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This study reviewed the incidence of heterotopic ossification and the functional limitations in a cohort of consecutive patients with prior stroke who underwent primary total hip arthroplasty (THA). Thirty-one primary THAs were performed in 22 patients who had a cerebrovascular accident prior to THA. Mean follow-up 35 months. The overall incidence of heterotopic ossification was 36%, with significant Brooker class III and IV heterotopic ossification reported in 22% of patients. The data suggest that prior cerebrovascular accident may pose an increased risk of significant heterotopic ossification following primary THA. Consideration of prophylaxis in this subset of patients may be warranted. [ABSTRACT FROM AUTHOR]

Since 1991, 43 one-stage sequential bilateral total hip arthroplasties (THAs) inpatients > or = 75 years have been performed by the authors. The results were assessed to determine whether thiss procedure can be performed safely and with good outcome in this subset of patients. These results were compared to those of 1 36 patients < 75 years who underwent the same procedure. The one-stage bilateral procedure was performed in all patients who had signiificant arthritic disease of both hips. There was no diffference in length of surgery or length of hospital stay. Patients > or = 75 years were more likely to experience minor postoperative morbidity such as ileus and urinary tract infections. The incidence of myocardial ischemia was 2.3% in the elderly group With a mean follow-up of 2.5 years, 90% of the elderly patients lived independently, 80% walked without assistive devices, and 90% were pain free. Therefore, one-stage sequential bilateral THA is a safe and effective option for patients > or = 75 years when pain and functional limitations affect quality of life.

Forty patients underwent 80 bilateral primary total hip replacements (THRs) under the same anesthesia (one-stage). Forty other patients who underwent unilateral primary THRs during the same time interval were selected to match the first 40 patients with regard to age, sex, diagnosis, weight, medical comorbidity, type of prosthesis used, and perioperative management protocol. An assumption was made in that each unilateral case represented the first side of bilateral THRs performed during two separate hospitalizations (two-stage). Analysis of the total hospital charges submitted to the insurance companies was made between the groups. On average, there was a 24% reduction (P<.05) for each case if bilateral THRs were done in one stage. This was primarily due to a significant decrease (P<.05) in the length of hospital stay in the one-stage group. There was no difference between the two groups in the operative time, estimated blood loss, or perioperative complications.

A prospective study of 119 consecutive primary ceramic total hip arthroplasties (Autophor, Smith & Nephew) was performed. Follow up was 100% at a minimum of 3 years. Six hips were revised during the course of the study (5%). Harris hip scores were 29.0 preoperatively, 78.7 at 6 weeks, and 92.6 at 3.4 years (range: 62 to 100). Ninety-one percent of the 107 surviving hips at follow up had a good or excellent hip score. The clinical results matched those of Mittelmeier. Thigh pain was a frequent finding, but rarely presented a clinical problem. Our incidence of thigh pain may be higher than that of others because no patients were lost to follow up. The ceramic portion of the Autophor Ceramic Hip was well tolerated clinically and radiographically. The femoral component was responsible for 2% to 4% of the revisions, and we have now replaced it with a stem designed for bony stabilization.