics or operative indication. There were 3 PPFs identified (0.3%) at mean 12.4 year follow-up and 15 dislocations (1.5%). The Lubinus SPII stem demonstrated excellent survivorship, low dislocation and negligible PPF rates up to 15 years following primary THA.

Introduction: Delayed presentation of acetabular fractures to tertiary care centres in developing countries poses a unique challenge. The poor surgical outcome is the result of soft tissue injury due to stretching, involving forceful reduction and the application of instruments in a narrow space. This can be reduced by modifying the management approach and involving an experienced surgical team.Method: Twenty-one cases presenting after one week to a tertiary care centre were included in the study. The demographic parameters were recorded, and patients were operated on at a mean of 10 days after trauma. The Kocher Legenbecks approach was used to access posterior injuries, while the iliofemoral and Pfannenstiel incision was used for anterior injuries. All the patients were followed for at least 1 year. Functional outcome was studied with the Modified Merle–d’Aubigne and Postel scoring system.Results: The mean age of patients was 39.25 years, and the majority were males (3:1). RTA was the most common mode of injury. Most surgeries (75%) were completed in 120 minutes or less, with a range of 90-180 minutes. The complications included traumatic nerve palsy in 3 cases, wound infection in 3 cases, two patients had heterotopic ossification, and non-congruent reduction in three cases. 90% of patients had good to excellent results (Matta score > 15).Conclusion: A thorough preoperative planning and study of 3D reconstructed CT images help in understanding complex anatomy and pattern. Good soft tissue skills, careful handling of neural tissues, and judicious use of reduction instruments reduce complication rates."