Introduction for Hip Society Proceedings

The Thirty-first Annual Open Meeting of the Hip Society and the Ninth annual collaboration between the Hip Society and the American Association of Hip and Knee Surgeons was held in New Orleans, LA on February 8, 2003. This year’s President of the Hip Society was Miguel Cabanela and this year’s President of the American Association of Hip and Knee Surgeons was Douglas Dennis.

The program was designed to update orthopaedic surgeons on advances and controversies in reconstructive hip surgery in adults. The field continues to make rapid advances and also to face new challenges.

The Presidential guest speaker was Laurent Sedel from France who spoke on Ceramic Prosthesis Fractures: History and Present Status. As one of the surgeons with the greatest experience with ceramics in orthopaedics, he provided a unique long-term perspective on ceramics in hip arthroplasty.

Four papers were honored with three Hip Society Awards. Noble et al received the Aufranc Award for an excellent anatomic study of developmental hip dysplasia, based on CT scanning. They documented the relationship between the severity of dysplasia and anatomy of the femur and acetabulum. Barrack et al and Bragdon et al shared the Charnley Award for two related animal studies that showed the potential value of osteoinductive recombinant proteins to restore acetabular bone stock and improve implant fixation in the setting of acetabular bone loss. Finally, Roeder et al received the Stinchfield Award for a report on the effect of patient age, gender, underlying diagnosis, and Charnley class on the time course and magnitude of change in functional parameters after THA.

The first session of the meeting focused on implant fixation and started with a question: Are we really doing any better than Sir John Charnley? The Iowa experience with Charnley THA was presented as a benchmark, followed by papers on polished tapered cemented stems, uncemented tapered stems, uncemented fully porous-coated stems, and uncemented sockets. All of these newer methods, at least with successful implant designs are producing midterm, and in some cases longer-term, results that rival the excellent results reported by Charnley.

The next session was entitled Wear in THA: A Critical Up-to-Date Look at Alternative Bearings. This group of papers began with a critical review of current methods to measure PE wear. New information on in vivo wear of cross-linked PE bearings measured by RSA, and new data on metal-on-metal implants and ceramic-on-ceramic articulations all were presented. Although each of these newer bearings has potential strengths and weaknesses, the emerging clinical data on all three bearings presented at this meeting provide reason for optimism.

Controversies and Hot Topics in Reconstructive Hip Surgery was the title of the next session. Topics included mini-incisions for THA, surface replacement, robotics and computer-assisted surgery, computer simulated surgery, femoroacetabular impingement as a cause of hip arthritis, and bone restoration with bone graft substitutes and osteoinductive agents.

A session followed on Complications of Hip Surgery. Evolving methods to treat infection, dislocation, and periprosthetic fractures were discussed, as were persistent thigh pain after hip arthroplasty and the complications of hip arthroscopy.

Later, revision THA was considered with presentations on uncemented sockets and treatment of pelvic osteolysis. The updated results of three methods of femoral implant fixation in revision surgery, fully porous-coated stems, impaction grafting, and modular fluted tapered stems were presented.

Osteonecrosis without femoral head collapse, an unsolved problem in hip surgery, was the subject of the next session. The role and results of femoral head-preserving procedures were reviewed. Updated information on the mediocre results of hemiresurfacing arthroplasty and better results of ceramic-on-ceramic THA for osteonecrosis also were presented.

The final session focused on techniques in hip reconstruction. Techniques presented included extended greater trochanteric osteotomies, well-fixed implant removal, grafting of osteolytic lesions, cementing liners into well-fixed shells, use of custom cages in revision THA and minimally-invasive two-incision THA.

This year’s program showed that reconstructive hip surgery in adults continues to move forward rapidly. New advances and technology are conquering some problems, such as implant fixation, and hold the promise of markedly reducing other problems, such as bearing surface wear. At the same time, the program showed that important areas for improvement remain, such as treatment of bone loss and treatment of osteonecrosis: both may benefit from new biologically based technologies and techniques that only now are being evaluated. This year’s program also suggests that the potential power of other new technologies, such as image-guided surgery and minimally-invasive surgery, are just being glimpsed; doubtless they will be the subjects of much interest in forthcoming years.