Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Hip 725 articles


What Is the Learning Curve for the Anterior Approach for Total Hip Arthroplasty?

Richard Noel Steiger MBBS, FRACS, Michelle Lorimer BSc(Math & Comp Sci) (Hons), Michael Solomon MBChB, FRACS

There are many factors that may affect the learning curve for total hip arthroplasty (THA) and surgical approach is one of these. There has been renewed interest in the direct anterior approach for THA with variable outcomes reported, but few studies have documented a surgeon’s individual learning curve when using this approach.

Does a Titanium-coated Polyethylene Press-fit Cup Give Reliable Midterm Results?

Nikki Hooper MBChB, Harry Sargeant MBChB, Chris Frampton PhD, Gary Hooper MD, FRACS

Uncemented acetabular components have demonstrated low revision rates and high patient satisfaction but with concerns regarding increased costs compared with monoblock cups. Some newer lower-cost uncemented monoblock options have become available in the last decade, but limited data are available on their performance.

Ceramic-on-ceramic THA Implants in Patients Younger Than 20 Years

Didier Hannouche MD, PhD, Flore Devriese MD, Jérôme Delambre MD, Frédéric Zadegan MD, Idriss Tourabaly MD, Laurent Sedel MD, Sylvie Chevret MD, PhD, Rémy Nizard MD, PhD

Poor survival of THA implants in very young patients has been attributed to use of cemented implants, wear of conventional polyethylene, and the presence of morphologic deformities in the proximal femur or in the acetabulum. Few studies have reported the long-term results of ceramic-on-ceramic implants in THAs in patients younger than 20 years.

Does Periacetabular Osteotomy Have Depth-related Effects on the Articular Cartilage of the Hip?

Andreas M. Hingsammer MD, Patricia E. Miller MS, Michael B. Millis MD, Young-Jo Kim MD, PhD

Osteoarthritis may result from abnormal mechanics leading to biochemically mediated degradation of cartilage. In a dysplastic hip, the periacetabular osteotomy (PAO) is designed to normalize the mechanics and our initial analysis suggests that it may also alter the cartilage biochemical composition. Articular cartilage structure and biology vary with the depth from the articular surface including the concentration of glycosaminoglycans (GAG), which are the charge macromolecules that are rapidly turned over and are lost in early osteoarthritis. Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) enables noninvasive measurement of cartilage GAG content. The dGEMRIC index represents an indirect measure of GAG concentration with lower values indicating less GAG content. GAG content can normally vary with mechanical loading; however, progressive loss of GAG is associated with osteoarthritis. By looking at the changes in amounts of GAG in response to a PAO at different depths of cartilage, we may gain further insights into the types of biologic events that are occurring in the joint after a PAO.

High Risk of Failure With Bimodular Femoral Components in THA

Aidin Eslam Pour MD, Robert Borden BS, Takayuki Murayama MD, Mary Groll-Brown BS, J. David Blaha MD

The bimodular femoral neck implant (modularity in the neck section and prosthetic head) offers several implant advantages to the surgeon performing THAs, however, there have been reports of failure of bimodular femoral implants involving neck fractures or adverse tissue reaction to metal debris. We aimed to assess the results of the bimodular implants used in the THAs we performed.

Adverse Reactions to Metal on Metal Are Not Exclusive to Large Heads in Total Hip Arthroplasty

Adolph V. Lombardi MD, Keith R. Berend MD, Joanne B. Adams BFA, Keri L. Satterwhite

There is some suggestion that smaller diameter heads in metal-on-metal total hip arthroplasty (MoM THA) may be less prone to the adverse reactions to metal debris (ARMD) seen with large-diameter heads.

Planar dGEMRIC Maps May Aid Imaging Assessment of Cartilage Damage in Femoroacetabular Impingement

Evgeny Bulat MA, Sarah D. Bixby MD, Carl Siversson PhD, Leslie A. Kalish ScD, Simon K. Warfield PhD, Young-Jo Kim MD, PhD

Three-dimensional (3-D) delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) helps quantify biochemical changes in articular cartilage that correlate with early-stage osteoarthritis. However, dGEMRIC analysis is performed slice by slice, limiting the potential of 3-D data to give an overall impression of cartilage biochemistry. We previously developed a computational algorithm to produce unfolded, or “planar,” dGEMRIC maps of acetabular cartilage, but have neither assessed their application nor determined whether MRI-based grading of cartilage damage or dGEMRIC measurements predict intraoperative findings in hips with symptomatic femoroacetabular impingement (FAI).

Short-term Risk of Revision THA in the Medicare Population Has Not Improved With Time

Kevin J. Bozic MD, MBA, Kevin Ong PhD, Steven Kurtz PhD, Edmund Lau MS, Thomas P. Vail MD, Harry Rubash MD, Daniel Berry MD

Advances in surgical technique, implant design, and clinical care pathways have resulted in higher expectations for improved clinical outcomes after primary THA; however, despite these advances, it is unclear whether the risk of revision THA actually has decreased with time. Understanding trends in short- and mid-term risks of revision will be helpful in directing clinical, research, and policy efforts to improve THA outcomes.

Total Hip Arthroplasty After Acetabular Fracture Is Associated With Lower Survivorship and More Complications

Zachary Morison MSc, Dirk Jan F. Moojen MD, PhD, Aaron Nauth MD, Jeremy Hall MD, Michael D. McKee MD, James P. Waddell MD, Emil H. Schemitsch MD

Despite modern fracture management techniques allowing for near anatomic reduction of acetabular fractures, there continues to be a risk of posttraumatic arthritis and need for total hip arthroplasty (THA). Few well-controlled studies have compared THA after acetabular fractures with THAs performed for other indications in terms of survivorship or complications, and none, to our knowledge, present 10-year survivorship data in this setting.

Risk Calculators Predict Failures of Knee and Hip Arthroplasties: Findings from a Large Health Maintenance Organization

Elizabeth W. Paxton MA, Maria C. S. Inacio PhD, Monti Khatod MD, Eric Yue MD, Tadashi Funahashi MD, Thomas Barber MD

Considering the cost and risk associated with revision Total knee arthroplasty (TKAs) and Total hip arthroplasty (THAs), steps to prevent these operations will help patients and reduce healthcare costs. Revision risk calculators for patients may reduce revision surgery by supporting clinical decision-making at the point of care.