• Dislocation
• hemiarthroplasty
• hip fracture
• mortality
• outcome

• Humans
• Hemiarthroplasty/adverse effects
• Hemiarthroplasty/methods
• Female
• Male
• Retrospective Studies
• Aged
• Aged, 80 and over
• Hip Dislocation/surgery
• Hip Dislocation/etiology
• Hip Dislocation/mortality
• Reoperation/methods
• Prosthesis Failure
• Treatment Outcome
• Hip Prosthesis
• Arthroplasty, Replacement, Hip/adverse effects
• Arthroplasty, Replacement, Hip/methods
• Hip Fractures/surgery
• Middle Aged
• Femoral Neck Fractures/surgery

• Complications
• Conversion
• Hemiarthroplasty
• Hip pathology
• Revision
• Total hip arthroplasty

• conversion
• total hip arthroplasty
• previous hip fracture surgery
• hip fixation
• hip hemiarthroplasty
• hip fracture surgeries
• conversion total hip arthroplasty
• hips
• hemiarthroplasties
• revision surgery
• intraoperative fractures
• oxford hip scores (ohs)
• cephalomedullary nail
• dynamic hip screw (dhs)

• Conversion
• Hip hemiarthroplasty
• Meta-analysis
• Revision
• Total hip arthroplasty

• Conversion
• Hemiarthroplasty
• Hip
• Meta-analysis
• Systematic review
• Total hip arthroplasty

• Humans
• Arthroplasty, Replacement, Hip/methods
• Arthroplasty, Replacement, Hip/adverse effects
• Hemiarthroplasty/methods
• Hemiarthroplasty/adverse effects
• Reoperation/statistics & numerical data
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Treatment Outcome

• Humans
• Analgesics, Opioid
• Arthroplasty, Replacement, Hip
• Pain, Postoperative/etiology
• Femoral Nerve
• Nerve Block/methods
• Randomized Controlled Trials as Topic

• MCID
• PROMs
• cTHA
• conversion
• total hip arthroplasty

• Humans
• Arthroplasty, Replacement, Hip
• Retrospective Studies
• Case-Control Studies
• Minimal Clinically Important Difference
• Patient Reported Outcome Measures
• Osteoarthritis
• Treatment Outcome

• arthroplasty
• dislocation
• dual mobility
• large femoral head
• revision total hip arthroplasty

• Femoral neck fracture
• Hemiarthroplasty
• Total hip arthroplasty

• conversation
• hemiarthroplasty
• hip
• hip fracture
• primary total hip arthroplasty
• total hip arthroplasty

• hip
• hip prosthesis
• neck of femur fracture
• orthopedics
• osteoarthritis
• total hip replacement

• Arthroplasty, Replacement, Hip/adverse effects
• Australia/epidemiology
• Femoral Neck Fractures/epidemiology
• Femoral Neck Fractures/surgery
• Hemiarthroplasty/adverse effects
• Hip Prosthesis/adverse effects
• Humans
• Prosthesis Design
• Prosthesis Failure
• Reoperation
• Risk Factors

• conversion
• conversion total hip
• cost
• infection
• primary total hip
• total hip arthroplasty

• Complications
• conversion
• hemiarthroplasty
• outcomes
• survivorship
• total hip arthroplasty

This study aimed to explore mid-term clinical results of cementless total hip arthroplasty (THA) with modified trochanteric osteotomy in Crowe type IV developmental dysplasia of the hip (DDH).

Thirteen patients (13 hips) with Crowe type IV DDH who underwent THA with modified trochanteric osteotomy between May 2013 and October 2015 were retrospectively analyzed. The mean follow-up duration was 5.2 years (range, 4.9–6.1 years).

The mean Harris Hip Score (HHS) significantly (p < 0.05) improved from 30.7 (range, 22–38) to 87.5 (range, 83–93). The mean leg length discrepancy (LLD) was 53.4 mm (range, 42.1–68.5 mm) preoperatively. The final LLD was 5.6 mm (range, 2.4–9.1 mm; p < 0.05). The mean leg length after surgery was 47.4 mm (range, 33.6–67.2 mm) and the femur shortening distance was 43.8 mm (range, 31.2–53.4 mm). The average duration of bone union for the greater trochanter (GT) was 2.5 months (range, 1.5–3.6 months). There was no infection, GT non-union, or loosening (septic or aseptic) of the stem or cup in any case.

THA with modified trochanteric osteotomy with a cementless cup is an effective treatment for Crowe type IV DDH. It can rebuild complex biomechanics and biology of hip dysplasia without increasing complications.

• Arthroplasty
• Crowe type IV
• Development dysplasia of the hip
• Dysplasia
• Trochanteric osteotomy

To investigate whether the risk of dislocation after total hip arthroplasty (THA) in patients with Crowe type IV developmental dysplasia of the hip (DDH) is high and to further identify the risk factors for postoperative dislocation in these patients.

This retrospective cohort study reviewed Crowe type IV DDH patients undergoing THA between January 2009 and December 2017 in our institution. Each Crowe type IV DDH patient was matched with three Crowe type I, II, or III DDH patients according to gender, side and date of operation. The primary outcome of this study was postoperative dislocation after THA. Occurrence, rate, classification, treatment and outcome of dislocation were documented in detail for all patients. The dislocation rates were compared between Crowe type IV DDH patients and Crowe type I, II, or III DDH patients. Demographic data, implant factors, and surgical factors were compared between the dislocation and no dislocation groups. Multiple logistic regression analysis was used to determine the independent risk factors for dislocation in Crowe type IV hips.

A total of 131 Crowe type IV hips were followed up for a mean of 76.5 ± 28.1 months. Three hundred and ninety‐three Crowe type I, II and III hips, including 261 type I hips, 94 type II hips, and 38 type III hips, were identified as controls and followed up for a mean of 76.4 ± 28.2 months. No significant difference was observed in follow‐up time between two groups (P = 0.804). One or more dislocations occurred in 22 of the 524 dysplasia hips (4.20%). Of the 22 dislocated hips, 20 hips (90.9%) were successfully managed with non‐operative treatment. Two patients (9.1%, one Crowe type I and one Crowe type IV) experienced recurrent dislocation and required revision surgery. Crowe type IV hips had a significantly higher postoperative dislocation rate than type I, II, and III hips (11.45% vs 1.78%, P < 0.001). The use of a 22‐mm femoral head (odds ratio [OR] = 23.55, 95% confidence interval [CI] = 1.901–291.788, P = 0.014), older age (OR = 1.128, 95% CI = 1.037–1.275, P = 0.031), and absence of false acetabulum (OR = 12.425, 95% CI = 1.982–77.879, P = 0.007) were identified as independent risk factors for dislocation in Crowe type IV hips.

Crowe type IV DDH patients were at a high risk of dislocation after THA, and using large femoral heads and improving abductor muscle strength may help decrease the rate of postoperative dislocation in such patients.

• Developmental dysplasia of the hip
• Postoperative dislocation
• Total hip arthroplasty

• Acetabular cup
• X-ray offset
• pelvic rotation
• radiographic angle

• Kaplan-Meier
• competing risk of death
• conversion hemiarthroplasty
• dislocation
• revision

• constrained liners
• dislocation
• operative treatment
• revision hip surgery
• total hip arthroplasty

• complications
• conversion THA
• hemiarthroplasty conversion
• revision THA
• revisions

• femoral neck fracture
• hemiarthroplasty
• periprosthetic fracture
• revision cementless hemiarthroplasty
• revision total hip arthroplasty

Purpose: We aimed to study clinical and radiological outcomes of conversion from hemiarthroplasty to Charnley hip replacement (CHR) with a particular concern over reported increased dislocation rate and literature review. Conversion of hip hemiarthroplasty to total hip replacement (THR) is a procedure reported to have high rates of complications. In the literature, there is no specific study on small head conversion. The purpose of this study was to evaluate the conversion of failed hip hemiarthroplasty to CHR with the use of modern implants. Methods: The study included 42 patients, who underwent the above procedure. The operations were carried out using a modern Charnley-type THR with a 22-mm diameter of femoral head and a trans-trochanteric approach. The mean follow-up was 75.7 months (range 25–171). Radiographs from the last follow up were evaluated for loosening and other reasons of failure. Clinical outcome was assessed using postoperative pain, function scores, complications and implant survivorship as well as radiological evaluation. Charnley’s modified pain and mobility scoring system were used for clinical and Hodgkinson and Harris’ criteria were used for radiological assessment. Results: Functionally, all of the patients showed improvement. Mean improvement in the pain level was by average of 2.4. On mobility assessment, 38 patients (90.4%) improved. Three patients (7.1%) had recurrent infections and three (4.8%) cases were treated with revision surgery and pseudarthrosis. Further complications occurred in 19.1%, not requiring operative treatment. On radiological evaluation, one (2.4%) case showed cup demarcation without bone loss, two (4.8%) cup migration, and one (2.4%) stem demarcation. Kaplan Meier survival analysis showed a survival of 90% at 96 months of follow up (95% CI (confidence interval), 60–90). Conclusion: Larger head might not be the answer to decrease the dislocation rate. Complication rates during revision of hip hemiarthroplasty to modern CHR with 22.225-mm head diameter were comparable to first-time THR revision despite having a smaller head.

• conversion of hemiarthroplasty to THA (total hip arthroplasty)
• dislocation
• failed hip hemiarthroplasty
• low friction arthroplasty

• Dislocation
• Hip hemiarthroplasty

Dislocation represents the most common complication after revision total hip arthroplasty (rTHA). Understanding risk factors for dislocation has a great clinical relevance for every hip surgeon in order to consider all surgical options for effective planning. The aim of this systematic review was to answer two main questions—(1) what are the risk factors for instability after rTHA? and (2) what are the best preoperative assessments and surgical options to avoid dislocation after rTHA?

Scientific databases were accessed to identify papers dealing with prevention and treatment of dislocation after rTHA. We performed a search using the keywords ‘revision hip arthroplasty’ and ‘dislocation’, ‘instability’, ‘outcome’, ‘failure’, ‘treatment’. After removal of duplicates and exclusion of works published in different languages, 33 articles were reviewed completely.

Risk factors were analysed in order to establish the most relevant and evidence-based treatments available in the current literature.

The risk of dislocation after rTHA can be reduced using some precautions inferred from the literature. The use of a larger femoral and acetabular component, elevated rim liner and dual mobility implants can significantly reduce the risk of dislocation after rTHA. However, care must be taken regarding patient-related risk factors since these cannot be addressed and modified. Hence, a complete evaluation of risk factors should be performed for each patient and procedure before starting rTHA.

• Dislocation
• Failure
• Hip arthroplasty
• Revision
• Risk factors
• Surgical treatment

• conversion
• dislocation
• dual-mobility constructs
• hip hemiarthroplasty
• large femoral heads
• total hip arthroplasty

Acetabular fractures in older patients are challenging to manage. The “fix and replace” construct may present a new paradigm for the management of these injuries. We present the current challenge of acetabular fractures in older patients. We present this in the context of the current literature. This invited editorial presents early results from our centre and the ongoing challenges are discussed.

• Acetabular fracture
• Total hip arthroplasty
• Trauma

• Bipolar hemiarthroplasty
• Bone grafting
• Femoral stem retention
• Isolated acetabular revision
• Total hip arthroplasty

• Acetabulum/surgery
• Aged
• Aged, 80 and over
• Arthroplasty, Replacement, Hip/methods
• Bone Transplantation
• Female
• Femur/surgery
• Follow-Up Studies
• Hemiarthroplasty
• Hip Dislocation/surgery
• Hip Joint/surgery
• Humans
• Male
• Middle Aged
• Osteolysis/surgery
• Periprosthetic Fractures/epidemiology
• Postoperative Complications/epidemiology
• Prosthesis Failure
• Reoperation/methods

Modern unipolar hip hemiarthroplasty, commonly used for displaced femoral neck fracture, is now modular, with both a variable length cobalt-chromium adapter-sleeve and large femoral head. Patients with these modular components may develop symptomatic trunnion corrosion, with elevated serum metal levels. We report the case of an 82-year-old woman, 5.5 years after a modular unipolar hip hemiarthroplasty, who presented with a 4-month history of hip pain and limp. Evaluation showed elevated serum cobalt and chromium levels and an acetabular cyst. At revision, fluid, tissue, and gross inspection were consistent with trunnion corrosion. The hip was revised with a ceramic head and dual mobility acetabular component, with a good result at 1 year. The designs of commercially available, modern unipolar hip hemiarthroplasty prostheses are reviewed.

• ALTR
• MACC
• corrosion
• hemiarthroplasty
• trunnion
• unipolar

The choice of primary hip hemiarthroplasty or total hip arthroplasty for displaced femoral neck fracture is still controversial. Revision hip arthroplasty not only increases risk and cost but also could result in worse outcome. Determining the risk factors for revision can help inform medical decision-making and aid in risk stratification of publicly reported outcomes. Therefore, we conducted a nationwide population-based study to identify the disease-related risk factors and construct a risk score nomogram to predict revision surgery.

Records of all 68,030 femoral neck fracture patients receiving partial hemiarthroplasty (HA) in 2000–2010, with no total hip arthroplasty (THA) or revision HA history, were collected from the National Health Insurance Research Database. Cox proportional hazard regression was used to estimate the risk of revision hip replacement (RHA). The score of each risk factor was the quotient of the regression coefficient of the variable by the regression coefficient for a 10-year increase in age. The predictive accuracy was tested using the area under the receiver operating characteristic curve (AUROC).

The revision risk for hemiarthroplasty increased in male, those with schizophrenia and end-stage renal disease patients had 1.58-, 1.88-, and 1.74-fold revision HA risk (95 % confidence interval (CI) = 1.40–1.78, 1.26–2.79, and 1.29–2.34, respectively). In a predictive model, the cumulative risk score ranged from 0 to 13 with a 5.08 to 91.82 % 10-year predicted RHA risk. The percentage of AUROC for 10-year RHA risk in nomogram was 61.9 (95 % CI = 60.0–63.4).

Males, schizophrenia and end-stage renal disease patients have higher risk of revision surgery after hemiarthroplasty for femoral neck fracture.

Displaced femoral neck fractures are common in the elderly patient. The surgical treatment options consist of a hemiarthroplasty (HA) or total hip arthroplasty (THA). However, the best surgical choice is still under debate. Bipolar HAs do not address preexisting arthritic changes of the acetabulum, which may lead to an unfavorable clinical outcome. The purpose of the present study was to conduct a long term follow-up analysis of the bipolar hemiarthroplasty with particular focus on the influence of preoperative acetabular osteoarthritis on the functional outcome.

In a retrospective observational study, the medical charts of consecutive patients treated with a bipolar hemiarthroplasty at a level one trauma center between 2004 and 2008 were reviewed before a final radiographic and clinical follow-up was performed. The outcome variables consisted of arthritic findings on the pre- and postoperative x-rays with particular focus on double fond osteophyte (DFO) and posterior wall sign (PWS) as well as the revision rate and functional scores.

This study included 102 patients with a mean age of 77.2 years. Most patients (75 %) had a Kellgren-Lawrence grading scale (KLGS) of 2 or 3. While only 30 % of patients had a DFO, most patients (73 %) had a PWS. The DFO correlated significantly with the KLGS, but no correlation was seen with the clinical outcome. Most patients showed a decreased offset by a mean of −7.8 mm. The mean modified Harris Hip Score (HHS) of 90.3 and the mean Merle d'Aubigné score of 10.8 correlated significantly. Despite a significant correlation of the HSS subcategory of pain and the preoperative KLGS, there was no statistical relationship between the arthritic x-ray measurements and the clinical outcome.

In the presented study population, the presence of radiographic acetabular osteoarthritis did not influence the clinical outcome after bipolar hemiarthroplasty for displaced femoral neck fractures.

• Bipolar hemiarthroplasty
• Double fond osteophyte (DFO)
• Femoral neck fracture
• Osteoarthritis and coxarthrosis
• Posterior wall sign (PWS)

Dislocation is one of the most frequent causes of failure of hemiarthroplasties of the hip, which is the most common treatment for femoral neck fractures in elderly patients. A revision with conversion to total hip arthroplasty is the gold standard in case of failure of closed reduction: however, the use of standard or modular components shows variable outcomes. The use of a dual mobility cup has been evaluated in patients with unstable implants, given the good outcomes obtained in primary and revision surgery. The aim of this study was to assess the results of revisions by dual mobility cups in unstable hemiarthroplasties.

Thirty-one patients (mean age 75.4 years) were retrospectively evaluated between 2006 and 2010 after conversion to total hip arthroplasty with dual mobility cups for recurrent dislocations. The mean number of dislocations was 2.6 (range 2–5). The evaluation was performed by the American Society of Anesthesiologists physical function score (ASA) and the Harris hip score, and several radiologic criteria.

The mean follow-up was 3.8 years. No recurrence of dislocation was recorded. The ASA score remained unchanged, and the mean Harris hip score improved from 62.2 before dislocation to 76.0 points postoperatively.

Dual mobility cups may be a useful option in the treatment of a hemiarthroplasty dislocation. No risk of a new revision due to instability after insertion of dual mobility cups resulted in our experience, and this option may be strongly considered in cases of revisions of unstable hemiarthroplasties.

Level of evidence IV.

• Dislocation
• Dual mobility cups
• Hemiarthroplasty of the hip
• Revision

• Aged
• Aged, 80 and over
• Arthroplasty, Replacement, Hip/methods
• Female
• Femoral Neck Fractures/surgery
• Follow-Up Studies
• Hip Prosthesis
• Humans
• Joint Instability/surgery
• Male
• Prosthesis Design
• Prosthesis Failure
• Recurrence
• Reoperation
• Retrospective Studies
• Risk Assessment
• Treatment Outcome

• constrained liner
• cumulative Risk
• dislocation
• instability
• large femoral head
• revision arthroplasty

• Cement
• fracture
• hemiarthroplasty
• hip
• modular
• orthogeriatric.

• Ceramic on ceramic
• Hip
• ankylosis
• arthroplasty
• bearing surfaces
• cementless total hip arthroplasty
• ceramics
• fused hip
• total hip arthroplasty

• Aged
• Aged, 80 and over
• Female
• Femoral Neck Fractures/complications
• Femoral Neck Fractures/diagnostic imaging
• Femoral Neck Fractures/physiopathology
• Femoral Neck Fractures/surgery
• Femur Head/blood supply
• Femur Head Necrosis/etiology
• Fracture Fixation, Internal
• Fracture Healing
• Humans
• Intra-Articular Fractures/complications
• Intra-Articular Fractures/diagnostic imaging
• Intra-Articular Fractures/physiopathology
• Intra-Articular Fractures/surgery
• Male
• Middle Aged
• Positron-Emission Tomography
• Predictive Value of Tests
• Prospective Studies
• Regional Blood Flow
• Tomography, X-Ray Computed

• Adult
• Aged
• Aged, 80 and over
• Arthroplasty, Replacement, Hip/adverse effects
• Female
• Follow-Up Studies
• Hip Dislocation/etiology
• Hip Joint/surgery
• Hip Prosthesis
• Humans
• Male
• Middle Aged
• Prosthesis Failure
• Reoperation
• Risk Factors
• Treatment Outcome

• Acetabulum/diagnostic imaging
• Hip Prosthesis
• Humans
• Tomography, X-Ray Computed/methods