Ultrasound-guided surgery for lateral snapping hip: a novel ultraminimally invasive surgical technique.

BACKGROUND: Greater trochanteric pain syndrome encompasses a range of causes of lateral hip pain including greater trochanteric bursitis, tendinopathy and tears of the gluteus minimus and medius, and lateral snapping hip (LSH). Surgical options for LSH range from open surgery to endoscopic surgery, including a diamond-shaped cut or a simple transversal release to gluteus maximus tendon release. Resection of an area of proximal iliotibial band (ITB) and step-cut or z-plasty lengthening have not proven superior to transverse release of the ITB. Therefore, making a complete and effective transverse cut guided by ultrasound may represent a potential advance over endoscopic surgery. PURPOSE: In this case series study, we describe how to perform proximal release of the ITB guided by ultrasound. METHODS: The surgical technique-either z-plasty or transverse section of the ITB-was first validated on 10 cadaver specimens and then used in clinical practice. Fourteen patients (5 males and 9 females) were operated from 2014 to 2018. Mean age was 43 years (29-62). RESULTS: The snap resolved in all patients, as verified actively during the surgical procedure as the patient has only local anesthesia. The VAS score for sports activity improved from 7 (5-9) before surgery to 0 (0-2) after 1 year. The HSS score improved from 58 points (47-72) to 96 at 1-2 years. There were no complications other than minor hematomas nor recurrences. CONCLUSION: Ultrasound-guided release of the LSH is a novel surgical option with encouraging results in patients for whom conservative protocols have failed. It can be performed under local anesthesia in an outpatient setting with minimal aggressiveness. It is relatively easy, quick, and painless; no stitches are required. Weight bearing is immediate, and patients usually need crutches for only 2-3 days. Although complete recovery may take 3 months, the rehabilitation protocol is fast and painless.

Effects of massage therapy for patients with thoracic facet joint disorders: A protocol for systematic review and meta-analysis.

BACKGROUND: Thoracic facet joint disorder is a common thoracic disorder in clinic, inducing pain and discomfort at the dislocated thoracic vertebrae, radiating to pain of the neck and back. The incidence of thoracic facet joint disorder is higher than the facet disorder of the cervical and lumbar vertebrae. Therefore, an ideal strategy to relieve thoracic facet joint disorder is urgently needed. In recent years, massage therapy has been increasingly accepted by thoracic facet joint disorder patients due to its lower costs, fewer unwanted side effects and safety for clinical use. In this systematic review, we aim to evaluate the effectiveness and safety of massage therapy for patients with thoracic facet joint disorder. METHODS: We will search the following electronic databases for randomized controlled trials to evaluate the effectiveness of massage therapy in treating thoracic facet joint disorder: Wanfang and PubMed Database, CNKI, CENTRAL, CINAHL and EMBASE. Each database will be searched from inception to October 2020. The entire process will include study selection, data extraction, risk of bias assessment and meta-analyses. RESULTS: This proposed study will evaluate the effectiveness of massage therapy for patients with thoracic facet joint disorder. CONCLUSIONS: This proposed systematic review will evaluate the existing evidence on the effectiveness and safety of massage therapy for patients with thoracic facet joint disorder. DISSEMINATION AND ETHICS: The results of this review will be disseminated through peer-reviewed publication. Because all of the data used in this systematic review and meta-analysis has been published, this review does not require ethical approval. Furthermore, all data will be analyzed anonymously during the review process. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/XMEJD.

Traditional therapies of Zhuang medicine improve pain and joint dysfunction of patients in rheumatoid arthritis: A protocol for systematic review and meta-analysis.

BACKGROUND: Rheumatoid arthritis (RA) is a common chronic inflammatory autoimmune disease, which can lead to joint destruction, dysfunction, finally deformity. Currently, Western medicine treats it with disease-modifying antireheumatic drugs, NSAIDs, glucocorticoid, biological agents, etc, which can induce adverse drug reactions. And now, as an important mean of treating RA, Zhuang medicine has been widely used in clinics, and has achieved significant efficacy. METHODS AND ANALYSIS: The following databases will be searched for relevant information before July 2020: PubMed, Embase, Cochrane Library, Web of Science, and China National Knowledge Infrastructure. MAJOR RESULTS: levels of C-reactive protein, erythrocyte sedimentation rate, Rheumatoid factor. Secondary results: morning stiffness time, range of motion, arthralgia, joint tenderness index, joint swelling index, total effective rate, adverse event. Data will be collected independently by 2 researchers, and the risk of bias in meta analysis will be evaluated according to "Cochrane Handbook for Systematic Reviews of Interventions". All data analysis will be conducted using Review Manager V.5.3. and Stata V.12.0. RESULTS: The curative effect and safety of traditional therapies of Zhuang Medicine treatment for RA patients will be evaluated systematically. CONCLUSION: The systematic review of this study will summarize the currently published evidence of traditional therapies of Zhuang Medicine treatment for RA to further guide its promotion and application.Open Science Framework (OSF) registration number: https://osf.io/c4xv3/.

Ultrasound-Guided Prolotherapy for Acromial Enthesopathy and Acromioclavicular Joint Arthropathy: A Single-Arm Prospective Study.

OBJECTIVES: Prolotherapy is an injection-based complementary treatment for various musculoskeletal diseases. The aim of this study was to evaluate the therapeutic efficacy of ultrasound-guided prolotherapy in the treatment of acromial enthesopathy and acromioclavicular joint arthropathy. METHODS: Thirty-one patients with chronic moderate-to-severe shoulder pain were recruited from September 2015 to September 2017. Ultrasound-guided prolotherapy was performed by injecting 10 mL of a 15% dextrose solution into the acromial enthesis of the deltoid or acromioclavicular joint capsule aseptically. Prolotherapy was given in 2 sessions separated by a 1-month interval. The pretreatment-to-posttreatment change in the pain visual analog scale (VAS) score was recorded as the primary outcome. The mean follow-up duration was 61.8 days. A paired t test was used to assess the difference in pretreatment and posttreatment VAS scores. A univariate logistic regression analysis was conducted to identify the demographic variables associated with substantial pain reduction after the intervention. Substantial pain reduction was defined as a posttreatment VAS score of 3 or less. RESULTS: Twenty of the 31 patients reported substantial pain reduction without adverse effects after the intervention. The mean VAS score reduction ± SD was 4.3 ± 2.6 (pretreatment, 6.8 ± 1.5; posttreatment, 2.5 ± 2.1; P < .01). CONCLUSIONS: Ultrasound-guided prolotherapy with a 15% dextrose solution is an effective and safe therapeutic option for moderate-to-severe acromial enthesopathy and acromioclavicular joint arthropathy.

Adolescent idiopathic scoliosis: The Tethered Spine III: Is fascial spiral the key?

This article reports on an observational and treatment case series involving 22 adolescents and preadolescents treated over a 15 year period who had or appeared to be developing idiopathic scoliosis (IS). Common patterns of muscle and fascial asymmetry were observed and treated. Most of these individuals had spinal area pain and the trigger points (TrPs) apparently responsible for this pain were located in muscles at some distance from the spine, yet referred pain to locations throughout the thoracolumbar spine. Asymmetries in tension in these muscles appear to tether the spine in such a way as to contribute to scoliotic curvatures. The most common pattern of asymmetrical muscle tension found in these individuals follows a particular spiral fascial plane and as the fascia in this spiral plane tightened, the scoliotic curvature appeared to increase. Evaluation also showed that 21 of 22 of these individuals have major ligamentous laxity and this may also have contributed to the development of scoliotic curvatures. Furthermore, each of these individuals has marked overpronation of the ankles, with arches that totally collapse when weight-bearing. Based on observation during the care of these 22 subjects, it appears that asymmetry in the degree of pronation may, in some individuals, be a contributing factor in the development of the spiral body organization involved in the development of scoliosis. Common patterns of joint dysfunction were also observed in many of these individuals. There were also some findings of significant muscle weaknesses that appeared to contribute to the development of the spiraling body organization. Treatment of the tethering of the spine from myofascial asymmetries and related joint dysfunction not only resulted in elimination of pain in almost all cases but also, in many cases resulted in significant reduction of scoliotic curvatures including reductions of rib humps. In other cases, it resulted in stabilization of scoliotic curvatures, and in some cases it may have slowed the rate of progression of curvatures. Stretching and strengthening exercises appeared to contribute to the stability of treatment gains. A segment of the treated population had atypical scoliotic curvatures that did not follow the typical spiral pattern. Even in these individuals, there were significant patterns of fascial restriction and joint dysfunction accompanying the curvatures. Prior traumatic injury was a common factor in almost all of these atypical cases. Treatment of myofascial TrPs and asymmetrical fascial tension and accompanying joint dysfunction is proposed as a useful approach to treating pain in adolescents who have or who appear to be developing scoliosis and to treating and controlling and/or decreasing many scoliotic curvatures. This case series is presented as a way to illuminate possible factors in the development of scoliosis and promising treatment strategies to address these factors and to eliminate pain and stabilize or decrease curvatures so that further research can more systematically evaluate the role of these factors. An addendum of two more cases is also included, because of the information that these cases add to the discussion and to treatment approaches. Including the addendum cases, 8 of the subjects had scoliosis as documented by x-rays. The other 16 appeared to be developing scoliosis according to criteria stated below.

Associations between yoga practice and joint problems: a cross-sectional survey among 9151 Australian women.

Yoga exercises have been associated with joint problems recently, indicating that yoga practice might be potentially dangerous for joint health. This study aimed to analyse whether regular yoga practice is associated with the frequency of joint problems in upper middle-aged Australian women. Women aged 62-67 years from the Australian Longitudinal Study on Women's Health (ALSWH) were questioned in 2013 whether they experienced regular joint pain or problems in the past 12 months and whether they regularly practiced yoga. Associations of joint problems with yoga practice were analysed using Chi-squared tests and multiple logistic regression modelling. Of 9151 women, 29.8% reported regular problems with stiff or painful joints, and 15.2, 11.9, 18.1 and 15.9% reported regular problems with shoulders, hips, knees and feet, respectively, in the past 12 months. Yoga was practiced sometimes by 10.1% and often by 8.4% of women. Practicing yoga was not associated with upper or lower limb joint problems. No association between yoga practice and joint problems has been identified. Further studies are warranted for conclusive judgement of benefits and safety of yoga in relation to joint problems.

[Sacroiliac joint injury treated with oblique insertion at anatomical points: a randomized controlled trial].

OBJECTIVE: To compare the effects of oblique insertion at anatomical points and conventional acupuncture for sacroiliac joint injury. METHODS: Eighty patients were randomly divided into an observation group and a control group, 40 cases in each one. In the observation group, oblique insertion therapy at anatomical points was used, and the 9 points of equal division (anatomical points) marked by palpating the anatomical symbol were treated as the insertion acupoints. In the control group, conventional acupuncture was applied, and perpendicular insertion was adopted at Huantiao (GB 30), Zhibian (BL 54) and Weizhong (BL 40), etc. In the two groups, the! treatment was given once a day and 5 times per week. Ten treatments were made into one course and two courses were required. The clinical effects, the changes of visual analogue scale (VAS) and Oswestry dysfunctional index. (ODI) before and after treatment were observed in the two groups. RESULTS: The total effective rate of the observation group was 90.0% (36/40), which was better than 72.5% (29/40) of the control group (P < 0.05). After treatment, the results of the VAS and ODI of the two groups were apparently declined (both P < 0.01), and those in the observation group were decreased more obviously (both P < 0.01). CONCLUSION: The effect of oblique inser-tion at anatomical points for sacroiliac joint injury is superior to that of conventional acupuncture, which can effectively relieve pain and improve the disfunction.

Relationship between functional capacity, joint mobility and pulmonary function in patients with systemic sclerosis.

BACKGROUND: In systemic sclerosis (SS), pulmonary involvement is currently the leading cause of mortality. Joint impairments limit the range of motion (ROM), which may reduce the functional capacity of these patients. AIM: To assess the correlation between the functional capacity, joints mobility, and pulmonary function parameters in adults with SS. METHOD: This was a cross-sectional study including ten SS patients who underwent goniometry, spirometry, carbon monoxide diffusing capacity (DLco) assessment, and the 6-min walk distance (6 MWD). RESULTS: Significant correlations were found between the 6 MWD and the tibiotarsal plantarflexion ROM (r = 0.65; P < 0.01), tibiotarsal dorsiflexion ROM (r = 0.64; P < 0.01), and hip adduction ROM (0.52; P < 0.05). Significant correlation was also observed between the 6 MWD and DLco (r = 0.61; P < 0.01). CONCLUSIONS: Although the 6 MWD can be influenced by cardiovascular and pulmonary impairments in SS, our results suggest that the musculoskeletal dysfunction play an important role in the functional capacity of these patients.

Canine thoracic costovertebral and costotransverse joints: three case reports of dysfunction and manual therapy guidelines for assessment and treatment of these structures.

The costovertebral and costotransverse joints receive little attention in research. However, pain associated with rib articulation dysfunction is reported to occur in human patients. The anatomic structures of the canine rib joints and thoracic spine are similar to those of humans. As such, it is proposed that extrapolation from human physical therapy practice could be used for the assessment and treatment of the canine patient with presumed rib joint pain. This article presents 3 case studies that demonstrate signs of rib dysfunction and successful treatment using primarily physical therapy manual techniques. General assessment and select treatment techniques are described.

Effect of capsular release in the treatment of shoulder stiffness concomitant with rotator cuff repair: diabetes as a predisposing factor associated with treatment outcome.

BACKGROUND: In spite of the high prevalence of shoulder stiffness during rotator cuff repair, optimal management remains unclear. PURPOSE: To identify the effect of capsular release during rotator cuff repair on the outcomes of patients with both shoulder stiffness and a rotator cuff tear, based on subgroup analyses. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Forty-nine consecutive patients (mean age, 61.5 ± 8.3 years) were enrolled who underwent arthroscopic repair of a small- to large-sized full-thickness rotator cuff tear and manipulation for concomitant shoulder stiffness (passive forward flexion ≤120°, external rotation at the side ≤45°). The first 21 consecutive patients underwent manipulation alone to treat stiffness; the second 28 consecutive patients underwent capsular release with manipulation. Among the 49 patients, 25 showed severe stiffness (forward flexion ≤100°, external rotation at the side ≤30°; 11 in the first series and 14 in the second series), and 15 had diabetes mellitus (30.6%; 6 in the first series and 9 in the second series). Shoulder range of motion was measured 6 weeks, 3 months, 6 months, and 1 year postoperatively and at final follow-up visit. Simultaneously, functional outcome was evaluated by visual analog scale for pain, American Shoulder and Elbow Surgeons score, Constant score, and muscle strength ratio (involved/uninvolved), and cuff integrity was assessed ultrasonographically at least 1 year postoperatively. RESULTS: All range of motion measurements, functional scores, and muscle strength ratios significantly improved postoperatively regardless of the treatment method of stiffness. No outcome measure differed significantly between patients who did and did not undergo capsular release, regardless of the severity of stiffness, except for a temporary improvement in external rotation at side 3 months postoperatively in favor of those who underwent capsular release in cases with severe stiffness. Among patients with diabetes mellitus however, those who underwent capsular release showed greater improvement in forward flexion after 3 months and 1 year and in external rotation at the side for all time points (all P < .05), except for 6 weeks postoperatively; these patients also had a significantly higher final American Shoulder and Elbow Surgeons score (P = .03). Of 21 patients who underwent manipulation alone and of 28 who underwent capsular release and manipulation, 2 and 1 developed retears, respectively. CONCLUSION: Both manipulation and capsular release with manipulation significantly improved range of motion and produced satisfactory functional outcomes. The outcomes did not differ between treatment methods for stiffness regardless of the severity of stiffness. In patients with diabetes mellitus however, capsular release at the time of rotator cuff repair seems to be beneficial, especially for external rotation and final postoperative function.

Inter-clinician and intra-clinician reliability of force application during joint mobilization: a systematic review.

Joint mobilizations are commonly used by clinicians to decrease pain and restore joint arthrokinematics following musculoskeletal injury. The force applied during a joint mobilization treatment is subjective to the individual clinician but may have an effect on patient outcomes. The purpose of this systematic review was to critically appraise and synthesize the studies which examined the reliability of clinicians' force application during joint mobilization. A systematic search of PubMed and EBSCO Host databases from inception to March 1, 2013 was conducted to identify studies assessing the reliability of force application during joint mobilizations. Two reviewers utilized the Quality Appraisal of Reliability Studies (QAREL) assessment tool to determine the quality of included studies. The relative reliability of the included studies was examined through intraclass correlation coefficients (ICC) to synthesize study findings. All results were collated qualitatively with a level of evidence approach. A total of seven studies met the eligibility and were included. Five studies were included that assessed inter-clinician reliability, and six studies were included that assessed intra-clinician reliability. The overall level of evidence for inter-clinician reliability was strong for poor-to-moderate reliability (ICC = -0.04 to 0.70). The overall level of evidence for intra-clinician reliability was strong for good reliability (ICC = 0.75-0.99). This systematic review indicates there is variability in force application between clinicians but individual clinicians apply forces consistently. The results of this systematic review suggest innovative instructional methods are needed to improve consistency and validate the forces applied during of joint mobilization treatments. This is particularly evident for improving the consistency of force application across clinicians.

Iatrogenic glenoid fracture after brisement manipulation for the stiffness of shoulder in patients with rotator cuff tear.

In combined stiffness with rotator cuff tear, the brisement manipulation with or without capsular release has been more common procedure prior to the rotator cuff repair. It is known to be relatively safe and easy procedure with rare complications. However, the present authors found the iatrogenic fracture of anteroinferior portion of glenoid after brisement manipulation during the arthroscopic rotator cuff repair. The patient was followed up with the routine postoperative protocol for rotator cuff repair, which was composed of 4 weeks of protection with abduction brace, passive and active assisted range of motion exercise afterward, and progressive strengthening exercise. Two years after surgery, the patient showed improved clinical score and healing of fracture fragment. However, iatrogenic glenoid fracture should be kept in mind when the brisement manipulation is performed during arthroscopic surgery.

Alumina-on-alumina THA performed in patients younger than 30 years: a 10-year minimum followup study.

BACKGROUND: THA in patients younger than 30 years presents challenges because of uncertainties regarding the long-term survivorship of prostheses. Alumina-on-alumina bearings, which exhibit little long-term wear, may be a reasonable option but the long-term survivorship is unknown. QUESTIONS/PURPOSES: We determined (1) the survival rate of alumina-on-alumina bearings in patients younger than 30 years after a 10-year followup, (2) the incidence of audible hip clicking and squeaking, (3) radiographic evidence of osteolysis, and (4) the effects on pregnancy, childbirth, and career choice. METHODS: We retrospectively reviewed 62 patients who had 75 THAs with alumina-on-alumina bearings followed more than 10 years (average, 11.5; range, 10-13.5 years). Mean patient age at the time of surgery was 24 years (range, 18-30 years). All operations were performed using the same cementless implant at a single center. We determined survival, presence of osteolysis, and function (Harris hip score, WOMAC). RESULTS: The 10-year survival rate of alumina-on-alumina bearings in THAs, with revision for any reason as the end point, was 98.9%. Audible hip clicking and squeaking were identified in 10 hips and two hips, respectively. No osteolysis was detected. None of the 11 patients who became pregnant had been affected by their THA during pregnancy or childbirth. Seven of the 14 patients who were unemployed at the time of index surgery stated that their THA affected their job choice. CONCLUSIONS: We found a high 10-year survival of cementless alumina-on-alumina bearings in THAs in patients younger than 30 years. Lifetime events such as job choice, pregnancy, and childbirth should be considered when choosing THA for patients younger than 30 years. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Postoperative autologous blood transfusion drain or no drain in primary total hip arthroplasty? A randomised controlled trial.

PURPOSE: Postoperative maintenance of high haemoglobin (Hb) levels and avoidance of homologous blood transfusions is important in total hip arthroplasty (THA). The introduction of a postoperative drainage autologous blood transfusion (ABT) system or no drainage following THA has resulted in reduction of homologous blood transfusion requirements compared with closed-suction drains. The purpose of this study was to examine which regimen is superior following THA. METHODS: A randomised controlled blinded prospective single-centre study was conducted in which 100 THA patients were randomly allocated to ABT or no drainage. The primary endpoint was the Hb level on the first postoperative day. RESULTS: The postoperative collected drained blood loss was 274 (±154) ml in the ABT group, of which 129 (±119) ml was retransfused (0-400). There was no statistical difference in Hb levels on the first postoperative day (ABT vs no drainage: Hb 11.0 vs 10.9 g/dl), on consecutive days (day 3: Hb 10.7 vs 10.2, p = 0.08) or in total blood loss (1,506 vs 1,633 ml), homologous transfusions, pain scores, Harris Hip Score, SF-36 scores, length of hospital stay or adverse events. CONCLUSIONS: The use of a postoperative autologous blood retransfusion drain did not result in significantly higher postoperative Hb levels or in less total blood loss or fewer homologous blood transfusions compared with no drain.

Surgical treatment of symptomatic discoid medial meniscus in childhood: a case report.

If the meniscus has a spherical shape and not a semilunary structure, it is called as discoid meniscus. This anomaly is generally seen in the lateral meniscus; however, it is rare in the medial meniscus. Although the discoid meniscus is usually asymptomatic in children and adolescents, it could present as a meniscal tear. An 11-year-old boy was admitted to our hospital with right knee pain and lack of extension of the knee joint. He was diagnosed as discoid medial meniscus. On physical examination, we observed tenderness at the knee joint line with an effusion of the knee and a restriction during the extension movement of the knee joint. McMurray test was positive. Conventional radiograms revealed widening of the medial joint line and cupping of the medial tibial plateau. Magnetic resonance imaging indicated a discoid meniscus image at sagittal slices. In this case, after the arthroscopic partial menisectomy, we obtained an excellent result at 2 years follow-up.

A review on frozen shoulder.

Of all the joints in the human body, the shoulder has the greatest range of motion. This allows complex movements and functions to be carried out, and is of vital importance to the activities of daily living and work. Any restriction or pain that involves the joint puts a huge amount of strain on patients, especially those who are in their most productive years of life. Frozen shoulder, a frequently encountered disorder of the shoulder, has been well recognised since the early 1900s. Although benign, it has great impact on the quality of life of patients. This article aims to provide an overview of the nature and the widely accepted management of this condition based on other studies.

[Electroacupuncture in combination with rehabilitation for treatment of motor impairment after elbow operation].

OBJECTIVE: To compare the clinical effect on motor impairment after elbow operation between electroacupuncture combined with rehabilitation and rehabilitation training. METHODS: Fifty-three cases were randomized into an electroacupuncture combined with rehabilitation group (group A, 30 cases) and a rehabilitation group (group B, 23 cases). In group A, electroacupuncture was applied on the stiff region of the elbow and Sanjian (LI 3), Shousanli (LI 10), Hegu (LI 4), Yanglingquan (GB 34), Yinlingquan (SP 9) as adjunctive acupoints. Additionally, the passive movement was followed in the elbow joint after needles removed. In group B, the constant passive movement exercise was applied. The therapeutic effect was observed after 1.5 months of treatment. Mayo Elbow Performance Score (Mayo) and range of motion (ROM) were analyzed statistically after treatment in two groups. RESULTS: Mayo score and elbow ROM were all improved significantly after treatment in two groups (all P < 0.01). Compared with group B after treatment, the total Mayo score, joint motion range and ability as well as elbow ROM were all improved much apparently in group A (all P < 0.01). CONCLUSION: Compared with rehabilitation therapy, electroacupuncture in combination of rehabilitation training can achieve much significant effect on the motion function recovery of elbow joint after fracture operation.

THA with Delta ceramic on ceramic: results of a multicenter investigational device exemption trial.

UNLABELLED: Although the published studies on the outcomes of total hip arthroplasty (THA) performed with currently available ceramic components show high survivorship and low bearing wear at midterm followup, concern over ceramic fracture and squeaking persist. For these reasons, the use of ceramic is limited. Recently, a new alumina matrix composite material (Delta ceramic) with improved material properties was developed to address these concerns. We report the early outcomes and complications of a prospective, randomized, multicenter trial of 263 patients (264 hips) at eight centers, comparing a Delta ceramic-on-ceramic (COC) articulation with a Delta ceramic head-crosslinked polyethylene bearing combination (COP). There were 177 COC hips and 87 COP hips. Complications were reported for all patients, whereas clinical and radiographic results were provided for the 233 patients with minimum 2-year followup (average, 31.2 months; range, 21-49 months). The Harris hip scores and clinical, radiographic, and survivorship outcomes were similar in both groups. There were four (2%) revisions in the COC group and two (2%) in the COP group. We encountered three intraoperative ceramic liner-related events. In addition, one patient receiving the COC underwent revision for chipping of the ceramic liner, and a second had ceramic fragmentation on followup radiographs but has not undergone revision. These liner related complications remain a concern. No patient reported squeaking in either group; this leaves us hopeful the new material will lessen the frequency of squeaking. In the short term, the Delta COC articulation provided similar functional scores and survivorship and complication rates with the ceramic head mated with crosslinked polyethylene. LEVEL OF EVIDENCE: Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.