We retrospectively reviewed 45 hip arthroplasties which were performed over a period of 20 years in 38 patients with cirrhosis of the liver. There was a high perioperative 30-day complication rate (26.7%). Advanced cirrhosis was associated with a higher risk of complications (p = 0.004) as also was increased age, a high level of creatinine, a low level of albumin, a low platelet count, ascites, encephalopathy and an increased operative blood loss. The survival of the prosthesis at five years was 77.8% and infection was a major cause of failure.

In view of the high rate of early complications and the limited longevity of the prosthesis, surgeons who perform hip arthroplasty on such patients should counsel them appropriately preoperatively.

There are several techniques for the accurate measurement of the migration of components after arthroplasty some of which require the operative placement of tantalum balls. We have reviewed the position and migration of these markers in 64 patients after total hip arthroplasty.

In 40% of cases, one or more balls was seen to be outside the proximal femur on the postoperative radiograph, although all were considered to be within the bone at operation. In two hips, one ball appeared to have migrated towards the joint, although none was seen within the joint. Misplacement was not related to the experience of the surgeon or the operative approach.

Migration analysis which necessitates the insertion of tantalum balls requires careful technique to avoid a potential source of third-body wear. It should probably be used only for research in small series of patients.