Magnetic Resonance Imaging Assessment of Abductor Muscles Shortly After Curved Periacetabular Osteotomy

BackgroundCurved periacetabular osteotomy (CPO) is performed via an anterior approach without detachment of the hip abductor muscles. This study aimed to evaluate the abductor muscle status shortly after CPO on magnetic resonance imaging (MRI).MethodsWe prospectively evaluated 38 hips in 38 patients 1 week and 3 months after CPO between October 2017 and July 2019. The status of the abductor muscles was assessed on MRI using the following criteria: grade 0, normal; grade I, strain/edema; grade II, partial tear; and grade III, complete tear. We also evaluated associations between muscle status and patients’ characteristics.ResultsOne week after CPO, the gluteus maximus was classified as grade 0 in all patients. The gluteus medius was grade 0 in 84.2% of patients and grade I in 15.8%. The gluteus minimus was grade I in 55.3% of patients and grade II in 44.7%. Three months after CPO, both the gluteus maximus and gluteus medius were grade 0 in all patients, while the gluteus minimus was still grade I in 47.4%. There were no significant differences between patients with a grade 0 and grade I gluteus minimus at 3 months after CPO in patients’ characteristics (age and body mass index) or clinical scores (Harris Hip Score and Japanese Orthopedics Association score).ConclusionBoth the gluteus minimus and medius showed abnormal appearances on MRI 1 week after CPO, whereas only the gluteus minimus showed abnormalities 3 months after CPO. This abductor muscle status did not affect the postoperative Harris Hip Score or Japanese Orthopedics Association score.     

Modifizierter transfemoraler Zugang zum Wechsel von Hüftendoprothesen mit modularen zementlos implantierbaren Revisionsschäften

OBJECTIVE: Removal of a loose or fractured stem in total hip arthroplasty. Implantation and secure fixation of a modular uncemented revision stem to restore painless joint function. INDICATIONS: Loose and/or broken prosthetic stem. Risk of intraoperative fracture or perforation of the femur when stem revision becomes unavoidable. Periprosthetic fracture. CONTRAINDICATIONS: Loose prosthetic stems that can be revised without the risk of perforation or fracture of the femur. Interprosthetic femoral fractures between the ends of hip and knee prosthetic stems that require total replacement of the femur. SURGICAL TECHNIQUE: Exposure of the femur anterior to the lateral lip of the linea aspera in the lateral intermuscular septum. 3.2-mm drill holes are made at the anterior and posterior ends of the planned bone flap. Osteotomy of the femur anterior to the junction of the vastus lateralis and the gluteus medius muscles. Posterior osteotomy as well as distal transverse osteotomy between the drill holes and distal anterior osteotomy. The anterior osteotomy is performed using a chisel passed under the vastus lateralis from distal to proximal at the anterior aspect. The osteotomized lateral femoral bone flap with muscle attachment is folded back. Implantation of a modular uncemented revision stem and fixation of the bone flap with double cerclage. POSTOPERATIVE MANAGEMENT: Thrombosis prophylaxis, physiotherapy, gait training with partial loading of the limb at 10 kg for a period of 6 weeks with hip flexion limited to 70 degrees. Then, free range of movement and increased loading by 10 kg per week. RESULTS: 74 modular uncemented revision stems were implanted in transfemoral technique and the outcomes clinically and radiologically analyzed over an average follow-up period of 20.2 +/- 12.1 months (10-43 months). The Harris Hip Score increased from a preoperative value of 42.21 to 85.97 points after 2 years. Subsidence was observed for four stems and early loosening for two stems. The press-fit anchorage of these latter two stems was < 3 cm.     

Asymptomatic Gluteal Tendinopathies Negatively Impact Outcomes of Total Hip Arthroplasty: A Propensity Score-Matched Study

BackgroundThe purpose of this study is to compare outcomes after total hip arthroplasty (THA) in patients with preoperative asymptomatic gluteus medius and minimus (GMM) pathology to a control group with no GMM pathology.MethodsPatients undergoing THA for osteoarthritis between August 2012 and March 2018 were retrospectively reviewed. Asymptomatic GMM pathology was considered as the presence of gluteal tendinopathy diagnosed by magnetic resonance imaging (MRI) without the following clinical symptoms: Trendelenburg gait or test, abductor weakness, and lateral thigh tenderness. Patients with asymptomatic GMM pathology were matched (1:1) to patients without GMM pathology on MRI. Two-year data were collected on patient-reported outcomes including Harris Hip Score, Forgotten Joint Score, pain, and satisfaction. Postoperative clinical examination, radiographic measures, complications, and revisions for both groups were reviewed.ResultsFifty cases of asymptomatic GMM pathology were successfully matched to 50 hips without GMM pathology on MRI. Patients with asymptomatic GMM pathology demonstrated significantly worse outcomes regarding 2-year Harris Hip Score (86.24 vs 92.39, P = .04), VAS for pain (1.82 vs 0.98, P = .05), and patient satisfaction (7.69 vs 9.16, P = .002). The study group exhibited significantly higher rates of lateral hip pain postoperatively. Two cases (4%) in the control group underwent a revision THA and 4 cases (8%) in the study group underwent revision THA.ConclusionIn patients undergoing THA for osteoarthritis, those with asymptomatic GMM pathology experience inferior 2-year postoperative patient-reported outcomes compared to a matched group. This finding should raise awareness surrounding this important pathology’s negative impact on surgical outcomes, thus warranting increased vigilance, and possibly justifying concomitant treatment, even in cases of asymptomatic GMM tears.Level of EvidenceLevel III - Retrospective comparative prognostic study.     

Late Repair of Abductor Avulsion After the Transgluteal Approach for Hip Arthroplasty

The abductor release sometimes does not heal after a transgluteal approach for hip arthroplasty. Factors influencing the success of subsequent repair are unclear. We used magnetic resonance imaging (MRI) to compare the condition of the gluteus medius with clinical outcome after late repair of abductor dehiscence in 12 total hip patients. Evaluation included a pain rating, gait evaluation, Trendelenburg test, strength grading, and Harris Hip Score. Most had both prerepair and postrepair MRI studies to assess the repair and to grade abductor muscle fatty degeneration. Two repairs without MRI were explored surgically. Although average pain, limp, and strength scores improved significantly, rerupture occurred in 4 subjects and fatty degeneration in the gluteus medius did not improve, even with intact repair. Nine patients were satisfied; 7 of these had an intact repair. Magnetic resonance imaging and operative observations suggest that chronic degeneration in the abductor mechanism is the major impediment to successful repair.     

MRI Assessment of Muscle Damage After the Posterolateral Versus Direct Anterior Approach for THA (Polada Trial). A Randomized Controlled Trial

BackgroundThere is controversy in literature whether the direct anterior approach (DAA) results in less muscle damage compared with the posterolateral approach (PLA) for total hip arthroplasty. The aim of this randomized controlled trial was to assess muscle damage between these two approaches.MethodsForty-six patients were included. Muscle atrophy, determined with the Goutallier classification, and muscle surface of twelve muscles were analyzed on magnetic resonance imaging images made preoperatively and one year postoperatively. Differences in component placement after DAA or PLA were assessed on radiographs. Harris hip scores and Hip disability and Osteoarthritis and Outcome Score were used as functional outcomes.ResultsExternal rotator musculature was damaged in both approaches. After PLA, the obturator muscles showed significantly more atrophy and a decrease in muscle surface. After DAA, the tensor fascia latae showed an increased muscle atrophy and the psoas muscle showed a decreased muscle surface. An increase in muscle surface was seen for the rectus femoris, sartorius, and quadratus femoris after both approaches. The muscle surface of the gluteus medius and iliacus was also increased after PLA. No difference in muscle atrophy was found between the approaches for these muscles. The inclination angle of the cup in PLA was significantly higher. No differences were found in functional outcomes.ConclusionDifferent muscle groups were affected in the two approaches. After PLA, the external rotators were more affected, whereas the tensor fascia latae and psoas muscles were more affected after DAA.     

New two-incision minimally invasive total hip arthroplasty: comparison with the one-incision method

Background  There has been increasing interest in performing total hip arthroplasty (THA) with minimally invasive surgery (MIS). This study was conducted to examine the effectiveness of MIS-THA using the new two-incision technique versus the one-incision technique. Methods  A consecutive series of 113 patients who underwent MIS-THAs (63 one-incision cases, 50 two-incision cases) were studied. One-incision THA was performed with a posterolateral approach. For the two-incision, the first incision for cup insertion was made over the anterolateral side of the hip. Intermuscular dissection was performed between the gluteus medius and the tensor fascia lata. The second incision, for stem insertion, was made on the posterolateral side of the hip along the fiber of the gluteus maximus. Intermuscular dissection was made between the gluteus medius and the piriformis. Results  Postoperative rehabilitation was significantly more rapid in the new two-incision group compared to the group with one incision. Postoperatively, the Harris Hip Score and the Western Ontario and the McMaster Universities Osteoarthritis Index score were significantly different between the two groups, especially the functional sections. Conclusions  The findings of this study show that our new two-incision MIS-THA is an excellent surgical modality that allows early rehabilitation.     

Extensively porous-coated stems for femoral revision: reliable choice for stem revision in Paprosky femoral type III defects

Between January 1999 and August 2008, ninety-six femoral revisions were performed with extensively porous-coated stems in Paprosky type III femoral defects (89 type IIIA and 7 type IIIB defects). Seven type IIIB defects with a mean canal of 16.5 mm were observed; 6 defects achieved stable bone ingrowth and 1 achieved stable fibrous condition. Average postoperative Harris Hip Score was 92.3±8 (range, 77-100), and all scores improved postoperatively. At a mean follow-up of 65.7 months, 92 stems achieved bone ingrowth, and 1 stem (type IIIB) achieved a stable fibrous condition. Three patients died from causes unrelated to the surgery during follow-up. The most frequent diagnosis for revision of the femoral component was loosening of the cementless stem (53 patients; 55.2%), followed by status after a Girdlestone procedure (21 patients; 21.8%), after total hip arthroplasty with acetabular wear (10 patients; 10.4%), loosening of the cemented stem (7 patients; 7.3%), and periprosthetic fracture (5 patients; 5.2%). The authors performed 65 total hip arthroplasty revisions, 23 femoral component revisions, and 8 revisions of femoral components with cemented liners in patients with well-fixed acetabular shells. Extensively porous-coated stems in femoral revision for Paprosky type III femoral defects provided good mid-term durability.     

Survival and Clinical Outcomes at 30 to 35 Years Following Primary Total Hip Arthroplasty With a Cementless Femoral Stem Fully Coated With Hydroxyapatite

BackgroundThe purpose of the present study was to update and report clinical outcomes and survival of primary total hip arthroplasty using a cementless double-tapered titanium fully hydroxyapatite-coated stem at a follow-up > 30 years.MethodsThe outcomes of this series of 347 primary total hip arthroplasties were already published at a follow-up > 25 years, during which only 12 stems were revised. Since then, there were two additional stem revisions, bringing the total to 14 stem revisions (all of which also required cup revision). Patients still living with the original stem were assessed using the modified Harris Hip Score and patient satisfaction (very satisfied, satisfied, dissatisfied, and very dissatisfied). Revision incidence was calculated using the Kaplan-Meier (KM) method and Cumulative Incidence Function (CIF) at 35 years.ResultsAt a mean follow-up of 33 years (range, 31 to 35 years), 32 patients (34 hips) were still living with the original stem. Their mean modified Harris Hip Score was 86 points (range, 46 to 100) and all patients (100%) were very satisfied or satisfied with surgery. The revision incidence at 35 years considering (a) stem revision for any reason was 9.5% using KM and 4.5% using CIF; (b) stem revision for aseptic loosening was 3.1% using KM and 2.1% using CIF; and (c) reoperation or revision of any component for any reason was 45.3% using KM and 26.3% using CIF.ConclusionThe present study has demonstrated excellent survival at 35 years for a cementless double-tapered titanium fully hydroxyapatite-coated stem.Level of EvidenceLevel IV, Retrospective cohort study.     

Short-term results of hip revisions with a curved cementless modular stem in association with the surgical approach

Introduction  A prospective study was designed to test the hypothesis that short-term results after hip revisions are in association with the surgical approach with lower clinical scores for the transfemoral approach. Materials and methods  A total of 120 hip revision operations with the modular cementless revision stem “Revitan Curved” (Zimmer GmbH, Winterthur, Switzerland), of which 42 replacements involved an endofemoral (posterolateral) approach and 78 implantations a transfemoral approach, were followed up over a period of at least 24 months. Results  In the early post-operative stage, stems implanted transfemoral were associated with significantly lower Harris Hip Scores and a significantly more frequent appearance of Trendelenburg signs. The differences lessened at the end of the follow-up period. Within the group of transfemoral implantation, all six stems with a circular fixation zone measuring less than 3 cm had subsided and two of these had become loose; none of the stems with greater fixation zones exhibited these properties. In the case of the endofemoral implants, three stems exhibited sinking but there did not appear to be any relationship between this event and length of fixation zone. Conclusion  The surgical approach has an association with the short-time outcomes of hip revsions using cementless modular stems. Transfemoral implantation of the “Revitan curved” stem requires a fixation zone of at least 3 cm and a longer period of rehabilitation.     

Patterns of osseointegration and remodeling in femoral revision with bone loss using modular, tapered, fluted, titanium stems

Radiographic signs of osseointegration with the use of fluted, tapered, modular, titanium stems in revision hip arthroplasty with bone loss have not been previously categorized. Serial radiographs of 64 consecutive hips with mean follow-up of 6.2 years were retrospectively reviewed. Bone loss was classified as per Paprosky classification, osseointegration was assessed according to a modified system of Engh et al, and Harris Hip Score was used to document pain and function. Seventy-four percent of the hips had type 3 or 4 bone loss. All stems were radiographically osseointegrated. Early minor subsidence was seen in 6.2% of the hips; definite bony regeneration, 73% of the hips; and stress shielding, 26% of the hips. These osseointegration patterns were different from those described for extensively porous-coated cobalt-chromium stems and had a bearing on the evaluation of fixation of these stems.     

大粗隆臀中肌骨瓣移植髋关节融合术

目的 :为探索髋关节融合的新方法 ,提高融合成功率而设计本术式。方法 :采用髋关节后外侧切口将臀中肌大粗隆骨瓣转移用于关节融合。结果 :全部病人都在较短的时间内获得坚强的融合 ,除 2例病人外 ,其余患侧膝关节功能基本恢复正常。结论 :臀中肌大粗隆骨瓣用于髋关节融合术具有创伤小 ,费用低 ,操作简便 ,效果可靠的优点。     

Long-term results of cementless anatomic total hip replacement in dysplastic hips

This perspective study analyzes the long-term outcomes of cementless anatomic total hip arthroplasty (THA) in patients with developmental dysplasia of the hip (DDH). Between 1990 and 2004, 100 ABG total hip prosthesis were implanted in 87 patients with DDH. The average follow-up was 9 years (range 4–18 years). The mean Harris Hip Score was 87.13 (SD = 14.6) at the last follow-up. Radiographic analysis showed good results for the stems, while in 38% of the hips we recorded periacetabular bone resorption. Mean linear polyethylene wear was 0.23 mm/year. Ten revisions have been performed, survival rate was 99% for the stems and 90% for the cups. Cementless THA with hemispherical cup and anatomical stem is recommended when possible for patients with DDH although high rates of polyethylene wear and subsequent osteolysis have been the limiting factor in the long-term success of this implant.     

Stay Short or Go Long in Revision Total Hip Arthroplasty With Paprosky Type II Femoral Defects: A Comparative Study With the Use of an Uncemented Distal Fixating Modular Stem and a Primary Monobloc Conical Stem With 5-Year Follow-Up

BackgroundIn the revisions for Paprosky type II femoral defects, diaphyseal fixating femoral stems are commonly used. To preserve bone stock, the use of a shorter primary conical stem could be an adequate alternative. The objective of this study is to compare the results of a primary conical stem to the more commonly used diaphyseal fixating modular revision stem in revision total hip arthroplasty surgery with Paprosky type II femoral defects.MethodsA total of 59 consecutive patients with Paprosky type II femoral defects from our prospective revision registry were included. Thirty patients who received a long distal fixating modular stem (Revision Stem, Lima Corporate) and 29 patients who received a primary conical short stem (Wagner Cone, Zimmer) were prospectively followed. Minimal follow-up time was 2 years for subsidence and patient-reported outcome measures and 5 years for complications, reoperation, and revision. We compared subsidence, perioperative complications, reoperations, femoral component survival, Oxford Hip Score, EuroQol 5 Dimension, visual analog scale (VAS) for pain at rest, and VAS for pain during activity between stems.ResultsBoth groups were comparable regarding demographic, clinical, and surgery-related characteristics. We found more perioperative complications and stem revisions with the modular revision stem than with the primary conical stem. There were no statistical differences in subsidence, EuroQol 5 Dimension, Oxford Hip Score, and VAS for pain at rest or during activity between both stems.ConclusionIn revision total hip arthroplasty with Paprosky type II femoral defects, uncemented primary monobloc conical femoral stems showed the same clinical result as distal fixating modular stems with fewer complications and fewer stem revisions.     

Cementless modular hip revision arthroplasty using the MRP Titan Revision Stem: outcome of 79 hips after an average of 4 years’ follow-up

Introduction As primary total hip replacements (THRs) become more common in older patients and younger, physically active patients, the number of revision arthroplasties will also increase. Femoral bone loss, joint instability and possible infections are a challenge for a surgeon performing revision arthroplasty of the hip. The severe proximal femoral bone loss indicates the use of revision stems with a distal fixation.Materials and methods In this study the clinical and radiological outcomes of 79 cementless stem revisions using the MRP Titan Revision Stem with an average follow-up time of 4 years were prospectively examined.Results The Harris Hip Score improved from preoperative 50.8±25.2 to postoperative 86.8±13.2. In all cases healing of bony defects could be found. For stem diameters larger than 17 mm, atrophy of the proximal femur and non-progressive radiolucent lines in zones 1 and 7 according to Gruen were detected. No disadvantages or complications of the Morse taper junctions were observed, and no osteolysis was detected in this region. Primary stable fixation was achieved in all but two cases. Three cases were revised again due to periprosthetic fracture (1) and persisting infection (2).Conclusion Given the encouraging results with the MRP Titan Revision Stem, the principle of uncemented diaphyseal fixation appears to solve most of the technical problems in cases of significant bone loss and obviously offers good preconditions for bony restoration.     

Two-stage hip revision arthroplasty: the role of the excision arthroplasty

Between 1995 and 2003, 41 septic hips in 40 consecutive patients (20 males, 20 females) were treated with a two-stage total-hip-arthroplasty revision. Seventeen patients with 18 relevant procedures (44%) were reviewed at a mean follow-up of 52 months. In 5 hips, an excision arthroplasty was present at review. Reimplantation had been performed in 13 hips. The interval between explantation and reimplantation averaged 158 days. The average age was 68 years and the mean ASA score 3.24 at explantation. Mean Harris Hip score was 60 points, the mean Mayo Hip Score 66 points. We found no significance (Harris Hip Score, t test) between results after reimplantation and with long-term excision arthroplasty. The excision arthroplasty as a long-term solution can be an alternative to reimplantation in the treatment of critically ill patients.     

Treatment of osteonecrosis of the femoral head by using the greater trochanteric bone flap with double vascular pedicles

The use of the bone flap transfer has been reported to be successful in treatment of patients with early to medium stage (Ficat and Arlet stage I‐III) osteonecrosis of the femoral head (ONFH). We examined the vascular anatomy and blood supply of the greater trochanter area and evaluated the feasibility of revascularization of the femoral head by using the bone flap pedicled with transverse and gluteus medius branches of the lateral circumflex femoral artery. Based on the anatomy study, from January 2002 to May 2004, 32 ONFH patients were treated with the greater trochanteric bone flap pedicled with double blood vessels. Fifteen femoral heads were Ficat and Arlet stage II and 17 were stage III. The mean follow‐up was 99.5 months. Two of the 32 patients required a total hip replacement due to severe hip pain after surgery. The overall Harris hip score improved from a mean of 55.2 points to 85 points. Our data suggest the procedure is relatively easy to perform, less donor‐site morbidity and useful for young patients with stages II to III disease with or without mild collapse of the femoral head. © 2013 Wiley Periodicals, Inc. Microsurgery 33:593–599, 2013.     

Cementless Acetabular Socket Revisions Using Metasul Metal-on-Metal Bearings

Thirty-four hips were treated with cementless acetabular socket revisions using a metal-on-metal bearing. The causes of revision were aseptic loosening in 33 hips and septic loosening in 1 hip. Revisions were performed for acetabular sockets in 28 hips and for acetabular sockets and femoral stems in 6 hips. Mean follow-up duration was 6.2 years (range, 4.0-9.1 years), and mean Harris Hip Scores improved from 56 to 92 points. No hip required further revision for aseptic loosening. Focal femoral osteolysis newly developed in zone I in 1 hip, which was treated by curettage and bone grafting. The authors suggest that second-generation metal-on-metal bearings in cementless acetabular socket revisions can achieve good medium-term clinical and radiographic results.     

Total hip arthroplasty using femoral head shelf autografts in dysplastic hips. Our experience

The present work deals with a series of 28 patients (a total of 31 hips) suffering from coxarthrosis in dysplasia of the hip. All patients had undergone arthroplasty where an autograft of cortico-cancellous bone was taken from the head of the patientís femur. In 21 of these hips the prosthetic components were not cemented while the other 10 cases were. The patients (average age 57 years 5 months) underwent radiography and were clinically evaluated using the Harris Hip Score. The average follow-up was 6 years and 7 months. In the 10 hips which had been cemented, the average pre-operative Harris Hip Score was 46.9 points (range 24-85) while it was 80.5 upon check-up (range 50-98). In the 21 hips which were not cemented the average pre-operative Harris Hip Score was 44.3 points (range 21-62) while, at the time of check-up it was 90.8 (range 60-100). Only in 3 cases (9.67%) did the cotyloid portion require reoperation because of mobilization. In all cases (100%) the graft integrated perfectly with the host bone. The present study provides encouraging data regarding the use of autografts of cortico-cancellous bone taken from the head of the femur during hip replacement in patients with coxarthrosis in dysplasia of the hip. No differences were seen between the cemented and non cemented prostheses.     

Outcome after total hip arthroplasty: Part II. Disease-specific follow-up and the Swedish National Total Hip Arthroplasty Register

The Swedish National Total Hip Arthroplasty Register records primary hip replacements, revisions and surgical technique/environmental factors. The end-point for failure is revision. A prosthesis still in place, however, does not mean success. Clinical and radiographic outcomes should describe in more detail the efficacy of hip replacement surgery instead of the relatively blunt outcome measure that the register can provide. We performed a clinical outcome analysis on patients with primary total hip replacement thus testing the adequacy of the end-point for failure in the Swedish register. 1,113 randomly selected patients who had had total hip replacement surgery between 1986 and 1995 answered a diseasespecific self-administered questionnaire (WOMAC). A cohort of 344 patients was studied, using the Harris Hip Score and a conventional radiographic examination as outcome measures. We found clinical failure rates of 13% and 20% for all implants after 10 years, using 60 points or revision as the definition of failure in the Harris Hip Score and WOMAC, respectively. The result, according to the register during the same period, was a 7% revision rate. The clinical failure rate depended on the type of evaluation tool, definition of failure and demographics, which made it difficult to decide whether there was a need for revision. With the exception of pain measured by the Harris Hip Score, the results showed no significant correlation between clinical failure and radiographic failure. Hence, with the knowledge that there is a difference between the revision rate according to the register and clinical outcome, the strict definition of failure in the register is useful as an end-point for primary hip replacement surgery.     

Uncemented Total Hip Arthroplasty Through the Direct Anterior Approach: Analysis of a Consecutive Series of 275 Hips With a Minimum Follow-Up of 10 Years

BackgroundThe purpose of this study was to document complications, outcomes, and 10-year survivorship of primary total hip arthroplasty (THA) using a direct anterior approach with an uncemented, straight, hydroxyapatite-coated stem and an uncemented cup.MethodsA retrospective, consecutive series of 275 primary THAs through a direct anterior approach with traction table using Medacta Versafit cup and Quadra-H stem with a minimum of 10-year follow-up was identified. The cumulative 10-year survival of the implants was estimated using Kaplan-Meier estimator. All complications, reoperations, and failures were analyzed. Subjective and clinical outcomes (Subjective Hip Value, Western Ontario and McMaster Universities Osteoarthritis Index, and Harris Hip Score) were measured.ResultsOf 256 patients (275 hips, 143 men and 113 women) with a mean age of 63 (range, 24-85) years, 48 (19%) patients (52 hips) deceased not related to the surgery after a mean time 49 months (range, 3-118) postoperatively. At >10-year follow-up, 9 THAs were revised. The overall implant survival rate was 96.8% (95% confidence interval, 94.4-98.7) at 10 years. One cup and 1 stem were revised because of aseptic loosening. At the last follow-up, the median Subjective Hip Value was 90% (range, 20-100), the Western Ontario and McMaster Universities Osteoarthritis Index score reached a median of 0.2 points (range, 0-6.3), and the median Harris Hip Score points was 99 (range, 29-100).ConclusionPrimary THA through an anterior minimal invasive approach with the mentioned implants showed low revision rates and good to excellent clinical outcome after at least 10 years.