We evaluated an operative technique, described by the Exeter Hip Unit, to assist accurate introduction of the femoral component. We assessed whether it led to a reduction in the rate of leg-length discrepancy after total hip arthroplasty (THA). A total of 100 patients undergoing THA were studied retrospectively; 50 were undertaken using the test method and 50 using conventional methods as a control group. The groups were matched with respect to patient demographics and the grade of surgeon. Three observers measured the depth of placement of the femoral component on post-operative radiographs and measured the length of the legs. There was a strong correlation between the depth of insertion of the femoral component and the templated depth in the test group (R = 0.92), suggesting accuracy of the technique. The mean leg-length discrepancy was 5.1 mm (0.6 to 21.4) pre-operatively and 1.3 mm (0.2 to 9.3) post-operatively. There was no difference between Consultants and Registrars as primary surgeons. Agreement between the templated and post-operative depth of insertion was associated with reduced post-operative leg-length discrepancy. The intra-class coefficient was R ≥ 0.88 for all measurements, indicating high observer agreement. The post-operative leg-length discrepancy was significantly lower in the test group (1.3 mm) compared with the control group (6.3 mm, p < 0.001). The Exeter technique is reproducible and leads to a lower incidence of leg-length discrepancy after THA.

Aims Iliopsoas pathology is a relatively uncommon cause of pain following total hip arthroplasty (THA), typically presenting with symptoms of groin pain on active flexion and/or extension of the hip. A variety of conservative and surgical treatment options have been reported. In this retrospective cohort study, we report the incidence of iliopsoas pathology and treatment outcomes. Methods A retrospective review of 1,000 patients who underwent THA over a five-year period was conducted, to determine the incidence of patients diagnosed with iliopsoas pathology. Outcome following non-surgical and surgical management was assessed. Results In all, 24 patients were diagnosed as having developed symptomatic iliopsoas pathology giving an incidence of 2.4%. While the mean age for receiving a THA was 65 years, the mean age for developing iliopsoas pathology was 54 years (28 to 67). Younger patients and those receiving THA for conditions other than primary osteoarthritis were at a higher risk of developing this complication. Ultrasound-guided steroid injection/physiotherapy resulted in complete resolution of symptoms in 61% of cases, partial resolution in 13%, and no benefit in 26%. Eight out of 24 patients (who initially responded to injection) subsequently underwent surgical intervention including tenotomy (n = 7) and revision of the acetabular component (n = 1). Conclusion This is the largest case series to estimate the incidence of iliopsoas pathology to date. There is a higher incidence of this condition in younger patients, possibly due to the differing surgical indications. Arthoplasty for Perthes' disease or developmental dysplasia of the hip (DDH) often results in leg length and horizontal offset being increased. This, in turn, may increase tension on the iliopsoas tendon, possibly resulting in a higher risk of psoas irritation. Image-guided steroid injection is a low-risk, relatively effective treatment. In refractory cases, tendon release may be considered. Patients should be counselled of the risk of persisting groin pain when undergoing THA. Cite this article: Bone Joint J 2021;103-B(2):305–308.

ALVAL is a widely recognized complication of MOM hip implants and needs to be considered early, even in completely asymptomatic patients with normal metal ion levels and normal radiographs.

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Background: A number of hip resurfacing arthroplasty implants have been found to have satisfactory clinical outcomes, suggesting implant design has a significant role. The aim of our study was to report the radiographic and clinical outcomes of a series of Conserve Plus hip resurfacing arthroplasty performed by a single surgeon. Methods: Our series included 51 consecutive resurfacings at mean follow-up of 7.61 yr performed through a modified Hardinge approach. Postoperatively, functional scores, ion levels, and hip radiographs were obtained at 6-8 wk, 6 mo, 1 yr, and yearly thereafter. Results: There were statistically significant improvements in University of California, Los Angeles Activity Score (UCLA), Oxford Hip Score (OHS), and Harris Hip Score (HHS), at 1 yr, with no further significant changes in functional scores identified at time of last review. Initial median postoperative cobalt and chromium levels were 1.06 and 1.77 μgl−1, with no significant increases at the time of last review. There were no significant differences in radiographic outcomes at the time of last review compared with early postoperative radiographs. Two implants required revision to THA. Kaplan-Meier analysis with revision as an endpoint found survivorship of 96% at up to 9.5 yr. Conclusions: This study found satisfactory survivorship and clinical outcomes with the Conserve Plus, and to our knowledge this is the largest series to date using the modified Hardinge approach.