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Rationale: Dislocation, wear, metallosis, and implant loosening are well-known complications of a failed total-hip arthroplasty (THA), and acetabular liner dissociation is an uncommon but catastrophic complication. To our knowledge, this is the first description of metallosis due to acetabular liner dissociation, but not presenting as a result of wear of a metal-on-metal articulation and a polyethylene liner of other articulation. Patient concerns: We described a 61-year-old man who had a 2-year history of pain in the right groin region after THA. Postoperative period of primary THA was uneventful. However, he did not undergo postoperative follow-up, and often participated in strenuous sports activities including mountain climbing and long-distance running. Diagnosis: Radiographs demonstrated superior subluxation of the femoral head and direct articulation and abrasion wear of the ceramic femoral head on the cup. Preoperative laboratory data revealed no signs of infection. Interventions: We performed revision THA using a direct lateral approach with ceramic-on-ceramic hip prosthesis. Outcomes: Postoperatively, the patient wore a hip orthosis for 6 weeks to prevent dislocation but was allowed full weight bearing. At 1-year follow-up, there was no recurrence of hip pain. Lessons: Wear of THA components can result in catastrophic failure of the implants and significant soft-tissue metallosis. Therefore, regular postoperative follow-up is necessary for early intervention, even in those with asymptomatic hips.

To evaluate the clinical feasibility of particle impaction bone graft and plate internal fixation for the treatment of proximal femoral bone tumors or tumor disease.From January 2013 to January 2016 a total of 26 cases of the proximal femur bone tumors or tumor lesions, neither pathological fracture, were retrospectively analyzed, including 12 males and 14 females with an average age of 34.2 years old ranging from 8 to 62 years old. The pathologic result involved fibrous dysplasia in 11 cases, bone isolation bone cyst in 7 cases, giant cell tumors of bone in 3 cases, aneurysm sample bone cyst in 3 cases, non ossifying fibroma in 1 case, benign fibrous histiocytoma in 1 case. No biopsy of the lesion was performed before the operation. Postoperative lesions were sent to pathology. The operation was treated by particle impaction bone graft and plate internal fixation.All patients were followed up to resume normal life for 8 to 42 months with an average of 25 months. The function assessment referenced to the bone and soft tissue tumor association (MSTS). At the end of the last examination, the positive and lateral X-ray films of the femur showed no low density shadow in the margin of bone graft and bone graft, and the bone healing in the bone graft area was good. No recurrence or metastasis was found in all patients, and no loosening or deformation of the internal fixator occurred. The hip function was well restored and no fracture or deformity progressed in all patients.The tumor recurrence in the proximal femur is related to curettage and bone grafting. After the curettage, the residual tumor cells were treated by chemical and physical methods. By this method, the disease can be cured for a long time, and it can reduce the recurrence and resume the function of the hip joint.

To evaluate the applicability of Porthsmouth modified physiological and operative severity score for the enumeration of mortality and morbidity (P-POSSUM) in predicting the mortality of the patients undergoing hip joint arthroplasty.A total of 141 patients (75 males and 66 females, aged 63.22 years+/-14.45 years on an average) undergoing hip joint arthroplasty during January 2002 and March 2005 were studied retrospectively with P-POSSUM. Their average physiological score and operative severity score were 17.48+/-5.16 and 12.43+/-3.05, respectively. The predicted postoperative mortality with P-POSSUM was compared with the observed value. Subgroup analysis was performed to investigate the predictive capability of P-POSSUM. POSSUM scoring system was used as the control.Three patients died after operation in this study actually. The average physiological scores were 32.33+/-9.87 in the death group and 17.16+/-4.56 in the survival group. The former was obviously higher than the latter, which showed statistical difference between the two groups (Wilcoxon rank sum test, P0.05). Perfect agreement was found between the observed death number and the predicted death number calculated by P-POSSUM (Cochran-Mantel-Haenszel chi(2) test, P0.05), though POSSUM overestimated the overall mortality.P-POSSUM can predict the mortality accurately in the patients undergoing hip joint arthroplasty, which is superior to POSSUM.