Total hip arthroplasty (THA) is a widely performed and successful surgical treatment for degenerative joint disease. With increasing use in younger and more active patients, the demand for durable, biocompatible, and low-wear implant materials has grown. Oxidized zirconium (Oxinium, Zr2.5Nb) was introduced as a promising femoral head material, combining the strength of metal with the low-friction properties of ceramic. Despite encouraging early results, clinical reports have documented complications including head wear, especially after dislocation, and metallosis. We present the case of a 64-year-old male who underwent primary THA in 2009 and required revision in 2021 due to severe metallosis. Notably, no dislocation was observed that could explain the damage to the Oxinium head. Surface and subsurface analyses using X-ray photoelectron spectroscopy (XPS) and micro-indentation hardness testing revealed wear and deformation inconsistent with Oxinium’s anticipated durability. These findings highlight the importance of the femoral head–polyethylene liner interface in implant longevity. Although Oxinium–XLPE articulations remain promising, risks such as damage to the femoral head, liner dislocation, impingement, and metallosis must be carefully considered. Surgical technique, liner placement, and locking mechanisms play critical roles in preventing failure. Further biomechanical and clinical studies are needed to optimize implant design and improve long-term outcomes.

Aims The purpose of this study was to develop a practical risk−score to predict poor neurological outcome after out−of−hospital cardiac arrest (OOHCA) for use on arrival to a Heart Attack Centre. Methods and Results Between May 2012 and December 2017, 1055 patients had OOHCA in our region, of whom 373 patients were included in the King's Out of Hospital Cardiac Arrest Registry (KOCAR). We performed prediction modelling with multi-variable logistic regression to identify factors independently predictive of the primary outcome in order to derive a risk score. This was externally validated in two independent cohorts comprising 474 patients. The primary outcome was poor neurological function at 6−month follow−up (Cerebral Performance Category 3-−). Seven independent variables for prediction of outcome were identified: Missed (Unwitnessed) arrest, Initial non-shockable rhythm, non-Reactivity of pupils, Age, Changing intra-arrest rhythms, Low pH<7.20 and Epinephrine administration. From these variables, the MIRA2CLE2 score was developed which had an AUC of 0.90 in the development and 0.85 and 0.89 in the validation cohorts. 3 risk groups of the MIRA2CLE2 were defined − Low risk (≤2−5.6% risk of poor outcome; Intermediate risk (3−4−55.4% of poor outcome) and high risk (≥5−92.3% risk of poor outcome). The risk-score performance was equivalent in a sub-group of patients referred for early angiography and revascularisation where appropriate. Conclusions The MIRA2CLE2 score is a practical risk score for early accurate prediction of poor neurological outcome after OOHCA, which has been developed for simplicity of use on admission to a Heart Attack Centre.

The aim of our study was evaluation of the Oxinium Femoral Heads in Hip Endoprosthesis: Clinical Outcomes, Wear Characteristics, and Long-Term Performance. Orthopaedic patients suffering from joint pain due to arthritis or injury and total hip arthroplasty (THA) is a common and very successful surgical option. THA involves replacing the damaged femoral head and acetabulum with prosthetic components, typically composed of metal alloys, ceramics and polymers. As the procedure becomes more common in younger, active individuals, there is growing demand for durable, low-wear implant materials. Oxidized zirconium Zr2.5Nb alloy (Oxinium, Ox Zr) was introduced as a promising alternative, designed to combine the strength of metal with the low-friction properties of ceramic. Oxinium is created by thermal heat treatment of zirconium-niobium alloy, resulting in a 4–5 µm thick ceramic-like surface diffusion layer. Oxinium femoral heads were expected to reduce wear and extend implant longevity. However, clinical reports have revealed complications. Findings include wear deformation of the Oxinium head, polyethylene liner dislocation, and metallosis in surrounding tissue. These failures are frequently associated with dislocation or impingement between the metal acetabular cup and the femoral head. We report on the case of 64 years old male his primary THA was in 2009 and revision surgery in 2021 after severe metallosis. The surface and subsurface of Oxinium head was examined by surface analytical method XPS and micro-indentation hardness measurements. These observations challenge the initial claims regarding Oxinium’s durability and wear resistance. In certain patients, particularly those at risk of joint instability or dislocation, Oxinium components may lead to accelerated wear, severe metallosis, and reduced implant longevity. The interface between an Oxinium femoral head and a highly cross-linked polyethylene (HXLPE) liner is critical to the long-term success of total hip arthroplasty (THA), particularly in preventing dislocation and wear-related complications. The Oxinium–HXLPE interface shows promise, but more biomechanical and clinical data are needed to refine implant design and surgical protocols.