The Total Hip Replacement is one of the most successful operations with excellent outcomes. Notwithstanding this there have been drives to improve patient satisfaction and outcomes. The SuperPATH (Super Capsular Percutaneously Assisted Total Hip) is one such technique that aims to do so. Here arthroplasty is performed via a minimally invasive technique first popularized in 2011. The approach is muscle sparing extensile accessing the hip superiorly. The scar is smaller and thus potentially aesthetically more acceptable for the patients. Further avoiding violating the posterior capsule and short external rotator or the abductors may theoretically expedite rehabilitation with no hip precautions and reduce the risk of dislocation. We describe the result of a single surgeon series of SuperPATH. There were 27 cases in 25 patients. The mean age was 64.4. The indication in all cases was osteoarthritis. 10 were right-sided and 17 left. The average length of operation was 128 minutes. The laterality of surgery did not affect the length of surgery (p=0.9). The median length of stay was 1 day. All had leg length less than 5mm difference with the exception of 1 case. The median cup inclination angle on the AP was 43 degrees (range:35-65). There were 4 complications in 3 patients. One patient suffered both dislocation and pulmonary embolus. One patient experienced significant leg lengthening. In one case the cup was radiographically open. No Late complications. SuperPATH minimally invasive hip arthroplasty is a viable operation for patients with hip osteoarthritis producing good short term clinical and radiographic outcome.

Purpose: The purpose of this study was to report all complications during the first consecutive 865 cases of bikini incision direct anterior approach (DAA) total hip arthroplasty (THA) performed by a single surgeon. The secondary aims of the study are to report our clinical outcomes and implant survivorship. We discuss our surgical technique to minimize complication rates during the procedure.

Methods: We undertook a retrospective analysis of our complications, clinical outcomes and implant survivorship of 865 DAA THA's over a period of 6 years (mean = 3.9yrs from 0.9 to 6.8 years).

Results: The complication rates identified in this study were low. Medium term survival at minimum 2-year survival and revision as the end point, was 99.53% and 99.84% for the stem and acetabular components respectively. Womac score improved from 49 (range 40-58) preoperatively to 3.5(range 0-8.8) and similarly, HHS scores improved from 53(range 40-56) to 92.5(range 63-100) at final follow-up (mean = 3.9 yrs) when compared to preoperative scores.

Conclusions: These results suggest that bikini incision DAA technique can be safely utilised to perform THA.

Introduction: Direct lateral approach (DLA) is a frequently used surgical approach for total hip arthroplasty (THA) worldwide. The best known unfavorable attribution of DLA is the damage on gluteal musculature during surgery. We aim to point out the relation between gluteus medius (GM) and gluteus minimus (GMi) MRI findings and gait parameters after a THA with DLA. Methods: We included 25 patients in our study who were operated for primary coxarthrosis with a DLA. All included patients had MRIs and gait analysis after surgery. We used patient’s non-operated hips as control group. SF-36 (Short form-36) was used to evaluate general health status for participants. HHS (Harris Hip Score) was used to obtain clinical outcome status. Results: Operated hip’s GM and GMi fatty degeneration (FD) levels were found significantly higher than healthy hip’s FD levels (p<0.05). Operated hip’s GMi and GM FD were correlated with HHS. (p<0.01 and p <0.05 respectively). Maximum pelvic obliquity on stance phase was significantly higher in the high level of GMi FD participant’s operated side compared to healthy side (p<0.05). There was no correlation between operated hip’s GM normalised volume and clinical scores (HHS and SF-36) of patients. There was no relation between operated and non-operated hip’s GM normalised volumes (p>0.05). Conclusion: We found the correlation between gait parameters and MRI findings in the patients who operated with a DLA and concluded that FD effects clinical scores.

Introduction: A well-documented method for gauging implant success and longevity in Total Hip Arthroplasty (THA) is through the measurement of its stability. Radiostereometric analysis (RSA) is considered the gold standard to quantifying motion. The purpose of this study was to evaluate the 2-year migration of a self-locking stem with reinforced proximal body. Methods: 30 participants undergoing primary THA for any cause (rheumatoid or inflammatory arthritis, osteoarthritis) were prospectively recruited in this study. All patients received a fully coated, triple-taper, self-locking design stem, with reinforced proximal body and proximal grooves perpendicular to load transmission. RSA radiographs were performed post-operatively and at 6 weeks, 6 months, 1- and 2 years. The Harris Hip Score (HHS), Oxford Hip Score (OHS) and EQ-5D were also collected. Results: At two years the median subsidence was 0.086 (IQR, 0.29); medial translation 0.029 (IQR, 0.18); posterior translation 0.07 (IQR, 0.21). The median total migration at different timepoints was 0.29 (IQR, 0,28) at 6 weeks; 0.21 (IQR, 0.20) at 6 months; 0.25 (IQR, 0.27) at 1 year; 0.26 (IQR, 0.32) at 2 years. Baseline PROM scores improved significantly at 2-years from pre-operatively. At 2 years HHS was 91 (IQR, 19.75), OHS 42 (IQR, 5) and EQ5D 0.837 (IQR, 0.19). Conclusion: 2-year migration results utilising RSA, showed that the triple-taper, self-locking design stem exhibited a predictable migration pattern and achieved initial stability. This is likely to be translated to long-term stability, which needs to be corroborated by longer-term outcome studies.

Introduction: Periacetabular osteotomy (PAO) is an established surgical technique to treat symptomatic hip dysplasia. The aim of this study was to evaluate the influence of pre-operative Tonnis grade of arthritis and pre-operative McKibbin index on the outcome of PAO.

Methods: A single-surgeon series of 387 PAOs were identified from a prospectively collected database between January 2013 and March 2020. Those cases for acetabular retroversion and those cases with femoral head under coverage due to other causes such as Perthes were excluded. Pre-operative Tonnis grade and McKibbin index was calculated. Patient reported outcome measures (i-HOT 12, NAHS, UCLA and EQ-5D) were collected prospectively.

Results: A total of 352 PAOs were included for final analysis. Of these 228 were unilateral cases, and 124 were bilateral hips (62 patients) with a female preponderance (n=330). Pre-operative Tonnis grade was: grade 0 = 143 hips; grade 1 = 163 hips and grade 2 = 46 hips. Mean pre-operative McKibbin index was 33.40 (range -11.20 to 90.10). Pre- operative Tonnis grade had a negative correlation with EQ5D-VAS, and NAHS at 6 months but not at 1 year. Similarly pre-op McKibbin index had a negative correlation for iHOT-12 change at 6 months and EQ5D-VAS at 6 months.

Conclusions: A lower preoperative Tonnis grade was associated with better outcome at six months but not at 12 months. Selected patients with Tonnis grade one and two degeneration with dysplasia may still be candidates for PAO, after appropriate counselling and may take a longer time to recover.

Introduction: Young adult hip pathology commonly affects patients of reproductive age. The extent to which hip arthroscopy (HA) treatments influence sexual function is not well described and limited to small cohorts. This study aims to describe trends in self-reported reported sexual function before and after HA.

Methods: Adult (≥18 years) patients who underwent HA between January 2012 and October 2020 were extracted from the UK Non-Arthroplasty Hip Registry. International Hip Outcome Tool 12 (iHOT-12) questionnaires were collected pre-operatively and at 6 and 12 months. The iHOT-12 then asks asking patients to quantify ‘how much trouble they experience with sexual activity because of their hip?’ with responses converted to a continuous scale (0-100) to measure function. Chi-squared and t-tests were used to compare categorical and continuous variables respectively.

Results: Of 7639 procedures (59% female, mean age 36.5 years (SD 11)), 91% (5616 of 6151 respondants) indicated pre-operatively that questions about sexual activity were relevant to them (male 93%, female 90%, p < 0.001). Overall, mean pre-operative sexual function increased from 42.0 (95%CI 41.2 to 42.8, n=5267) to 61.8 (60.6 to 63.1, n=2393) at 6 months, and 62.1 (60.8 to 63.5, n=2246) at 12 months post-operatively.

At 12 months, both sexes saw significant improvement in their pre-operative sexual function scores (p<0.0001). There was no significant difference in pre- or post-operative scores when comparing younger (<40 years) and older (>40 years).

Conclusions: Most patients can expect to experience improvement in their sexual function following hip arthroscopy, regardless of sex or age group.

Background: One-stage, bilateral, short-stem total hip arthroplasty (1B-ssTHA) represents an alternative to staged, unilateral, short-stem total hip arthroplasty (U-ssTHA); however, the safety and reliability of 1B-ssTHA remain unknown. This study aimed to compare the functional outcomes, complications, and mortality rates between 1B-ssTHA and U-ssTHA.
Methods: A retrospective, matched-pair study was performed, including 216 short stems implanted in 162 patients. 54 patients were treated with 1B-ssTHA. Patients were matched by gender, age, body mass index (BMI), and American Society of Anesthesiologists (ASA) classification. 46 full matches could be accomplished. The mean follow-up time were 61.7 months (1B-ssTHA group) and 63.4 months (U-ssTHA group). Mortality, complication, and revision rates were documented. For clinical examinations, the visual analogue scale (VAS) was used to evaluate satisfaction, rest pain, and load pain, and the Harris Hip Score (HHS) was determined.
Results: No surgery-related deaths were observed. At mid-term, none of the 1B-ssTHA patients required stem revision. The rate of complications for both groups was low. The mean drop in haemoglobin measured in the 1B-ssTHA group was 4.42 mg/dl, compared with 3.18 mg/dl in the U-ssTHA group. The HHS in both groups were excellent (>98 points). Satisfaction rates were significantly higher in the 1B-ssTHA group (p = 0.04) than in the U-ssTHA group.
Conclusion: 1B-ssTHA is an effective and beneficial procedure for a selected population. Mortality, complications, implant survival, and clinical outcomes were comparable to those for a matched group with U-ssTHA. However, an increase in blood loss must be acknowledged for the 1B-ssTHA procedure.

Aims: To investigate regionally the validity of the patient consent process for lower limb arthroplasty against set data standards, with a view to ascertaining whether the consent process could be improved, and if so, how? Methods: Regional data from eight hospital trusts (fifty data sets per hospital: twenty-five hip and twenty-five knee replacement surgeries) across England was collected retrospectively from May 1st 2021, collated and analysed against pre-determined set criterion. Data standards included exploring the risks and benefits of surgery and whether alternative options were offered. Capacity to consent for procedure-specific surgery was measured as patients’ ability to understand, weigh up, retain and communicate their decisions regarding surgery. Results: Capacity was only successfully fulfilled and documented regionally in 11.6% of hip and 13.9% of knee replacement surgeries, despite Consent Form 1 being completed in 94.8% and 88.5% of these same cases, respectively. Procedure specific consent was obtained in 74.0% and 72.1% of cases. Consent for ‘Type’ and ‘Brand’ of implant was often neglected. Furthermore, there was a separate consent clinic, in just over half of lower limb arthroplasty cases, 55.5% for hip and 57.6% for knee replacement surgeries. Conclusion: We propose a novel solution, where digitalisation, involving interactive multimedia/audio-visual demonstrations to explain surgical procedures, could revolutionise the consent process. Given the high volume of clinical negligence claims made, the implications of this will have far-reaching consequences across all specialties, where obtaining valid and informed consent for procedures remains integral to quality patient care.

Introduction: This study reports the ten-year polyethylene liner wear rates, incidence of osteolysis, clinical outcomes and complications of a multicentre randomised controlled trial comparing Oxidised Zirconium (OxZr) versus Cobalt-Chrome (CoCr) femoral heads with ultra-high molecular weight polyethylene (UHMWPE) and highly cross-linked polyethylene (XLPE) liners in total hip arthroplasty (THA).

Methods: Patients undergoing primary THA were recruited from four institutions and prospectively allocated to the following treatment groups: Group A - CoCr femoral head with XLPE liner; Group B - OxZr femoral head with XLPE liner; and Group C - OxZr femoral head with UHMWPE liner. The outcomes of 262 study patients were analysed at ten years follow-up.

Results: Patients in group C were associated with increased liner wear rates compared to patients in group A (p<0.001) and group B (p<0.001) at ten years follow-up. Patients in group C were also associated with increased risk of osteolysis and aseptic loosening requiring revision surgery compared with patients in group A (p=0.007) and group B (p=0.007). There was a non-statistically significant trend towards increased liner wear rates in group A compared with group B (p=0.128).

Conclusion: The use of UHMWPE was associated with progressively increased annual liner wear rates after THA. At ten years follow-up, this translated to UHMWPE leading to an increased incidence of osteolysis and aseptic loosening requiring revision surgery compared to XLPE. Femoral heads composed of OxZr and CoCr did not have any differences in risk of osteolysis, functional outcomes, or revision surgery at ten years follow-up.

The main concerns of THA in younger patients less than 35 years is high failure rate. The present study is the largest in number in current literature focusing on clinic-radiological outcome with minimum 5 years follow-up.

Prospective analytical study of 110 patients (160 hips) operated between July 2004 and June 2012 with a minimum 5 years duration post surgery were assessed during their follow up. Functional outcome analysis and satisfaction level were assessed by Harris Hip Score, SF-36 score and WOMAC scores. Radiological parameters were compared with immediate post-operative X-rays. Student’s t-test was used to compare the HHS, WOMAC and SF-36 scores.

Sixty (54.5%) were unilateral, fifty (44.5%) were bilateral cases. Mean follow-up was 8.16 years (5-12 years). Mean age at surgery was 28.96 years. Commonest cause avascular necrosis (50%), ankylosing spondylitis (22%). 92.8% Cementless implants with 70.7% ceramic on ceramic, 24.6% Ceramic on Poly and 3% metal on poly. Average acetabular inclination was 40.43deg±6.0, anatomical anteversion was restored 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. The femoral stem was in neutral in 55.6% (n=89). All the scores showed significant improvement (p<0.0001). None had infection or loosening. Seventy percent were able to sit cross legged and squat.

Outcome of total hip arthroplasty in young patients age less than 35 years shows significant improvement with respect to pain relief and functional disability. This is the largest series with minimum 5 years follow-up published in literature until now.