Even in extensive osteonecrosis of the femoral head in younger patients, a femoral head-preserving method is preferable. We developed a new technique using the lateral approach as used in traditional core biopsy; the osteonecrotic lesion was removed and impacted bone grafts were used to regain sphericity and prevent collapse. In this prospective one surgeon study, we included 28 consecutive hips in 27 patients with extensive osteonecrotic lesions (ARCO classification Stage 2 [11 hips], Stage 3 [14 hips]; and Stage 4 [three hips]); 14 hips had preoperative collapse. The mean age of the patients was 33 years (range, 15–55 years). At a mean followup of 42 months (range, 24–119 months), eight hips (29%) were converted to a total hip arthroplasty (THA). Of the 20 reconstructions that were in situ, 18 were clinically successful (90%) and 70% were radiologically successful. Patients who were younger than 30 years at surgery had a radiologically significant better outcome, even patients with higher stages of osteonecrosis. Patients with preoperative collapse and use of corticosteroids had disappointing results. This method is attractive as a salvage procedure, is relatively simple and quick, and it does not interfere with an eventual future hip arthroplasty.

Providing relevant information on disease and self-management helps patients to seek timely contact with care providers and become actively involved in their own care process. Therefore, health professionals from primary care, multiple hospitals and health organisations jointly decided to develop an educational program on osteoarthritis (OA). The objective of the present study was to determine preliminary effects of this OA educational program on healthcare utilization and clinical outcomes. We developed an educational group-based program consisting of 2 meetings of 1.5 h, provided by a physiotherapist, a general practitioner (GP) and orthopaedic surgeon or specialized nurse. The program included education on OA, (expectations regarding) treatment options and self-management. Patients were recruited through searching the GPs’ electronic patients records and advertisements in local newspapers. At baseline and at 3 months follow-up participating OA patients completed questionnaires. Paired-sample t-tests, McNemar’s test and Wilcoxon Signed-Rank test were used to estimate the preliminary effects of the program. A total of 146 participants in 3 districts attended the sessions, of whom 143 agreed to participate in this study; mean age 69.1 years (SD10.2).107 (75%) participants completed both baseline and follow up assessments. The proportion of participants who had visited their GP in the 3 months after the program was lower than 3 months previous to the program (40% versus 25%, p-value 0.01). Also, we observed a decrease in proportion of patients who visited the physio- and exercise therapist, (36.1% versus 25.0%, p-value 0.02). Both illness perceptions and knowledge on OA and treatment options changed positively (Δ-1.8, 95%CI:0.4–3.4, and Δ2.4, 95%CI:-3.0 - -1.6 respectively). No changes in BMI, pain, functioning and self-efficacy were found. However, a trend towards an increase in physical activity was observed. Our results show that a multidisciplinary educational program may result in a decrease in healthcare utilization and has a positive effect on illness perceptions and knowledge on OA due to clear and consistent information on OA and it treatment options. Netherlands Trial Register ( NTR5472 ). Registered 22 September 2015.

Introduction: This retrospective analysis evaluates 10 patients with a late infection of a cemented total hip arthroplasty (THA) treated with two-stage revision with retention of the original well-fixed femoral cement mantle. Methods: Clinical, laboratory, and radiological outcomes were evaluated. The average age at the first-stage revision procedure was 61.5 years (range 38-80 y). The mean follow-up period was 26 months (range 5-54 m). Results: Successful eradication of the primary microorganism was achieved in 2 patients. These patients had negative cultures at second stage and did not show any signs of infection during follow-up. The other 8 patients were considered as failures. In 3 patients, the femoral cement mantle was removed after the first stage due to recurrent infection in Girdlestone situation. In 2 patients, cultures showed the same micro-organism at first and second stage, treated with 3 months of antibiotics after second stage. 2 patients showed negative cultures at second stage but still had recurrent infection afterwards. These where treated with debridement and implant retention (DAIR) and 3 months of antibiotics. 1 patient was treated with suppressive antibiotics for persistent prosthetic joint infection after second stage, despite DAIR and therapeutic antibiotic treatment. Conclusions: Based on this study, results of two-stage revision with retention of femoral cement mantle are disappointing in treatment of infected THA. Therefore, more research is required to determine which patients are appropriate for cement-within-cement revision.

Background and purpose: Long-term follow-up of young patients following cemented primary THA is scarce. Therefore, we analyzed the survival of all consecutive primary THAs in patients under 25 years performed at our institute.Patients and methods: All primary THAs performed in patients younger than 25 years in our tertiary care institute between 1988 and 2015 were included (n = 119). Cemented fixation was used in all patients. In the case of acetabular bone deficiencies, reconstruction was performed using impaction bone grafting (IBG). We used Kaplan–Meier analysis to determine the survival of the primary THA with endpoints revision for any reason and aseptic loosening.Results: The mean age at the primary THA was 20 years. The most prevalent diagnosis was avascular necrosis (31%). The mean follow-up of the primary THA was 11 years (range 0–32). 2 patients (2 hips) were lost to follow-up. 16 revisions were registered. The survival of any component for endpoint revision for any reason was estimated at 92% (95% confidence interval [CI] 84–96) and 81% (CI 67–90) at 10- and 15-year follow-up, respectively. The survival of any component for endpoint revision for aseptic loosening was 99% (CI 93–100) and 88% (CI 71–95) at 10 and 15 years, respectively. 3 hips were revised due to infection.Conclusion: Favorable long-term outcomes of primary THA in very young patients can be obtained using cemented fixation and IBG.

Survival of cemented short Exeter femoral components in primary total hip arthroplasty

Bone support of a custom triflange acetabular component over time