 EDITORIAL Hip surgery – state of the art TOTALLY HIP 2017: GOTHENBURG

A. R. J. Manktelow, With a procedure recently described as ‘The Manktelow et al6 describe an increased rate T. Gehrke, operation of the century’,1 and with the clinical of re-operation when fractures are incorrectly F. S. Haddad success of total hip arthroplasty recognised in classified. The difficulties involved in making the United Kingdom by a commemorative the correct fracture ‘characterisation’7-10 are postage stamp, the hip surgeons of today are discussed. the custodians of one of the most successful With increased use of a ‘cement-in-cement’ interventions in modern medicine. With an revision technique in Europe, Mohaddes et ageing, yet increasingly active population, and al11 report the results of using two different with patient expectations high, the hip surgeon stems with this relatively conservative is presented with a challenge to meet those approach to femoral revision from the Swed- aspirations, striving to ensure excellent out- ish Hip Arthroplasty Register. The impor- comes with evidence-based choices in implant tance of establishing the correct indications and bearing surface technology. It is also for this procedure is highlighted as the way to important that choices are governed by an match the previously reported12,13 successful appreciation of an increasingly challenging outcomes. health economic environment. Malchau et al14 detail blood metal ion There is no limit to the level of complexity analysis early and at mid-term follow-up fol- with which a patient can present. If we are to lowing both the ASR hip resurfacing (DePuy, continue to improve longevity and functional Warsaw, Indiana) and metal-on-metal hip outcome, it is essential that surgeons are fully replacement. With the indications for explora-

 A. R. J. Manktelow, BSc, aware of the available options in surgical tech- tion and revision in these cases obvious only in MBBS, FRCS(Ed), FRCS(Orth), nique and implant selection. An understanding a certain percentage of cases, the clinical signif- Consultant Trauma and Orthopaedic Surgeon, of changes in the indications for surgery, of the icance of changing blood metal ion levels, and Department of Academic evolution of patient information and education identifying those at particular risk of a damag- Orthopaedics, Trauma and 15-18 Sports Medicine, and of the rehabilitation possibilities, is also ing reaction remains a relevant challenge. Nottingham University important. Glyn-Jones et al19 describe the use of CT Hospitals NHS Trust, Nottingham, UK. This supplement summarises several key analysis to identify when osseous impingement topics from the Totally Hip 2017 Meeting in occurs in Cam deformity, showing that it can  T. Gehrke, MD, Orthopaedic Surgeon, Medical Director and Gothenburg. occur relatively early in flexion. Definitive Head Surgeon, Professors Gehrke, Parvizi and Shohat2 indications for surgical correction of this HELIOS ENDO-Klinik Hamburg, Holstenstrasse 2, 22767, review the implications of recently published increasingly common diagnosis are unclear, Hamburg, Germany. guidelines to prevent periprosthetic infection.3 thus developing and understanding functional  F. S. Haddad, BSc MD (Res), Recently, there has been an emphasis on defining imaging will probably aid with the therapeutic FRCS(Tr&Orth), Professor of 20-23 Orthopaedic Surgery, Editor-in- and developing an algorithm for diagnosis and algorithm. Chief management, however, prevention must remain Haddad et al24 provide data on the early The Bone & Joint Journal, 22 Buckingham Street, London, the most important consideration. The authors functional and patient-reported outcomes fol- WC2N 6ET and NIHR University evaluate pre-, peri- and post-operative options. lowing the use of a short stem uncemented College London Hospitals Biomedical Research Centre, Reflecting the increasing prevalence and the femoral component, and contrast these to UK. clinical resource implications that surround their outcomes with a more conventional 4 Correspondence should be sent managing periprosthetic femoral fractures, longer stem component. Determining the to F. S. Haddad; email: there are two papers relating to this topic. Fink location and extent of the femoral fixation [email protected] and Oremak5 describe the benefits and reliable required to achieve excellent clinical out- ©2017 Haddad et al versatility in the use of modular taper fluted comes and long-term function, continues to doi:10.1302/0301-620X.99B4. 25 BJJ-2017-0188 $2.00 stems in the management of failed fracture fix- be a point of contention. Clinical data are ation; further supporting the importance of an presented which show encouraging results Bone Joint J 2017;(4 Supple B):1–2. accurate assessment at presentation. with short stems.

VOL. 99-B, No. 4, APRIL 2017 1 2 A. R. J. MANKTELOW, T. GEHRKE, F. S. HADDAD

We hope the papers presented in this supplement will 11. Cnudde P, Kärrholm J, Rolfson O, Timperley AJ, Mohaddes M. Cement-in- cement revision of the femoral stem: analysis of 1179 first-time revisions in the challenge present thinking, allow surgeons to reflect and to Swedish Hip Arthroplasty Register. Bone Joint J 2017;99-B(4 Supple B):27–32. determine what is truly best for their patients. We hope that 12. Sandiford NA, Jameson SS, Wilson MJ, et al. Cement-in-cement femoral com- surgeons will find the information contained supportive in ponent revision in the multiply revised total hip arthroplasty. Bone Joint J 2017;99- their quest to provide patients with the outcomes they B:199–203. 13. Mounsey EJ, Williams DH, Howell JR, Hubble MJ. Revision of hemiarthroplasty expect and deserve. Moving forward, we hope that discus- to total hip arthroplasty using the cement-in-cement technique. Bone Joint J 2015;97- sion and review will facilitate our drive to advance the field B:1623–1627. of hip surgery and to maintain the momentum generated by 14. Galea V, Laaksonen I, Matuszak S, Connelly J, Muratoglu O, Malchau H. Mid- term changes in blood metal ion levels after Articular Surface Replacement arthro- our predecessors. plasty of the hip. Bone Joint J 2017;99-B(4 Supple B):33–40. This is an open-access article distributed under the terms of the Creative Com- 15. Matharu GS, Berryman F, Brash L, et al. Can blood metal ion levels be used to mons Attributions licence (CC-BY-NC), which permits unrestricted use, distribu- identify patients with bilateral Birmingham Hip Resurfacings who are at risk of tion, and reproduction in any medium, but not for commercial gain, provided adverse reactions to metal debris? Bone Joint J 2016;98-B:1455–1462. the original author and source are credited. 16. Osman K, Panagiotidou AP, Khan M, Blunn G, Haddad FS. Corrosion at the head-neck interface of current designs of modular femoral components. Bone Joint J 2016;98-B:579–584. References 17. Berber R, Skinner J, Board T, et al. International metal-on-metal multidisciplinary 1. Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip teams. Bone Joint J 2016;98-B:179–186. replacement. Lancet 2007;370:1508–1519. 18. Whitehouse MR, Endo M, Zachara S, et al. Adverse local tissue reactions in 2. Parvizi J, Shohat N, Gehrke T. Prevention of periprosthetic joint infection: new metal-on-polyethylene total hip arthroplasty due to trunnion corrosion. Bone Joint J guidelines. Bone Joint J 2017;99-B(4 Supple B):3–10. 2015;97-B:1024–1030. 3. Parvizi J. Periprosthetic joint infection. Bone Joint J 2015;97-B:1157–1158. 19. Fernquest S, Arnold C, Palmer A, Broomfield J, Denton J, Taylor A, Glyn- Jones S. Osseous Impingement Occurs Early in Flexion in Cam-Type Femoroacetab- 4. da Assunção RE, Pollard TC, Hrycaiczuk A, et al. Revision arthroplasty for ular Impingement; A 4-Dimensional Computed Tomography Model. Bone Joint J periprosthetic femoral fracture using an uncemented modular tapered conical stem. 2017;99-B(4 Supple B):41–48. Bone Joint J 2015;97-B:1031–1037. 20. Fontana A, de Girolamo L. Sustained five-year benefit of autologous matrix- 5. Fink B, Oremak D. Hip revision arthroplasty for failed osteosynthesis in peripros- induced chondrogenesis for femoral acetabular impingement-induced chondral thetic Vancouver type B1 fractures using a cementless, modular, tapered revision lesions compared with microfracture treatment. Bone Joint J 2015;97-B:628–635. stem. Bone Joint J 2017;99-B(4 Supple B):11–16. 21. Loh BW, Stokes CM, Miller BG, Page RS. Femoroacetabular impingement osteo- 6. Khan T, Grindlay D, Ollivere B, Scammell B, Manktelow A, Pearson R. A sys- plasty. Bone Joint J 2015;97-B:1214–1219. tematic review of Vancouver B2 and B3 periprosthetic femoral fractures. Bone Joint J 2017;99-B(4 Supple B):17–25. 22. Fukui K, Trindade CA, Briggs KK, Philippon MJ. Arthroscopy of the hip for patients with mild to moderate developmental dysplasia of the hip and femoroace- 7. Haddad FS. Periprosthetic femoral fractures. Bone Joint J 2016;98-B:433–434. tabular impingement. Bone Joint J 2015;97-B:1316–1321. 8. Abdel MP, Houdek MT, Watts CD, Lewallen DG, Berry DJ. Epidemiology of 23. Basheer SZ, Cooper AP, Maheshwari R, Balakumar B, Madan S. Arthroscopic periprosthetic femoral fractures in 5417 revision total hip arthroplasties Bone Joint J treatment of femoroacetabular impingement following slipped capital femoral epiph- 2016;98-B:468–474. ysis. Bone Joint J 2016;98-B:21–27. 9. Abdel MP, Watts CD, Houdek MT, Lewallen DG, Berry DJ. Epidemiology of 24. Hossain F, Konan S, Volpin A, Haddad FS. Early performance-based and patient- periprosthetic fracture of the femur in 32 644 primary total hip arthroplasties. Bone reported outcomes of a contemporary taper fit bone-conserving short stem femoral Joint J 2016;98-B:461–467. component in total hip arthroplasty. Bone Joint J 2017;99-B(4 Supple B):49–55. 10. Duncan CP. The Unified Classification System (UCS): improving our understanding 25. Feyen H, Shimmin AJ. Is the length of the femoral component important in primary of periprosthetic fractures. Bone Joint J 2014;96-B:713–716. total hip replacement? Bone Joint J 2014;96-B:442–448.

HIP SUPPLEMENT TO THE BONE & JOINT JOURNAL