Highly cross-linked polyethylene (HXLPE) is the most commonly used bearing surface in total hip arthroplasty (THA) because of its superior wear properties, but long-term results in young patients are limited. We report on the clinical outcome, radiographic wear patterns and survivorship of 72 patients ≤50 years old who had a 28-millimeter cobalt-chromium femoral head on HXLPE acetabular liner. Mean and median true linear wear rates at average ten-year follow-up were 0.0104 and 0.016 mm per year +/− 0.07 mm. Mean and median two-dimensional volumetric wear rates were 12.79 mm3 and 5.834 mm3 per year +/− 26.1mm3 as determined by Martell analysis. As a result of the minimal wear profile, there was no evidence of radiographic osteolysis and no wear-related revisions.

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Periprosthetic fractures around a total knee arthroplasty (TKA), comminuted and intra-articular femur fractures, or fracture nonunions in osteoporotic bone represent technically challenging problems. This is particularly true when the fracture involves a loose femoral component or the pattern results in suboptimal fixation potential. These clinical indications often arise in an older and comorbid patient population in whom a principal goal of treatment includes allowing for early mobilization. Limited data indicate that arthroplasty via distal femoral replacement (DFR) is a reasonable alternative to open reduction and internal fixation, allowing for early ambulation with low complication rates. We performed a retrospective review of trauma and arthroplasty surgeries at three tertiary referral institutions. Adult patients treated for the above with a DFR were included. Patients with active infection, open and/or high-energy injuries and revisions unrelated to fracture were excluded. Patient demographics, treatment details, and outcomes were assessed. Between 2002 and 2017, 90 DFR's were performed for the above indications with a mean follow-up of 24 months. Postoperatively, 80 patients (88%) were allowed to weight bear as tolerated, and at final follow-up, 9 patients (10%) remained dependent on a wheelchair. The average arc of motion at final follow-up was 95 degrees. There were seven (8%) implant-related complications requiring secondary surgeries: two infections, one with associated component loosening; one fracture of the hinge mechanism and one femoral component failure in conjunction with a patellofemoral dislocation (both requiring revision); one case of patellofemoral arthrosis in a patient with an unresurfaced patella; one periprosthetic fracture with associated wound dehiscence; and one case of arthrofibrosis. In each of these cases, only modular components of the DFR were exchanged. All nonmodular components cemented into the femur or tibia were retained. DFR provides a viable reconstruction option in the treatment of acute distal femur fractures, periprosthetic femur fractures, and fracture nonunions. We noted that in an elderly patient population with high comorbidities, the complication and secondary surgery rates remained relatively low, while allowing for immediate weight bearing.

The survivorship of contemporary total hip arthroplasty has improved substantially as a result of the success of highly cross-linked polyethylene. Nevertheless, there is limited information on its performance in extremely young patients. The purpose of this study is to evaluate the (1) clinical and radiographic outcomes, (2) polyethylene wear rates, and (3) mid-term survivorship of total hip arthroplasty in patients 21 years or younger using highly cross-linked polyethylene. After Institutional Review Board approval, the authors identified 45 patients aged 21 years or younger (56 hips) who underwent primary total hip arthroplasty with highly cross-linked polyethylene at their institution by the senior author between 2000 and 2009. Patients were followed for a minimum of 2 years, or until revision. At a mean follow-up of 57 months, modified Harris Hip Scores, Western Ontario McMaster Universities Arthritis Index scores, Short Form-12 physical function scores, and University of California, Los Angeles activity scores improved significantly in all patients. There was no radiographic evidence of osteolysis in any patient. The mean linear polyethylene wear rate was 0.02 mm per year. Survivorship was 98% with one revision for acetabular loosening at 71 months. Total hip arthroplasty in patients 21 years or younger with highly cross-linked polyethylene had excellent clinical and radiographic outcomes at mid-term follow-up. Longer-term data are needed in this patient population to confirm continued survivorship in the extremely young. The level of evidence used for this study was level III.

When faced with a well-fixed acetabular component during revision total hip arthroplasty (THA) in the setting of recurrent instability, reconstructive options are limited, and consequences can prove dire if removal leads to severe bone loss or pelvic discontinuity. Our aims are to report the surgical technique, early survivorship, radiographic improvements, and complications on a consecutive, retrospective series of 13 hips in 12 patients who were treated with a cup-in-cup surgical technique to address multiply recurrent dislocations in the setting of a well-fixed cup. If determined to be stable and acceptably positioned upon intraoperative assessment, the acetabular component is retained, a second shell is cemented into the preexisting cup, and a dual mobility or standard polyethylene liner bearing is utilized. At 2-year minimum follow-up, the cup-in-cup arthroplasty exhibited an overall 85% survivorship. Two subjects required subsequent revisions: one for infection and one for ongoing instability in the setting of general noncompliance. No revisions were performed for loosening of the cup-in-cup interface. The median affected leg length was increased by 2.8 mm (p = 0.04) and horizontal offset improved by an average of 6.9 mm (p < 0.001). There were a total of four dislocations in two subjects after cup-in-cup revision arthroplasty with no failures at the cup–cup cement interface. Our series demonstrates acceptable early outcomes in terms of improved stability and decreasing the need for further revision surgery while utilizing the cup-in-cup revision arthroplasty technique in situations of recurrent dislocations.