Total Hip Replacement with a Fully Hydroxyapatite-Coated Shortened Stem: Five- to Thirteen-Year Follow-Up Results.

Background: Shortened femoral stems aim to mimic the biomechanical performance of traditional stems while preserving more bone and minimizing soft tissue damage. Our objective is to assess the outcomes of patients treated with a shortened stem (Furlong Evolution, JRI Orthopaedics, Sheffield, UK) to analyze the implant's efficacy and survivorship. Methods: This retrospective observational study included all patients aged 18 to 70 undergoing uncemented shortened stem total hip replacement at Hospital del Mar between 2010 and 2018. Hip function and pain were assessed with the Merle d'Aubigné-Postel scale and visual analog scale, respectively. A radiographic analysis measured stem and cup orientation, leg length discrepancy, stem subsidence, and radiolucencies around the cup. Perioperative complications, prosthetic failures, and reoperations were documented. Results: A total of 109 patients (74 male, 35 female) of a mean age of 51.8 ± 8.8 years were included. The average follow-up was 91 ± 17.4 months. Radiographically, 71 (65.1%) of the stems had been inserted at the appropriate angulation (±3°), and 102 (93.6%) of the cups had been placed in the Lewinnek safety zone. Leg length discrepancy was observed in 19 (17.4%) cases. The mean Merle d'Aubigné-Postel score improved from 13.1 ± 1.39 preoperatively to 17.8 ± 0.49 at 6 months postoperatively (p < 0.001). Merle d'Aubigné-Postel subscales also reflected a statistically significant improvement (p < 0.001). The mean pain score 12 months postoperatively was 0.52 ± 1.22, with 95.4% of patients declaring themselves satisfied or highly satisfied. The expected 13-year survival according to a Kaplan-Meier analysis was 100% in the absence of infection and 91.3% if revision for any cause is taken as a survival endpoint. Conclusions: The shortened stem under analysis provides excellent functional results and long-term survival rates.

Labral reconstruction with polyurethane implant.

Surgical treatment of labral injuries has shifted from debridement to preservation over the past decades. Primary repair and secondary augmentation or reconstruction techniques are aimed at restoring the labral seal and preserving or improving contact mechanics. Currently, the standard of care for non-repairable tears favours the use of auto- or allografts. As an alternative, we present our initial experience using a synthetic, off-the-shelf polyurethane scaffold for augmentation and reconstruction of segmental labral tissue loss or irreparable labral damage. Three patients aged 37-44 (two male, one female) with femoroacetabular impingement without associated dysplasia (Wiberg > 25°) or osteoarthritis (Tönnis <2) were included in this series. Labral reconstruction (one case) and augmentation (two cases) were performed using a synthetic polyurethane scaffold developed for meniscal substitution (Actifit®, Orteq Ltd, London, UK) and adapted to the hip. Clinical results were analysed with patient-reported outcomes (PROMs) using non-arthritic hip score (NAHS) and daily live activities hip outcome score (DLA HOS) and magnetic resonance images (MRI) at 2- and 4-year follow-up. Clinically improvement was seen in all PROMs at 4 years. The NAHS scores improved from 57.7 to 82.3 (50.9% improvement) and HOS from 59 to 79.3 (35.3% improvement). Last follow-up MRIs confirmed the presence of the scaffold; however, the scaffold signal was still hyperintense compared to native labrum. There was no shrinkage in any scaffold and no progression to hip osteoarthritis seen. Reconstruction or augmentation of segmental labral defects with a polyurethane scaffold may be an effective procedure. At 4 years after implantation, our small cases series resulted in improved hip joint function, reduced pain and scaffold preservation on follow-up imaging.

Fracture of the femoral component after a lightning strike injury: A case report.

A fracture of the stem in a total hip arthroplasty (THA) is an uncommon complication. We report a case of femoral stem fracture in a 55-year-old male patient after a lightning strike. A revision was conducted using a Wagner osteotomy and a revision prosthesis. Dall-Milles cerclages were used to close the osteotomy. The postoperative evolution was satisfactory, with an immediate partial weight bearing, consolidation of the osteotomy after three months and return to daily activity without pain.

Two-stage revision of hip prosthesis infection using a hip spacer with stabilising proximal cementation.

Two-stage revision hip arthroplasty for infection using an antibiotic-loaded cement spacer has been used frequently with good results. However, spacer instability is also frequent. Proximal cementation of the spacer could avoid spacer dislocation. We retrospectively assessed 35 patients in whom a 2-stage revision hip arthroplasty for infection was carried out using an antibiotic-loaded cement spacer with gentamicin (Spacer-G) in which the spacer was proximally cemented in 16 patients. The mean follow-up was 32 months. We assessed spacer stability and infection elimination. There were 8 spacer dislocations (22.9%), 5 in hips without proximal cementation and 2 in hips with proximal cementation (p>0.05). There was no fracture in any hip. Reinfection occurred in 5 hips (14.3%), in 3 with the same microorganism, while 2 had a different microorganism. Our results indicate that the proximal cementation of the spacer prevents its dislocation. Infection was eliminated in 86% of the hips.