Hypothetically, hydroxyapatite-coated anatomic-shaped femoral stems and hemispheric acetabular cups should improve biologic fixation of the implant and strength transmission to the bone, improving unsatisfactory results of the first cementless hip prosthesis focused on the stress-shielding phenomenon at the femur and failure of the threaded acetabular cups. A consecutive series of 312 patients who had primary Anatomique Benoist Giraud hip prostheses unilaterally implanted were followed up. We analyzed the clinical and radiographic results and report the outcomes 7-10 years after implantation. Two hundred thirty-two patients were assessed at 7-10 years. The survival rate for the implant was 96.8%; 77.2% of patients had no pain, 72.4% maintained total mobility, and 62.9% were able to walk without restrictions. However, radiologic assessment shows that problems improved but did not disappear. More than 55% of femurs had signs of proximal stress-shielding develop. More important, substantial polyethylene wear was observed in at least 62% of the acetabular inserts at 7-10 years followup.Cemented hip prostheses have been implanted with satisfying results since the 1960s. 7,8 However, the relatively frequent onset of pain and disability, secondary to loosening at the prosthesis-cement or cement-bone interfaces 26,28,36 has impaired long-term outcomes, particularly in young patients.The first cementless designs, characterized by straight and very stiff distally fixed cementless stems, had serious stress-shielding phenomenons. 30,34 Threaded acetabular cups also failed after 4-5 years. 30,34 To avoid these problems new fixation systems were developed, 15,16 and new models were designed. New hemispheric press-fit acetabular cups and new anatomic-shaped femoral stems transmitted load in the metaphyseal area, theoretically reducing the stress-shielding effect. However, this effect did not disappear, although it became weaker. 20,44 A new step to improve proximal fixation of the femoral stem consisted of using HA coating on its metaphyseal part to facilitate bone ongrowth. 1,19,21 Another problem detected in cemented prostheses was the appearance of osteolysis secondary to inflammatory reactions against polyethylene (PE) and cement particles. 29,36 The problem of osteolysis has not disappeared with new cementless implants, 37 although now its origin is PE wear. This probably is the most serious threat to implant survival according to Harris who stated, "the problem is osteolysis". 23 A prospective international study evaluated the midterm followup results of an anatomic proximal hydroxyapatite (HA)-coated stem and hemispheric HA-coated cup hip prosthesis. The aim of the study was to monitor the clinical and radiographic outcome of patients implanted with the ABG system. The early, 2-year, and 5-year results have been published, 48,49 and the 7-to 10-year results are presented here. Although HA-coated implants have been investigated for more than a decade, only a few midterm results are published. 4,14 At first, our hypothesis...

This review summarizes the existing economic literature, assesses the value of current data, and presents procedures that are the less costly and more effective options for the treatment of periprosthetic infections of knee and hip. Optimizing antibiotic use in the prevention and treatment of periprosthetic infection, combined with systemic and behavioral changes in the operating room, the detection and treatment of high-risk patient groups, as well as the rational management of the existing infection by using the different procedures according to each particular case, could allow for improved outcomes and lead to the highest quality of life for patients and the lowest economic impact. Nevertheless, the costeffectiveness of different interventions to treat periprosthetic infections remains unclear.

Background Conversion of hip arthrodesis to a THA reportedly provides a reasonable solution, improving function, reducing back and knee pain, and slowing degeneration of neighboring joints associated with a hip fusion. Patients generally are satisfied with conversion despite the fact that range of mobility, muscle strength, leglength discrepancy (LLD), persistence of limp, and need for assistive walking aids generally are worse than those for conventional primary THA.

Our results suggested that minimally invasive lateral approach has not provided significant benefits over conventional lateral approach for the implantation of a total hip arthroplasty.