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Introduction: The anatomical Lubinus SPII-stem is commonly used in hemi-arthroplasty for femoral neck fractures (FNF), combined with either the bipolar Variocup, the Unipolar Head (UH) and a newly introduced unipolar Modular Trauma Head (MTH). Similar constructs like the MTH are reported to have risk of corrosion and wear. This is the first publication evaluating the MTH.

Aim: To describe the revision rate of the SPII-stems/heads which were divided into 3 groups (Variocup, UH, MTH). The head types are compared by their rate of revision at 2 years, due to any cause and to dislocation. Revision and mortality rates up to 10 years are reported.

Methods: This observational cohort study based on prospectively registered data from the Swedish Arthroplasty Register included 33,059 patients with hemiarthroplasty 2005-2021 due to FNF. SPII-stems combined with Variocup (n = 7,281), UH (n = 23,980), MTH (n = 1,798) were included. The follow-up ended at 10 years for Variocup and UH, for MTH at 2 years. Kaplan-Meier survival analyses was used, with a 95% confidence interval (CI). Patients were censored at death or at the end of the study (31 December 2021).

Results: The 2-year revision rate regardless of cause was similar between the groups: after Variocup 3.5% (CI, 3.1-4.0), UH 3.1% (CI, 2.9-3.4), MTH 3.5% (CI, 2.6-4.5).At 10 years, the Variocup and UH had similar revision rates; 4.6% (CI, 4.0-5.2) and 5.0% (CI, 4.4-5.6).For revision due to dislocation at 2 years Variocup 2.3% (CI, 1.9-2.7) had an inferior outcome compared to UH 1.5% (CI, 1.3-1.7). The MTH had an intermediate outcome, 1.7% (CI, 1.0-2.3). Variocup had a higher dislocation related revision rate, until the 10th year.The 2-year-mortality was 36% (CI, 35-37) after Variocup, 43% (CI, 42-43) after UH and 44% (CI, 41-47) after MTH.

Conclusions: The hemi-heads have comparable revision rates within 2 and 10 years. The new MTH performs similar to the standard UH. The bipolar Variocup is associated with more revisions due to dislocation.

Purpose: To assess clinical and radiographic outcomes of anterior acetabular wall reconstruction and cup revision in patients with anterior acetabular wall defects and associated iliopsoas tendinopathy (IPT) following total hip arthroplasty (THA).

Methods: 7 patients with IPT (defined as groin pain that increased with active hip flexion) and pre-revision computed tomography (CT) scans showing anterior acetabular wall defects and cup-iliopsoas impingement were included. During cup revision, an autologous biconvex iliac crest graft was harvested and placed over the anterior acetabular wall defect before press-fitting a revision cup. Cup inclination and anteversion, axial and sagittal cup overhang, and iliopsoas muscle strength (0-5) were evaluated pre- and post-revision. Forgotten joint score (FJS; 0-100), Oxford hip score (OHS; 0-48), hip pain (0-10), satisfaction (0-10), graft osseointegration and resorption were evaluated post-revision.

Results: Pre-revision cup inclination was 43.7 ± 9.4°, anteversion was 30.4 ± 10.5°, axial overhang was 6.6 ± 7.9 mm, and sagittal overhang was 14.2 ± 4.8 mm. Immediate post-revision cup anteversion was 33.0 ± 7.9°, inclination was 45.3 ± 5.1°, while there was no axial or sagittal overhang. At 60.3 ± 5.6 (52-70) months follow-up, 6 of 7 patients were available for assessment (1 patient had died). Iliopsoas muscle strength increased from 3.9 ± 0.7 to 4.6 ± 0.9, FJS was 77.5 ± 32.8, OHS was 40.3 ± 12.8, hip pain on VAS was 0.2 ± 0.4 at rest and 2.3 ± 2.6 during activities. Patient satisfaction with surgery was 8.3 ± 2.3, but 1 patient was dissatisfied and reported persistent hip pain. Last follow-up CT scans were available for 4 of 7 patients, with 3 showing osseointegrated grafts and no graft resorption.

Conclusions: Anterior acetabular wall reconstruction and cup revision resulted in satisfactory clinical outcomes at a minimum follow-up of 4 years in 5 of 7 cases. Most patients fully recovered their iliopsoas muscle strength, had minimal to no pain, excellent FJS, and an osseointegrated acetabular wall graft.

Background: Impaction bone grafting (IBG) has been shown to be effective and reliable for contained or medial large acetabular defects, but large segmental rim defects may need alternative options for reconstruction. We hypothesised that IBG combined with lateral trabecular augments in large segmental acetabular bone defects can provide comparable results to IBG combined with conventional metallic meshes.

Methods: In a series of 382 acetabular revisions using IBG 30 hips with a lateral trabecular augment (case group) were matched for age, gender and bone defect with 54 controls (with a lateral mesh). The mean follow-up was 5 years. All hips had a Paprosky 3A or 3B bone defect. Clinical outcome, radiological results and re-revisions rate were analysed in each over time. A Kaplan-Meier analysis was used to determine the survival of the cup, with radiological failure and re-revision as the endpoints.

Results: 5 (16.7%) hips in the case group and 9 (16.7%) in the control group were re-revised. The 10-year survival for reoperation for any reason was 80.8% (95% CI, 69.7-92.0) and 93.3% (95% CI, 84.0-100) respectively. At latest follow-up the mean Harris Hip Score was 85.3 in the case group and 82.9 in the control group (p = 0.4). In the case group, 7 (23%) hips showed acetabular radiological migration, 3 requiring further revision surgery. In the control group, 12 (22%) hips showed acetabular radiological migration, with 6 needing re-revision. Acetabular radiological migration was more frequent in hips with a greater radiological horizontal distance (p = 0.01).

Conclusions: IBG combined with lateral trabecular augments in large segmental acetabular bone defects was comparable to IBG combined with a lateral mesh. Improvements in surgical reconstruction could decrease the radiological migration rates of the acetabular component.

Background: Constrained liners (CLs) have been used in revision total hip arthroplasty (rTHA) with varying results. Relatively few studies have identified specific risk factors for failure. This study aimed to assess implant survivorship and complication rates, identify risk factors for constraint-related complications, and assess the effect of multiple factors present in a single case.

Methods: We conducted a retrospective analysis of 101 rTHAs for various aseptic indications and as second-stage procedures for periprosthetic joint infection (PJI) utilising 2 models of conventional single-articulation CLs. We excluded 8 cases in which the liners were removed early due to PJI and assessed the risk factors for constraint-related complications in the remaining 93 cases. The mean follow-up duration for complication-free cases was 6.5 years (range 4.7-10.5 years).

Results: The incidences of dislocation of a prosthetic head and loosening of the acetabular component were 19.8% and 5.0%, respectively. We also observed 8 cases where the locking ring of the liner was dislodged without dislocation (1 case required re-revision). The presence of factors related to impingement (cup retention, smaller internal diameter CLs, signs of probable impingement from the femoral side) was associated with higher rates of constraint-related complications. The presence of factors related to soft-tissue stabilisers did not increase the rate of complications. The simultaneous presence of multiple impingement-related risk factors resulted in worse outcomes.

Conclusions: CLs may be less effective for treating or preventing instability related to impingement. CLs should be used with caution or avoided when multiple impingement-related risk factors are present.

Introduction: Isolated femoral head and polyethylene liner exchange is commonly performed with varying surgical approaches used for the primary THA (pTHA) and the revision THA (rTHA). The purpose of this study is to investigate the prevalence and postoperative outcomes associated with concordance and discordance in isolated head-liner exchange.

Methods: A retrospective chart review from May 2016 to November 2023 was performed for all patients at 2 institutions who underwent isolated head-liner exchange. 175 patients had minimum 1-year follow-up with complete information regarding surgical approach and outcomes. 175 included were grouped based on their pTHA approach including posterior approach (PA), anterolateral (AL), and direct anterior (DA), and their subsequent rTHA approach. Demographics and postoperative outcomes were compared between groups. Chi-square tests were used to measure associations between surgical approaches and postoperative complications, with a p-value of <0.05 signifying statistical significance.

Results: Our study included 175 patients with isolated head-liner exchange, with a mean age of 68.5 ± 10.4 years. Of the 175 patients, 100 (57.1%) received primary THA via the posterior approach (PA), with 68.0% having concordant revisions. For the anterolateral (AL) and direct anterior (DA) primary approaches, 91.1% and 94.7% of revisions were concordant, respectively. Indication for revision differed by approach, particularly within the PA group, where instability favoured concordant revisions, and metallosis favoured discordant revisions. There was no significant difference in perioperative outcomes between concordant and discordant approaches, except the concordant group had more EBL, higher rates of transfusions, reoperations, and discharge to skilled nursing facilities (SNF).

Conclusions: In pTHA cohort, patients with PA approach were more likely to undergo head-liner exchange with a discordant approach via DA or AL. As no significant associations were found in any combination of discordant approaches with postoperative complications, surgeons should choose their head-liner approach without significant concern for discordance.

Background: The association between primary total hip arthroplasty (THA) approaches and short-term mortality rates remained unexplored. This study aimed to compare short-term mortality rates between the direct anterior (DAA), posterolateral (PL), anterolateral (AL) and direct lateral (DL) approaches and determine associated factors.

Methods: A registry study was conducted using data from 2007 to 2023 of the Dutch Arthroplasty Register. 30- and 90-day mortality were compared between approaches using the chi-square test and the logistic regression analysis to adjust for confounders (age, sex, patient's physical status [ASA] classification, fixation method, body mass index [BMI] and smoking status). Multivariate regression models were used to determine factors associated with short-term mortality. Sensitivity analyses for time periods (2007-2012, 2013-2017, 2018-2023) were performed.

Results: The study comprised 379,108 patients (mean age 69.9 ± 9.5, male 33.8%). The AL, PL and DL approaches demonstrated a significantly larger likelihood for 30-day mortality compared to the DAA after adjusting for confounders (DAA: reference; AL: OR 2.32 [1.52-3.57], p < 0.001; PL: OR 1.79 [1.36-2.36], p < 0.001; DL: OR 2.78 [1.69-4.57], p < 0 .001). In ASA I-II patients, likelihood for 90-day mortality for the AL, PL and DL approaches was significantly higher than the DAA approach (DAA: reference; AL: OR 2.293, p < 0.001; PL: OR 1.963, p < 0.001; DL: OR 2.016, p < 0.001). In ASA III-IV patients, differences were not significant, except when comparing the DL to the DAA approach (OR 1.484, p = 0.011). Increased age, male sex, surgical approach and cemented fixation were significantly associated with 30- and 90-day mortality.

Conclusions: Findings were suggestive that the DAA provides a reduced likelihood for short-term mortality compared to the PL, AL and DL, after adjusting for confounding factors. Differences in mortality rate were more substantial in healthy patients and remained similar irrespective of time periods. Increased age, male sex, surgical approach, and cemented fixation increased likelihood on short-term mortality.

Objective: Does the use of staples or sutures for wound closure have a lower surgical site infection rate in patients receiving primary total hip arthroplasty (THA)?

Design: Prospective, randomised controlled multicentre trial.

Methods: 535 patients undergoing THA were included and randomised into 2 groups: 268 wounds were closed with staples, and 267 with sutures. Primary outcome was surgical site infection (SSI). Secondary outcomes were prosthetic joint infection (PJI), other wound complications (dehiscence, necrosis and prolonged drainage) and duration of admittance. Follow-up occurred at 2, 6, and 12 weeks, and at 1 year.

Results: There were no significant demographic differences between the 2 groups. SSI occurred more frequently when wounds were closed with staples (4% compared to 1% with sutures; OR 2.8; CI, 0.885-0.952; p = 0.057). SSI was treated with oral antibiotics. The staples group showed significantly more wound complications (17% compared to 5%; OR 3.943, CI 2.073-7.498; p = 0.000). Wound discharge was significantly prolonged in the staples group (n = 40, compared to n = 12 in the sutures group; OR 3.728; CI, 1.909-7.281; p = 0.000). There was no significant difference in PJI (p = 0.364).

Conclusions: In this large RCT comparing staples with sutures after THA, the use of staples is associated with a nearly 3 times greater risk of SSI (OR 2.8; p = 0.057). Staples significantly prolong wound discharge. The use of sutures for wound closure after THA is advised.Trial registration: Staples Or Sutures trial (S.O.S. trial) http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3946, NTR3946.

Background: The presence of radiolucent lines (RLLs) around total hip replacement (THR) stems correlates with stem failure. However, the zone this occurs in is significant. The widely adopted Gruen Zone classification has disadvantages and is unlikely to be reflective of uncemented biomechanics. We propose a simpler system for describing these changes and introduce its relevance clinically.

Methods: In a single-centre retrospective study CORAIL THR stems implanted between 2010 and 2013 were analysed. On postoperative radiographs 2 parallel "SKY" lines divided the stem bone interface into 3 zones A, B and C. 1 year and 5 years postoperative radiographs were reviewed by 5 surgeons for the presence and location of RLLs. The revision rates of the UK's National Joint Registry were correlated with the presence of RLLs.

Results: 1113 stems were included.331 (29.7%) had RLLs, 273 (24.5%) in zone A only, 50 (4.5%) in zones A and B and 8 (0.7%) in all 3 zones A, B and C. In absence of RRLs in zone A, no RLLs were identified in the other zones. 73% RRLs appeared in the first postoperative year, the remaining at 5 years follow-up.1.8% (20 of 1113) stems were revised. The revision rate for stems with RLLs in zone A alone was 2.9%, with RLLs in zone A and B it was 12% and with RLLs in all 3 zones it was 12.5%.The odds of revision were 4.7 times higher (p = 0.007) with RLLs in Zone A and 6.6 times higher (p < 0.001) with RLLs in Zones B and C compared to those without.

Conclusions: The SKY lines can be used to classify RLLs and predict the risk of revision for the CORAIL stem. Stems with RLLs progressing beyond the first SKY line from zone A into Zone B-C should be considered higher risk for revision and hence followed-up closely for signs of failure. Absence of RLLs or RLLs in Zone A only can be discharged to patient-initiated follow-up.

Background: The objective of this study was to determine the effect of bone marrow aspirate concentrate (BMAC) on long-term patient outcomes when used as an adjuvant to acetabular repair of the labrum.

Methods: A systematic review and meta-analysis were completed following PRISMA 2020 guidelines. Included in the analysis were controlled studies which assessed functional outcomes via the International Hip Outcome Tool-33 (iHOT-33) 12 or 24 months after acetabular repair with BMAC adjunct. 4 studies totaling 315 participants were analysed.

Results: Pooled effect sizes for iHOT-33 scores were not significantly different between control and treatment groups at 12 (p = 0.14, Cohen's D ≏ 0.79) or 24 months (p = 0.30, Cohen's D ≏ 0.56).

Conclusions: Non-significant trends in favour of BMAC augmentation were found in this study. However, the trends reported are promising and warrant further investigation with further randomised controlled trials.

Purpose: Studies on short-stem total hip arthroplasty (THA) in young patients with developmental dysplasia of the hip (DDH) are limited, with no studies on long-term outcomes. Our study aimed to investigate whether the Mayo conservative hip stem demonstrates favourable mid- to long-term outcomes in these patients.

Methods: This retrospective study included 42 patients (50 joints) with DDH aged <55 years who underwent THA using the Mayo conservative hip stem and excluded those with a follow-up period <5 years. Radiographic evaluation involved comparison of the immediate postoperative anteroposterior images with those at the final follow-up. Clinical evaluations utilised the Japanese Orthopaedic Association (JOA) hip score and major postoperative complications, including revision surgery.

Results: The mean age of the patients was 48.8 years, with a median follow-up of 11 years. According to the Crowe classification, 35, 11, and 4 cases were classified as Types I, II, and III, respectively. According to the Dorr classification, 29 and 21 cases were classified as Types A and B, respectively. Radiographically, spot welds were observed in 98% of joints in zones 2 or 6, whereas stress shielding was evident in 94% (zone 1) and 54% (zone 7) of the joints. Stem sinking ⩾3 mm was observed in 2 joints. No periprosthetic femoral fractures, dislocations, or infections were observed.

Conclusions: The Mayo conservative stem in young patients with DDH resulted in favourable mid- to long-term outcomes, including stability and bone preservation. The stem is an effective treatment strategy for these patients.