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iations are likely an underestimate of the true risk posed to patients with severe DDH, as these patients were unable to be stratified in the present analysis.

Limited literature exists concerning the femoral cement mantle quality that can be achieved through an anterior approach in total hip arthroplasty (THA). We radiologically evaluated the quality and thickness of the femoral cement mantle in patients undergoing THA utilizing the direct anterior approach (DAA).

Immediate postoperative anteroposterior and lateral radiographs of 116 consecutive patients who underwent hybrid or fully cemented THA using the DAA and cemented Quadra-C stem (Medacta, International, SA, Switzerland) were assessed by 2 arthroplasty surgeons blinded to the study. Surgical indications were hip osteoarthritis or subcapital hip fracture. The cement mantle and stem alignment were evaluated using the Barrack classification and Khalily methods, respectively. After calibration of radiographs, the thinnest part of the cement mantle per Gruen zone was recorded. Parameters were compared between obese and nonobese patients.

Agreement between raters was substantial for the cement quality in anteroposterior (k= 0.707,

≤ .001) and moderate for lateral radiographs (k= 0.574,

≤ 001). The cement mantle was graded A in 39.25%, B in 53.0%, and C in 7.75% of anteroposterior radiographs and similarly for lateral radiographs (40.1% A, 51.75% B, 9.5% C). 93% of stems had neutral alignment. The mean thinnest cement mantle (

= .237) and incidence of inadequate cement mantle (<2 mm) per zone (

= .431) were comparable between Gruen zones. The cement mantle quality (

= .174) and inadequacy (

> .05) and stem alignment (

= .652) were comparable between obese and nonobese patients.

DAA enables correct implantation and effective cementation of straight femoral stems. A high-quality cement mantle can be achieved using DAA even in obese patients.

DAA enables correct implantation and effective cementation of straight femoral stems. A high-quality cement mantle can be achieved using DAA even in obese patients.

It is unclear whether a connection exists between femoral head size, offset, neck length, and cup abduction angles, and rate of revision in metal-on-metal (MoM) total hip arthroplasty (THA) implant systems.

A retrospective review of MoM THA completed by a single surgeon with a single implant between 2003 and 2008 was conducted. Patient demographics, implant data, radiographs, and revision details were collected at follow-up. Incidence rates for revision and osteolysis were calculated in regard to the femoral head size, stem offset, neck length, and cup abduction angles.

Six hundred and ninety two THAs were identified, with 79% of patients returning for a median follow-up of 10.3 years (interquartile range= 6.0-12.3). The median time to revision was 7.5 years (interquartile range= 5.3-9.9) among 27 total revision surgeries. The overall incidence rate of revision was 5.4 revisions per 1000 person-years, 3.0 revisions per 1000 person-years for adverse local tissue reaction. Hips with a cup abduction angle of ≤40° had revisions at nearly twice the rate of those with an angle of 41°-50° (incidence rate ratio= 1.98, 95% confidence interval 0.92, 4.29). Hips with a 9 mm neck length had an increased rate of revision (incidence rate ratio= 5.94, 95% confidence interval 1.33, 26.55) relative to those with a neck length of 0 mm. Rates of osteolysis were similar between implants of different head sizes, neck lengths and cup abduction angles.

MoM implant systems with longer necks and smaller cup abduction angles may lead to increased need for revision. Results from this study suggest a need for closer long-term follow-up of MoM THA systems.

MoM implant systems with longer necks and smaller cup abduction angles may lead to increased need for revision. Results from this study suggest a need for closer long-term follow-up of MoM THA systems.

Changes in spinopelvic and lower extremity alignment between standing and relaxed sitting have important clinical implications with regard to stability of total hip arthroplasty. This study aimed to analyze the effect of body mass index (BMI) on lumbopelvic alignment and motion at the hip joint.

A retrospective review of patients who underwent full-body stereoradiographs in standing and relaxed sitting for total hip arthroplasty planning was conducted. Spinopelvic parameters measured included spinopelvic tilt (SPT), pelvic incidence (PI), lumbar lordosis (LL), PI minus LL (PI-LL), proximal femoral shaft angle (PFSA), and standing-to-sitting hip range of motion. Propensity score matching controlled for age, gender, PI, and hip ostoarthritis grade. Patients were stratified into normal (NORMAL; BMI, 18.5-24.9), overweight (OW; 25.0-29.9), and obese (OB; 30.0-34.9) groups. Alignment parameters were compared using one-way analysis of variance.

There were 84 patients in each group after propensity score matchng to compensate for soft-tissue impingement that occurs anterior to the hip joint and limiting hip flexion.

In countries with publicly funded health care, there is an increasing need for explicit rationing for total joint arthroplasty (TJA). Menadione nmr The Oxford Hip and Knee Scores (OHS/OKS) have been used to set access thresholds for TJA despite not being developed for that purpose. The aim of this study was to determine whether preoperative OHS/OKS can aid rationing decisions by investigating the changes in general health-related quality of life after TJA.

OHS/OKS, Short Form-12, and Short Form-6D (SF-6D) scores were collected preoperatively and at 1year postoperatively in a cohort of patients undergoing total hip arthroplasty (THA; n= 713) and total knee arthroplasty (TKA; n= 520). The association between preoperative OHS/OKS and postoperative score and the change in OHS/OKS and SF-6D was investigated, adjusting for age and gender.

The mean Oxford scores improved from 13.9 to 40.7 (OHS) and 15.6 to 37.4 (OKS). The mean SF-6D improved after THA (0.53 to 0.80) and TKA (0.56 to 0.78) (all

< .0001). Poorer preoperative Oxford scores were associated with poorer postoperative OHS/OKS and SF-6D but larger improvements. For every 5 points lower preoperative OHS/OKS, the postoperative SF-6D score was worse by a margin of 0.019 (THA) and 0.023 (TKA).

Preoperative OHS/OKS can help inform rationing decisions. A lower preoperative OHS/OKS will result in greater gains but a lower final outcome score in general health-related quality of life.

Preoperative OHS/OKS can help inform rationing decisions. A lower preoperative OHS/OKS will result in greater gains but a lower final outcome score in general health-related quality of life.