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Aim: The aim of this study was to determine whether patients treated with a caged reconstruction for metastatic acetabular disease would have a construct survival superior to that of their life expectancy., Patients and Methods: We undertook a retrospective study, in a single centre in the United Kingdom, reviewing outcomes for 19 patients (20 hips) treated with a cage reconstruction for metastatic disease of their acetabulum over 6 years. Inclusion criteria were those with an impending fracture of the acetabulum, metastatic dissociation, fracture of the acetabulum and or femur and those whose life expectancy was considered by the oncology team to be >6 months., Results: In all patients the Restoration GAP II acetabular cage (Stryker, Howmedica Osteonics Corp, NJ, USA) was used in conjunction with a cemented acetabular cup and cemented femoral stem. The mean age at the time of surgery was 68 (44-87) years with breast cancer being the most common primary malignancy (31%) followed by prostate cancer (26%).Radiological survivorship estimates were 94.1% (95% CI, 99.2-65.0) at 12 and 24 months, 70.6% (95% CI, 93.6-16.0) at 36 months and 35.3% (95% CI, 78.2-1.2) at 48 months. There were 3 radiological failures of the implant due to disease progression. Complications occurred in 3 patients with 2 developing deep infection which was treated with suppressive antibiotic therapy following aspiration of the hip. 1 patient suffered a hip dislocation following trauma which was successfully reduced closed and no further intervention was required., Conclusions: This study represents the first published case series of the use of the GAP II cage in patients with metastatic acetabular disease. The construct generally outlives the patient and hence is suitable for the treatment of acetabular metastases.

Introduction: Hip resurfacing remains a valid option in young male patients. The creation of the optimum cement mantle aids fixation of the femoral component. If the cement mantle is too thick the prosthesis can remain proud leading to early failure or if it penetrates too far into the femoral head, it may cause osteonecrosis., Method: 18 of 96 femoral heads collected from patients undergoing total hip arthroplasty were matched for their surface porosity. They were randomly allocated into 2 different cementing groups. Group 1 had the traditional bolus of cement technique, while group 2 had a modified cementing technique (swirl) where the inside of the femoral component was lined with an even layer of low viscosity cement., Results: The traditional bolus technique had significantly greater cement mantle thickness in 3 of 4 zones of penetration ( p  = 0.002), greater and larger air bubble formation (6 of 9 in bolus technique vs. 1 in 9 in swirl technique, p  = 0.05) and more incomplete cement mantles compared with the swirl technique. There was no relationship to femoral head porosity., Conclusion: The swirl technique should be used to cement the femoral component in hip resurfacing. Long-term clinical studies would conform if this translates into increased survivorship of the femoral component.

Purpose: The porosity of the femoral head prepared for hip resurfacing has not been previously described. This is important as greater pore size increases the penetration of bone cement and excessive cement penetration can cause osteonecrosis., Methods: 96 osteoarthritic femoral heads were harvested at total hip arthroplasty and prepared for hip resurfacing. The porosity of the bone cement interface in hip resurfacing was calculated from digitised black and white photographs using MatLab software., Results: The mean porosity was 0.63. Increased porosity was associated with larger femoral heads in both the coronal and sagittal dimensions and cysts in the femoral head. It was not associated with gender, age, body mass index (BMI), smoking, alcohol or corticosteroid consumption., Conclusion: The porosity of the femoral head has been shown to be 0.63. Future studies of cementing techniques in hip resurfacing should include this porosity in their designs. The surgeon prior to hip resurfacing should consider altering his cementing technique when cysts are present on the preoperative radiographs.

Aim: To compare the long-term clinical and radiological results of metal-on-polyethylene hybrid total hip replacement (THA) with metal-on-metal Birmingham hip resurfacing (BHR) in young, active patients., Patients and Methods: From the 1st consecutive 63 hips in young, active patients who underwent BHR by the senior author, 54 (51 patients) were matched to patients who had undergone THA with regard to age, gender, body mass index and preoperative levels of activity. Radiologically, all hips were assessed for migration and osteolysis, THAs for polyethylene wear and BHRs for a pedestal sign. Patient-reported outcomes, mortality and revision rates were compared., Results: The mean follow-up of the patients with a hybrid THR was 19.9 years and for those with a BHR, 17.6 years. 13 patients with a hybrid THR and 5 with a BHR had died. 1 hybrid THR and 3 BHRs were lost to follow-up. The revision rate of the hybrid THRs was 14/54 and of the BHRs 6/54. Log rank comparison of Kaplan-Meier survival estimates demonstrated a significantly lower mortality in the BHR group ( p = 0.039; hazard ratio [HR] = 0.37 [95% CI, 0.15-0.95]) but a non-significant difference in revision rates ( p = 0.067; HR = 0.43 [95% CI, 0.18-1.06]). The BHRs recorded superior OHS ( p = 0.03), UCLA ( p = 0.0096), and EuroQol visual analogue scores ( p = 0.03). Significantly more BHRs had run, played sport and undertaken heavy manual labour in the month preceding follow-up., Conclusion: After 18 years, patients with BHRs remained more active with a lower mortality rate but demonstrated no significant difference in revision rates. Both groups demonstrated progressive radiological changes at long-term follow-up.

Patients presenting with skeletal metastatic lesions requiring surgery are increasing, this is due to an ageing population and improved oncological survival following advances in medical management. Furthermore, patients are living longer with skeletal metastatic disease. The majority of bone metastases occur in the proximal femur. Robust diagnosis (Biopsy) and treatment is required to ensure that patients can mobilise fully weight bearing immediately post-surgery and that the construct should outlive the patients expected survival. We review the changing management of metastatic disease in the proximal femur.

Hip joint replacement is 1 of the most successful surgical procedures of the last century and the number of replacements implanted is steadily growing. An infected hip arthroplasty is a disaster, it leads to patient suffering, surgeon's frustration and significant costs to the health system. The treatment of an infected hip replacement is challenging, healing rates can be low, functional results poor with decreased patient satisfaction. However, if a patient-adapted treatment of infected hip joints is used a success rate of above 90% can be obtained.Patient-adapted treatment is based on 5 important concepts: teamwork; understanding the biofilm; diagnostic accuracy; correct definition and classification of PJI; and patient-tailored treatment.This review presents a patient-adapted treatment strategy to prosthetic hip infection. It incorporates the best aspects of the single and staged surgical strategies and promotes the short interval philosophy for the 2-stage approach.

Cement-in-cement femoral component revision is a useful and commonly practised technique. Onerous and hazardous re-shaping of the original cement mantle is required if the new stem does not seat easily. Furthermore, without removing the entirety of the original cement mantle, the freedom to alter anteversion or leg length is difficult to predict preoperatively. We present data from in vitro experiments testing the compatibility of the top cemented stems according to UK registry figures (NJR 2013). This data augments preoperative planning by indicating which revision stems require minimal or no cement reshaping when being inserted into another stem's mantle. We also present the maximum shortening and anteversion that can be achieved without reshaping the original cement mantle.

The histological specimens from 29 failed metal-on-metal (MoM) hip arthroplasties treated at our institution were reviewed. Five patients had a failed MoM total hip arthroplasty (THA), and 24 patients a failed hip resurfacing. Clinical and radiographic features of each hip were correlated with the histological findings. We report three major histological subtypes. Patients either have a macrophage response to metal debris, a lymphocytic response (ALVAL) or a mixed picture of both. In addition we observe that the ALVAL response is located deep within tissue specimens, and can occur in environments of low wear debris. The macrophage response is limited to the surface of tissue specimens, with normal underlying tissue. Patients with subsequently confirmed ALVAL underwent revision surgery sooner than patients whose histology confirms a macrophage response (3.8 vs. 6.9 years p<0.05). Both histological subtypes (ALVAL and macrophage dominant) are responsible for abnormal soft tissue swellings.

We report a new surgical technique for refractory trochanteric bursitis, performed in 43 patients between May 1988 and December 2003. Fourteen patients had developed trochanteric bursitis after primary total hip arthroplasty (THA), six after revision THA, 17 for no definable reason (idiopathic) and seven after trauma. Follow-up ranged from six months to 15 years (mean five years). Outcome was measured by the patients symptoms at interview and whether the patient would have had the procedure again. Outcome depended on aetiology: 100% of traumatic, 88% of idiopathic and 64% after primary THA were successful. All operations after revision THA were unsuccessful. Transposition of the gluteal fascia is indicated in patients with idiopathic, traumatic and post primary THA trochanteric bursitis, but not after revision THA. (Hip International 2005; 15: 212-7).