The goals of surgical treatment are to obtain anatomical reduction, obtain stable fixation, and allow early rehabilitation. Results of conservative management of intertrochanteric fractures are not satisfactory due to the increased risk of cardiopulmonary complications related to immobilization. External fixation has been well-established as an alternative treatment modality for intertrochanteric fractures in elderly and medically-compromised patients. The authors reviewed the related literature and reported on three cases of elderly patients that suffered from intertrochanteric fractures and had severe medical co-morbidities. They were successfully treated by external fixation under local anesthesia.

Purpose: This study was accomplished to evaluate the clinical & radiological results of cementless total hip arthroplasty using a fully hydroxyapatite-coated femoral stem after follow up of at least, 2 years.
Materials and Methods: Thirty one hips in 28 patients, who underwent primary total hip arthroplasty using a fully hydroxyapatite-coated femoral stem between september 2007 and May 2009, were followed up for more than 2 years after surgery. The average age of patients was 67 years old, and the average duration of follow up was 35 months. Preoperative diagnosis was 17 cases of osteonecrosis and 10 cases of femoral neck fracture. Clinical evaluation was done by Harris hip score (HHS). Radiological evaluation was done in terms of stability of components, subsidence of femoral stem and occurrence of osteolysis.
Results: The average of HHS improved from 34.3 preoperatively to 82.6 at final follow-up. Radiologically, fixation by bony ingrowth was 23 cases(74%) and fibrous ingrowth was 8 cases(26%). Subsidence was within 2-4 mm and occurred within 6 weeks in all 5 cases. There were 4 cases of intra-operative femoral fracture, 1 case of superficial infection.
Conclusion: Short-term clinical and radiological results of cementless total hip arthroplasty using a fully hydroxyapatite-coated femoral stem were not good enough. Radiologically, bony ingrowth were no more than 74%. Therefore, longer-term follow up would be necessary.

Purpose: The purpose of this study is to report clinical and radiographic results over a period of two 2 years after cementless total hip arthroplasty (THA) with fourth generation ceramic-on-ceramic articulation.
Materials and Methods: We studied 22 patients, 23 cases which were followed up for two years among 25 patients, 26 patients who underwent cementless THA with the fourth generation ceramic between April 2009 and December 2009. The average age of the patients was 55.9 years old(22 to 72 years old), and the average follow-up duration was 28 months(24 to 32 months). A clinical evaluation was performed using the Harris hip score (HHS), and radiologic evaluation was based on acetabular cups and osteolysis of the femoral stems, instability, distance, angle, and so on.
Results: HHS showed an increase, from 54 for before-surgical treatment, to 91 at the last follow-up. Inguinal pain was observed in one case, and femoral pain was observed in two cases. Stable fixation was achieved in all cases, and no instability, osteolysis, or movement of acetabular cups and femoral stems was observed.
Conclusion: Clinical and radiological short-term results for use ofthe fourth generation ceramic-on-ceramic cementless THA have favorable so far. Further follow-up study should be performed for evaluation of the long-term results.

Purpose: To evaluate the treatment outcome for Type A2 or above intertrochanteric fractures in elderly patients using cementless bipolar hemiarthroplasties incorporating a standard (tapered, rectangular) stem.
Materials and Methods: We retrospectively reviewed the records of 37 patients who had undergone bipolar hemiarthroplasty between February 2006 and February 2010 in our hospital, and who had received follow up evaluation for more than two years after the surgery. The mean patient age was 73.5 years (range 65-88 years), and 16 patients were male and 21 were female. We evaluated the the results of their treatment by analyzing the operation duration, volume of bleeding, measured results for the recovery of walking capability, and any complications and radiologic findings.
Results: The mean operation duration was 75.3 minutes(50-185 minutes). The average total volume of bleeding was of 755.5 cc(75-1,400 cc). Upon the final follow-up visit, 27 patients(72.9%) had recovered more than 80% of their pre-injury Barthel index values(72.8±15.1). Complications included one case of deep infection, one case of acetabular erosion, and 3 cases of greater trochanter non-union. There were no cases of revisions due to prosthesis loosening or for other reasons.
Conclusion: Cementless bipolar hemiarthroplasty using a tapered, rectangular stem is a viable alternative treatment for type A2 intertrochanteric fractures in elderly patients which supports rapid patient mobilization ability.

Purpose: To evaluate the correlation between MRI findings and hip joint lesions evaluated by arthroscopy in patients affected by paralabral cyst.
Materials and Methods: Of patients treated by hip arthroscopy from Jan 1996 to Mar 2010, 17 cases symptomatic of paralabral cyst as observed by preoperative MRI were analyzed. The presence of an acetabular labrum tear, and the location and size of the cyst were evaluated using both preoperative MRI and intraoperative arthroscopy. Visual analogue scale (VAS), modified Harris hip scale, and Hip outcome score results were compared as determined by the two assessment methods.
Results: According to the MRI findings, the locations of the cysts included 5 cases in the anterosuperior, 2 anterior, 4 anteroinferior, 2 posterosuperior and 4 posteroinferior. The mean size of all cysts was 25.1×12.5×13.8 mm³. Postoperatively, the mean VAS score for all patients improved from 7.7 to 1.5, their modified Harris hip score improved from 58.8 to 90.7, and their Hip outcome score improved from 54 to 93.5.
Conclusion: Painful paralabral cyst was mainly associated with an acetabular labral tear and we concluded that observation of paralabral cyst upon preoperative MRI provided indirect evidence of proximal acetabular labral pathology.

Purpose: Non-cement total hip arthroplasty for unstable intertrochanteric fracture in elderly patients is regarded as another surgical technique preventing complications such as non-union, long term limitation of weight bearing, pressure sore, pulmonary thromboembolism after open reduction or closed reduction with intramedullary nailing, or plate fixation. We would like to announce the short-term results of primary non-cement total hip arthroplasty with double strands and double loops figure of 8 wiring for unstable intertrochanteric fracture in elderly patients.
Materials and Methods: All of the 20 patients admitted to the hospital between April 2010 and February 2012 who underwent non-cement total hip arthroplasty with double strands and double loops figure of 8 wiring for unstable intertrochanteric fractures were evaluated. The mean age was 71.1(57-86), there were nine males, and 11 females, with an average follow up period of six months. The post-operative state was evaluated by Harris hip score.
Results: The mean operation time was 95 min, and the average blood loss was 800 cc. Mean Harris hip score at the last available follow-up was 92.7, and, among the patients, 15 had all functions of daily life without limitation of walking distance, one had hip dislocation, one had breakage of strands. Pressure sore, deep vein thrombosis, and pulmonary thromboembolism were absent. Radiography at the last available follow-up showed no loosening of the femoral stem in any of the patients, and 13 patients had osteogenesis around the fracture site, and there was no osteolysis.
Conclusion: Primary non-cement total hip arthroplasty with double strands and double loops figure of 8 wiring in elderly patients with unstable intertrochanteric fractures showed satisfactory results. These results are expected to be useful for further studies with a long-term follow-up and in development of a reduction method.

In cases of sero-negative rheumatoid arthritis (RA), no abnormal findings are observed on blood tests and its clinical course is favorable, compared to sero-positive RA. In the acute phase of sero-negative RA, infiltration of neutrophils may be the only pathologic finding on frozen section biopsy. Thus, it might be misdiagnosed as pyogenic arthritis. We report on a case of acute sero-negative RA misdiagnosed as pyogenic arthritis during hip surgery with review of the literature.

Purpose: The purpose of this study was to evaluate the usefulness of our method, which estimated femoral stem alignment using a c-arm when the broach was inserted, for prevention of femoral stem malalignment.
Materials and Methods: A total of 103 hips were enrolled in this study. All patients underwentprimary hip arthroplasty from October 2011 to February 2013. The study was conductedretrospectively. Intraoperative estimated femoral stem alignments and final femoral stem alignments were classified into three groups. Multinomial logistic regression analysis was performed for analysis of factors (age, sex, diagnosis, body mass index, femoral stem size, osteoporosis, and proximal demur geometry) thatmight affect intraoperatively estimated femoral stem alignment.
Results: The distribution of intraoperative estimated femoral stem alignment was 80(78%) in the neutral group, 18(17%) in the varus group, and 5(5%) in the valgus group. The distribution of final femoral stem alignment was 100(97%) in the neutral group, 2(2%) in the varus group, and 1(1%) in the valgus group. There was no statistically significant factor affecting the intraoperatively estimated femoral stem alignment.
Conclusion: Intraoperative estimated femoral stem alignment using a c-arm is an effective method for prevention of femoral stem malalignment.

Purpose: The purpose of this study is to report on the short term follow-up of patients who underwent arthroscopic acetabular labral repair for femoroacetabular impingement and acetabular labral tear..
Materials and Methods: A total of 45 consecutive patients who underwent arthroscopic acetabular labral repair after diagnosis of femoroacetabular impingement and acetabular labral tear from January 2008 to December 2010 were included in this study. Modified Harris hip score (MHHS), VAS, Hip outcomes score (HOS), and patient satisfaction were used for evaluation of the clinical results.
Results: Patients included 22 males and 23 females, and the mean age of the patients was 33.0(range, 16-54) years old, and the mean follow up period was 26.7(range, 24-56) months. Of the clinical results, mean VAS score was 6.4 and 2.5 points before and after surgery, respectively, and mean MHHS score improved from 59.5 points before surgery to 85.4 points after surgery. Activities of daily living and sports-related activities of HOS were 58.3% and 51.2%, respectively, before surgery, and 83.0% and 79.8% after surgery. Revision arthroscopic surgery was performed on five cases(12.1%); labro-synovial adhesion, three cases, pull-out of suture anchor, one case, heterotropic ossification, one case.
Conclusion: Arthroscopic acetabular labral repair is considered an effective treatment for femoroacetabular impingement and accompanying acetabular labral tear.

Purpose: The purpose of this study was to evaluate the outcomes of total hip arthroplasty (THA) with an ABG I hip prosthesis after a minimum ten-year follow up.
Materials and Methods: From January 1996 to March 2001, 121 hips in 104 patients, whi were followed up for a minimum of ten-years, were enrolled in this study. The clinical and radiographic outcomes were evaluated and Kaplan-Meier survival analysis was performed.
Results: The mean Harris hip score at the last follow-up was 84 points. A radiolucent line around the cup, osteolysis, and cup loosening were observed in 5 hips(4.1%), 53 hips(43.8%), and 5 hips(4.1%), respectively. In the femoral side, osteolysis and stem loosening were observed in 11 hips(9.1%) and 2 hips(1.7%), respectively. The mean linear wear rate of the polyethylene liner was 0.23 mm/yr. Forty four revisions(36.3%) were performed. The outcomes were similar regardless of the cause of primary THA. The survival rate with the end point of revision due to cup loosening was 56.3%, and revision due to stem loosening was 98.1% after a 16 year follow-up.
Conclusion: High polyethylene wear and the disappointing survival rate of the ABGI cup were observed after a minimum ten year follow-up. Therefore, close observation of patients who have received an ABG I prosthesis is necessary.