Background
While short-stem design is not a new concept, interest has surged with increasing utilization of less invasive techniques. Short stems are easier to insert through small incisions. Reliable long-term results including functional improvement, pain relief, and implant survival have been reported with standard tapered stems, but will a short taper perform as well?

A Short Tapered Stem Reduces Intraoperative Complications in Primary Total Hip Arthroplasty

The outcome after total hip replacement has improved
with the development of surgical techniques, better pain management
and the introduction of enhanced recovery pathways. These pathways
require a multidisciplinary team to manage pre-operative education,
multimodal pain control and accelerated rehabilitation. The current economic
climate and restricted budgets favour brief hospitalisation while
minimising costs. This has put considerable pressure on hospitals
to combine excellent results, early functional recovery and shorter
admissions. In this review we present an evidence-based summary of some common
interventions and methods, including pre-operative patient education,
pre-emptive analgesia, local infiltration analgesia, pre-operative
nutrition, the use of pulsed electromagnetic fields, peri-operative
rehabilitation, wound dressings, different surgical techniques, minimally
invasive surgery and fast-track joint replacement units. Cite this article: Bone Joint J 2013;95-B:1587–94.

Enhanced recovery in total hip replacement: A clinical review

Size and location of the lesion, subchondral collapse occurrence, and articular cartilage involvement are general disease progression criteria for direct osteonecrosis of the femoral head (ONFH) classifications. Treatment options for ONFH are usually based on individual factors and lesion characteristics. Although spontaneous repair of ONFH occurs in some cases, untreated ONFH is unlikely to escape the fate of subchondral collapse and usually ends up with total hip arthroplasty. Operations to preserve the femoral head, e.g., core decompression and bone grafting, are usually recommended in younger patients. They are helpful to relieve pain and improve function in the affected femoral head without subchondral collapse, however, poor prognosis after surgical procedures remains the major problem for ONFH. Pharmacological and physical therapies only work in the early stage of ONFH and have also been recommended as a supplement or prevention treatment for osteonecrosis. Following advances in basic science, many new insights focus on bone tissue engineering to optimize therapies and facilitate prognosis of ONFH. In this review, disease classifications, current treatment options, potential therapies, and the relevant translational barriers are reviewed in the context of clinical application and preclinical exploration, which would provide guidance for preferable treatment options and translation into novel therapies.

Review of various treatment options and potential therapies for osteonecrosis of the femoral head

Non-traumatic osteonecrosis of the femoral head commonly affects young adults between the third and fifth decade of life. It is the leading cause of hip joint replacements in many Asian countries including Taiwan. The ultimate goal is the preservation of the involved hip. However, this is often challenging since early diagnosis is difficult, the etiologies are miscellaneous, the pathogenesis is unclear, and successful treatment is undetermined. As a consequence, this disease remains well-known but not fully-understood. This review provides an update of the progress from clinical studies to basic bench work in terms of natural history, risk factors, genetic predilections, diagnosis, staging, and miscellaneous therapeutic modalities.

Non-traumatic osteonecrosis of the femoral head - from clinical to bench.

Dynamic behavior of tripolar hip endoprostheses under physiological conditions and their effect on stability.

The effect of necrotic lesion size and rotational degree on the stress reduction in transtrochanteric rotational osteotomy for femoral head osteonecrosis--a three-dimensional finite-element simulation.

Background Minimally invasive total hip arthroplasty has been reported to have a better functional recovery by minimizing soft tissue trauma as compared with the conventional approach. This study analyzed the hospital course and early clinical outcomes of a series of 63 two-incision total hip arthroplasties. Methods Sixty patients (63 hips) were enrolled between September 2003 and July 2004 and followed for two years. Preoperatively, demographic data, body mass index, and diagnosis were recorded. Hip function and quality of life were assessed using the Harris hip score and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC). Results The mean operating time, blood loss, wound length, and hospital stay were 151 minutes, 700 ml, 9.9 cm, and 5 days, respectively. The mean cup abduction angles were 42.9 degrees and the mean cup anteversion angles were 17.9 degrees. Transient lateral femoral cutaneous nerve injuries occurred in 15.9% of cases. Intraoperative femoral fracture occurred in 2 cases and superficial wound infection occurred in 1 case. Despite these incidents, overall results show a majority of patients can achieve quicker recovery and satisfactory functional results with minimally invasive total hip arthroplasty. Conclusions This study analyzed the accuracy and quality of total hip arthroplasty using a minimally invasive approach and found the post-surgery results were not compromised by sparing muscles and limiting surgical field exposure. We suggest using the minimally invasive approach for total hip arthroplasty based on the encouraging clinical outcomes documented in this study.

Hospital course and early clinical outcomes of two-incision total hip arthroplasty.

The purpose of this study was to describe the surgical technique and to investigate results of a modified two-incision total hip replacement using either intraoperative fluoroscopy or imageless navigation. Twenty-nine patients (30 hips) with a minimum follow-up of one year were enrolled in this study. The patients were evaluated at 3, 6, 12 weeks, 6 months, and 1-year. The functional recovery as represented by the Harris hip score and WOMAC scale were better in the fluoroscopy group of patients at the early postoperative stage (3 wks). Thereafter, both groups showed rapid recovery with no difference in scores. Injury to the lateral femoral cutaneous nerve was the most commonly seen complication and it occurred in 6 hips (fluoroscopy 2; imageless 4). The symptoms were transient and resolved in 6 months in all 6 cases. This study demonstrated that the role of intraoperative fluoroscopy could safely be replaced by an imageless navigation system for the MIS-2 THA.

Two-incision total hip replacement: Intra-operative fluoroscopy versus imageless navigation for cup placement

We radiographically measured the bipolar cup position to analyze the direction of joint force acting on the bipolar cup The abduction angle of the bipolar cup was measured in each radiograph taken immediately and at six 12 weeks and yearly after the operation Radiographs in patients with weight bearing were also investigated The results indicated that the abduction angle of the bipolar cup was 241° ± 112° immediate postoperatively and was 162° ± 51° at 6 weeks, 161° ± 51° at 3 months, and 162° ± 51° at 1 year The cup abduction angles with weight bearing were not different from those without weight bearing and were 159° ± 49°, 162° ± 44°, and 161° ± 47° on the supine, double-legged stance, and single-legged stance radiographs, respectively Because the position of the bipolar cup reflects the direction of loads pivoting on it, the direction of the joint force in the frontal plane acting on the bipolar prosthesis is about 16° to vertical

The position of the bipolar cup reflects the direction of the hip contact force acting on it

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The effect of necrotic lesion size and rotational degree on the stress reduction in transtrochanteric rotational osteotomy for femoral head osteonecrosis--a three-dimensional finite-element simulation.

Hospital course and early clinical outcomes of two-incision total hip arthroplasty.

Two-incision total hip replacement: Intra-operative fluoroscopy versus imageless navigation for cup placement

The position of the bipolar cup reflects the direction of the hip contact force acting on it