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There are limited long-term results of using ceramic-on-ceramic (CoC) bearings in total hip arthroplasty (THA) in a large number of patient cohorts. The purpose of this study was to evaluate the minimum 10-year clinical and radiological outcomes and survivorship in a single surgeon series of CoC-THA. Among the 1,039 patients (1,391 hips) who underwent primary THA at our institution between 2008 and 2011, 49 patients (69 hips) experienced paralysis or death, and 194 patients (239 hips, 19%) were lost to follow-up. The remaining 796 patients (1,083 hips) were assessed at a mean of 11 years (range, 10 to 13 years) using the modified Harris hip score (mHHS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and a questionnaire on articular noises. Survival analysis was used to estimate the survivorship. Radiological evaluation was performed on 869 hips at the final follow-up. Survivorship at 11 years was 98.3% for revision or aseptic loosening, and 98.2% for reoperation. At the final follow-up, the mean mHHS and WOMAC scores were 93 (range, 12 to 100) and 14.4 (range, 3 to 66), respectively. There were 131 (12%) hips that experienced squeaking, but no patient required revision. No fracture of the ceramic was observed. Radiological evaluation at the final follow-up revealed that 3 (0.3%) hips exhibited loosening, 2 (0.2%) had femoral osteolysis, 81(9.3%) acquired radiolucencies, and 35 (4%) showed heterotopic ossification. This CoC bearing for THA had a high survivorship and excellent functional outcomes for at least 10 years. [ABSTRACT FROM AUTHOR]

Objective: To report the long‐term outcomes of total hip arthroplasty (THA) with fourth‐generation ceramic‐on‐ceramic (CoC) bearing in patients with ankylosing spondylitis (AS). Methods: We retrospectively identified 180 primary THAs performed in 110 patients with AS, including 100 (90.9%) men and 10 women (9.1%), from 2009 to 2011.The mean age of the patients at surgery was 33 years (range, 16 to 65 years). Cementless prostheses with fourth‐generation CoC bearings were used in all patients. Survivorship of the implants and postoperative complications were calculated. Functional improvement was assessed by the hip flexion‐extension range of motion (ROM) and Harris hip score (HHS). A special noise assessment questionnaire was performed at the last follow‐up. The cumulative incidence of noise was calculated by the Kaplan–Meier method with 95% confidence intervals (CIs). Clinical characteristics and functional outcomes were compared in the hips with noise to those without noise. Results: The mean follow‐up was 11 years (range, 10 to 12 years), and survivorship of the implants was 99.4% at the most recent follow‐up. The complications included dislocation (one hip, 0.6%), periprosthetic joint infection (one hip, 0.6%), mild to moderate pain (five hips, 2.8%), heterotopic ossification (12 hips, 6.7%), and noise (52 hips, 28.9%). The flexion‐extension ROM improved significantly with a median from 10° (range, 0 ~ 130°) to 100° (30 ~ 130°) after THA (p < 0.001), and the HHS increased significantly from 41 ± 20 to 90 ± 8 (p < 0.001). The cumulative incidence of noise at 0.5, 5, and 10 years was 6.1% (95% CI, 2.6 ~ 9.6), 16.7% (95% CI, 11.2 ~ 22.1), and 28.9% (95% CI, 22.2 ~ 35.5), respectively, and that of squeaking at 0.5, 5, and 10 years was 4.4% (95% CI, 1.4 ~ 7.4), 13.3% (95% CI, 8.4 ~ 18.3), and 23.9% (95% CI, 17.6 ~ 30.1), respectively. None of the patients with noise generation in the hip reported it affecting daily activities or causing dissatisfaction. No differences in age, sex, BMI, disease duration, bilateral THA, the frequency of bony ankylosis, the proportion of using a 36‐mm‐diameter femoral head, pre/postoperative flexion‐extension ROM, or pre/postoperative HHS were found between hips with noise and those without noise (p > 0.05). Conclusion: THAs with fourth‐generation CoC bearings exhibit excellent long‐term survival and clinical outcomes in patients with AS, with a very low dislocation rate. The incidence of noise associated with CoC bearings in THA performed in patients increases over time, but it does not affect postoperative hip function or daily activities. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate the distribution of lower limb alignment in Crowe IV developmental dysplasia of the hip (DDH) before and after total hip arthroplasty (THA). Patients and Methods: We retrospectively included 64 Crowe IV DDH patients (87 hips) who underwent THA between February 2010 and May 2019. Radiographic parameters were measured on full limb length standing anteroposterior radiographs, including hip-knee-ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), anatomical lateral distal femoral angle (aLDFA), and anatomical tibiofemoral angle (aTFA). Results: HKA improved from 176.54°± 3.52° preoperatively to 179.45°± 4.31° at the last followup (P< 0.001). According to the preoperative HKA, 40 hips were defined as knee valgus alignment. The majority of them were characteristic of a valgus mLDFA and a valgus or neutral mMPTA (35%, 47.5%). After THA, there were still 22 hips defined as knee valgus alignment. More than 50% of them were characteristic of a valgus mLDFA and a neutral mMPTA. Five hips (22.7%) revealed valgus alignment in both mLDFA and mMPTA. Twenty-one hips (24.1%) remained knee valgus alignment before and after surgery. One hip, defined as neutral alignment, preoperatively turned into valgus alignment after surgery. Conclusion: Both preoperative and postoperative sources of valgus alignment were mainly from the femoral side among Crowe IV DDH patients. THA mainly played a positive role in the reconstruction of lower limb alignment in these patients. [ABSTRACT FROM AUTHOR]

Objective: To investigate variation of the pelvis in unilateral Crowe type IV developmental dysplasia of the hip (DDH) and analyze the reliability of pelvic landmarks. Methods: We retrospectively received preoperative anteroposterior pelvic radiographs for 89 adult patients with unilateral Crowe type IV DDH at our institution between September 2008 and May 2019. Forty‐eight patients without a false acetabulum was type IVA and 41 with a false acetabulum was type IVB. The heights of the ilium, acetabulum, and ischium areas in affected and unaffected sides were measured. The ratios of the three areas in entire pelvis are calculated. The discrepancies of bilateral iliac crest, inferior sacroiliac articulation, teardrop, and ischial tuberosity on the bisector of the pelvis were also measured. Results: The mean heights of the ilium, acetabulum, ischium areas in the affected side were 74.4, 88.6, and 37.0 mm, respectively, in type IVA group and 77.7, 83.5, and 37.8 mm, respectively, in type IVB group. The heights in the unaffected side were 82.1, 84.6, and 43.8 mm, respectively, in type IVA group and 84.6, 82.0, and 44.0 mm, respectively, in type IVB group. The ratios of the ilium, acetabulum, ischium areas in affected side of Crowe type IVA group were 0.37, 0.44, and 0.19, respectively, and the ratios in unaffected side were 0.39, 0.40, and 0.21, respectively. The ratios in affected side of Crowe type IVB group were 0.39, 0.42, and 0.19, respectively, and the ratios in unaffected side were 0.40, 0.39, and 0.21, respectively. The discrepancies of bilateral iliac crest, inferior sacroiliac articulation, teardrop, and ischial tuberosity on the line of the bisector of the pelvis in Crowe type IVA group were 5.6, 5.2, 2.0, and 7.1 mm, respectively. Those in Crowe type IVB group were 8.1, 3.5, 3.5, and 4.9 mm, respectively. Conclusions: Pelvic asymmetry was a common occurrence in unilateral Crowe type IV DDH in adults. Furthermore, it should be reliable to use teardrop as pelvic landmark to balance leg length discrepancy in preoperative planning. [ABSTRACT FROM AUTHOR]

Purpose: The study assessed the correlation among the patients' perception of leg length discrepancy (LLD) after total hip arthroplasty (THA) in patients with unilateral Crowe type IV developmental dysplasia of the hip (DDH) and the four methods of measuring the leg length in the full-length standing anteroposterior radiographs. Methods: Sixty patients with unilateral Crowe type IV DDH were recruited in this retrospective study between January 2012 and January 2019. Four methods of measurement were used: 1) TD-TP: distance between the inferior aspect of teardrop (TD) and the midpoint of tibial plafond (TP); 2) CH-TP: distance between the center of the hip (CH) or acetabular cup and the TP; 3) GT-TP: distance between the apex of greater trochanter (GT) and the TP; and 4) FL+TL: the sum of femoral length (FL) and tibial length (TL). Results: Association was found among the patients' perception on LLD with difference in TD-TP (OR=1.157), and the difference in FL+TL (OR=1.166). The area under the curve of the difference in FL+TL and the difference TD-TP (0.704 and 0.679) was significantly higher than those of the difference in CH-TP and the difference in GT-TP (0.564 and 0.483). With the calculated threshold of LLD set at 9.0 mm, the sensitivity and specificity of the difference in TD-TP and the difference in FL+TL were 57.7%, 79.4% and 61.5%, 79.4%, respectively. Conclusion: Patients' perception on LLD had good correlation and reliability on the difference of FL+TL and the difference of TD-TP on both sides in the full-length standing anteroposterior radiographs after THA in patients with unilateral Crowe type IV DDH. The calculated threshold of the difference in FL+TL and the difference in TD-TP was set at 9.0 mm to assess the patients' perception on LLD. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to determine whether dislocation height can predict the use of subtrochanteric osteotomy in patients with Crowe type IV hip dysplasia.Patients and Methods: We retrospectively included 102 patients affected by unilateral Crowe type IV developmental dysplasia who underwent primary total hip arthroplasty with modular cementless stem from April 2008 to May 2019 in our institution. Based on radiographs and operative notes, we found 62 hip arthroplasties were performed with subtrochanteric osteotomy and 40 without subtrochanteric osteotomy, which were named as the (subtrochanteric osteotomy) STO group and non-STO group, respectively. The predictive values of height of greater trochanter, height of femoral head/neck junction, and distalization of greater trochanter were analyzed using receiver operating characteristic (ROC) curves.Results: The ROC curves showed that distalization of greater ntrochanter had the highest areas under the ROC curve (AUC), at 0.998. This was followed by height of greater trochanter and height of head/neck junction, which had AUCs of 0.937 and 0.935, respectively. The optimal thresholds of these three indicators were 4.84 cm, 6.05 cm, and 4.26 cm. At the last follow-up, six dislocations occurred (five in the STO group and one in the non-STO group). Four hips were treated by closed reduction and two by open reduction. Three patients (all in STO group) developed femoral nerve palsy with skin numbness on the frontal thigh or tibia and all recovered in a year. At outpatient visit, the limb length was measured. LLD was <1 cm in 83/102, 1-2 cm in 18/102, and >2 cm in 1/102.Conclusion: This study reveals that indicators of dislocation height are useful in predicting the use of subtrochanteric osteotomy during total hip arthroplasty for Crowe type IV hip dysplasia. However, a comprehensive, multivariate analysis may be required to validate these results. [ABSTRACT FROM AUTHOR]

Objective: To explore the leg length balance in total hip arthroplasty (THA) with shortening subtrochanteric osteotomy (SSTO) or not for unilateral Crowe type IV developmental dysplasia of the hip (DDH) through the evaluation of postoperative full‐length anteroposterior radiographs. Methods: The postoperative radiographs of 60 patients with unilateral Crowe type IV DDH from July 2012 to May 2019 were retrospectively reviewed. All patients underwent THA using the Pinnacle Acetabular Cup system, a ceramic liner and femoral head, and the S‐ROM stem with a proximal sleeve or cone. Patients with leg length discrepancy (LLD) < 10 mm were defined as the non‐LLD group. To identify differences associated with SSTO, the group was further divided into two groups based on whether the patient underwent SSTO. A total of 48 patients (26 for SSTO and 22 for non‐SSTO) were in the non‐LLD group. There were 3 male and 45 female patients. The mean age of the patients in the non‐LLD group was 39 years. These data, including leg length, femoral length, the height of center of rotation (COR) of the hip, the depth of the sleeve or cone in the femoral medullary canal and the height of the greater trochanter, were measured. Results: In the non‐LLD group, the femoral lengths in both SSTO and non‐SSTO groups were significantly shorter on the operated side compared with the contralateral side, and the mean discrepancy in the SSTO group was approximately equal to the mean length of the SSTO. The mean height of the COR of the hip on the operated sides in both SSTO and non‐SSTO groups was 13.2 mm, and the contralateral sides were 15.2 and 15.5 mm, respectively. The depth of the sleeve or cone in the femoral medullary canal between SSTO and non‐SSTO groups was 21.7 and 30.6 mm, respectively. The depth of the sleeve or cone in the SSTO group was negatively correlated with the length of SSTO. The heights of the greater trochanter in the operated and contralateral sides were 5.3 and 16.6 mm in the SSTO group, and 13.2 and 17.2 mm in the non‐SSTO group, respectively. Conclusions: Shortening subtrochanteric osteotomy led to femoral shortening on the operated side for patients with unilateral Crowe type IV DDH. The position of the sleeve or cone should be close to the apex of the greater trochanter to compensate the length of the SSTO. The position of the sleeve or cone without SSTO should be adjusted to make sure that the height of the greater trochanter on the operated side is close to that on the contralateral side. [ABSTRACT FROM AUTHOR]

Introduction: Sexual activity is often an important component of life. To date, no studies have examined sexual activity before and after total hip arthroplasty (THA) in male patients with ankylosing spondylitis (AS). The purpose of the current study was to evaluate the effect of THA on sexual activity and to explore the most commonly reported and comfortable coital position for male AS patients with hip involvement. Methods: Data from 31 male AS patients who underwent THA for hip involvement were retrospectively reviewed. Information from the International Index of Erectile Function (IIEF), the Harris Hip Score (HHS) and other clinical parameters was collected and monitored over time. We compared the above-mentioned parameters before surgery and 2 years after surgery and analysed the correlation between changes on the IIEF and changes in clinical parameters. Results: The domain and total scores of the IIEF, except EF, were significantly higher after surgery than were those before surgery (p < 0.05). There was a significant positive correlation between changes on the IIEF and improvement in flexion-extension range of motion (ROM), adduction-abduction ROM and HHS (p < 0.05). Most patients (26/31, 83.9%) resumed sexual activity 5–12 weeks after surgery. The pre- and postoperative distributions of the most commonly reported and comfortable position were not significantly different (p > 0.05). Conclusions: Successful THA may improve sexual activity in male AS patients with hip involvement. Changes in hip ROM show the most significant correlation with improvement in sexual activity. Resumption of sexual activity occurs within 5–12 postoperative weeks. [ABSTRACT FROM AUTHOR]