Background Uncemented press-fit acetabular cups without screws rely on the elastic recoil of the bone for its primary stability and tend to leave polar gaps with its use. The clinical significance of these gaps and the functional outcome of the patients with polar gaps is evaluated in this study. Methods This comparative analysis was done on 224 cementless primary THA using Deltamotion® Hip System from January 2010 to December 2017. Patients were divided into two groups based on the presence or absence of polar gaps on immediate post-operative radiographs. Patients were observed for their clinical, radiological and functional outcomes with regular follow ups. At each follow-up, patients' clinical outcome was evaluated using the Harris Hip Score (HHS) and Patient Reported Outcome Measures (PROMs). Results 14 of 224 patients(6.25%) demonstrated polar gaps in their immediate post-operative radiographs. No statistically significant difference was noted in the final mean HHS between the two groups. The polar gaps ranged from 0.5 to 1.8 mm (mean-1.09 mm). None of the patients showed progression of the polar gaps. All patients showed bony ingrowth into the gaps at a mean of 8.57 months. Conclusion The presence of polar gaps in the immediate post-operative radiographs are not of a major clinical significance provided a secure peripheral fit is achieved intra-operatively. The functional outcome and rehabilitation in such patients is at par with that seen in the patients without polar gaps. Disappearance of these polar gaps is a rule rather than an exception. © 2018 Delhi Orthopedic Association. All rights reserved.Background Metal-on-Metal (MoM) total hip arthroplasty (THA) represents a very controversial procedure because of the possibility of postoperative adverse local tissue reaction (ALTR). This study investigates the reliability of the ultrasound scan as a diagnostic tool to quantify a clinically useful threshold in the level of periprosthetic fluid collection to suggest implant revision. Methods This study includes 116 patients (123 implants) who received an Articular Surface Replacement XL (ASRTMXL, De Puy Synthes, USA) MoM THA. The study group included 56 males and 60 females with a mean age of 66.6 years (range, 15-86 years). All patients were clinically and radiologically annually evaluated (according to the Harris Hip Score) up to a mean follow-up of 7.5 years (min. 1.4 - max. 10.3 years) from the primary surgery all patients underwent standard ultrasound evaluation of the affected hip and Cobalt/Chromium blood detection testing according to a custom-made diagnostic algorithm for MoM THA revision. Results At final follow-up, 51 (43.1%) of 117 implants underwent revision after a mean of 6 years (1.79-9.26) from the primary ASR implant. The authors found a statistically significant correlation between Cr (p = 0.015) and Co (p = 0.009) blood values and different ultrasound grades. Statistical analysis showed a significant association between periprosthetic fluid collection and revision surgery (p  less then  0.0001) and the final revision risk was estimated to be 7 times greater in patients with ultrasound grade ≥ 2 (peri-prosthetic collection ≥ 20 mm). Conclusions This study confirms the reliability of ultrasound evaluation in detecting clinically significant peri-prosthetic joint effusions a new diagnostic algorithm for MoM THA revision is here presented. Longer follow up studies are mandatory to better understand the potential advantages of this diagnostic protocol. https://www.selleckchem.com/products/Mycophenolic-acid(Mycophenolate).html © 2019 Delhi Orthopedic Association. All rights reserved.Background Perioperative opioid use is becoming an increasingly concerning topic in total joint arthroplasty (TJA). The current study aims to add to the paucity of prior studies that have detailed perioperative opioid use patterns and the effects of preoperative chronic opioid use among a cohort of total hip arthroplasty (THA) patients. Methods A retrospective analysis of 256 consecutive patients who underwent a THA at our institution between February 2016 and June 2016 was performed. Two cohorts were compared patients deemed 1) preoperative chronic opioid users, and 2) non-chronic users. Variables compared included baseline characteristics, quality metrics, and patients' opioid use histories 3 months prior to surgery and 6 months following surgery. Results Of the 256 patients, 54 (21.1%) patients were identified as preoperative chronic opioid users. Baseline characteristics including age, gender, BMI, and ASA scores were similar between both cohorts. Discharge disposition, value-based purchasing (VBP) costs, length of stay (LOS), emergency room visits, and postoperative office visits were similar between the two cohorts. Readmission rates (30-day, 90-day, and 6-month) were significantly higher (p  less then  0.05) in the chronic opioid users cohort. By the 6-month postoperative time period, chronic opioid users were consuming approximately 100-times the morphine equivalents than non-chronic users. Conclusions The current study demonstrates that a substantial proportion of preoperative chronic opioid users continue to consume large amounts of opioids up to 6-months following THA surgery. Furthermore, preoperative chronic use is significantly associated with poorer quality outcomes, specifically with respect to readmission rates. Level of evidence Level II, Prognostic Study. © 2019 Delhi Orthopedic Association. All rights reserved.The treatment of severe acetabular defects in revision total hip arthroplasty (Paprosky type IIIa and IIIb) is demanding and choosing the appropriate surgical technique remains controversial. The introduction of trabecular metal augments has led to a variety of new treatment options. The authors present a case of a Paprosky Type IIIb acetabular defect due to eight subsequent revisions of the left hip. The patient was treated with an alternative treatment option using multiple tantalum wedges. Anatomical reconstruction was achieved and at 12 months follow-up, the patient was pain free and was able to walk without walking aids. © 2018.Modular hip stems offer many advantages in revision arthroplasty. However, the region of modularity is prone to failure. Fracture of the non-cemented fluted tapered titanium Modular Prosthesis (MP) stem is relatively rare. We present here a case of a distal non-traumatic fracture of the MP stem and review the previously reported cases. A 53-years old, relatively active, male patient with a body mass index (BMI) of 37 kg/m2 had a fracture of the non-cemented MP stem on the left side after five years without complaints. The BMI was 45 at the time of implantation of the MP stem. His weight was significantly reduced, but the stem failed and fractured at an atypical site, quite distal to the modular junction. The broken stem with a relatively small diameter had been exchanged to a larger one. Fracture of the non-cemented fluted proximally-modular distally-tapered titanium MP stem might occur after years. Even in cases of good bone quality of the proximal femur, patient BMI and activity level should be considered when selecting the stem diameter.