Maintenance of the bone stock is a primary goal in hip surgery. The idea of a resurfacing hip prosthesis had already been proposed in the past without success. The improvement in prosthetic materials, however, has mades it possible to reconsider the use of resurfacing prostheses. We report our experience with the Birmingham hip resurfacing (BHR) prosthesis.

We operated on 58 patients (60 hips, two bilaterally), 31 men, 27 women, with a mean age of 47.9 years (25–76) and a mean follow-up of 27 months (1–42). We used the posterolateral approach with the patient in lateral decubitus. We performed a clinical and radiographic examination before surgery and at 1 and 6 months postoperatively. We recorded a statistically significant improvement in the clinical score at 6 months after surgery, with respect to the preoperative examination. Major complications were two fractures of the femoral neck and one infection. We recorded also peri-prosthetic calcifications in two patients, calcifications of the ileopsoas in two and ileopsoas tendinitis in one.

In conclusion, in our experience, the BHR prosthesis reproduced the biomechanics of the hip and minimised the risk of luxation. The preliminary clinical results are encouraging, also for difficult cases.

The use of conventional stems in hip arthroplasty may be difficult in cases of dysplasia, coxa vara or coxa valga, after fracture or proximal femur osteotomy. In fact the morphologic alterations of the proximal femur might require prosthetic components characterised by small size and different neck angles to restore correct joint biomechanics. In these cases we are often compelled to compromise between the ideal implant aneiversion and fit and what we can really achieve. An alternative to conventional prostheses is represented by custom-made prostheses.

For 3 years we have been using the Modulus stem in the treatment of morphologic disorders of the hip. The conic shape of the stem easily fits the different morphologies of the proximal femur, whereas the modularity of the neck makes it possible to correct length, inclination and declination of the femural neck. We studied 59 patients by clinical and radiographic examination before surgery and 1, 3, 6 and 12 months postoperatively. We recorded a statistically significant improvement in the clinical score already at 1 month but this was even better at 6 months after surgery, with respect to the pre-operative examination.

With the use of this prosthesis, the recovery of correct joint biomechanics together with high tribologic standards could improve the implant survival, leading to cost reduction and patient satisfaction.

The increase in knee arthroscopy performed on an out-patient basis, along with the need for cost reduction and a safe and rapid patient discharge, has underlined the importance of adequate anaesthesia techniques. We designed this study to compare efficacy, efficiency and surgeon’s satisfaction of total intravenous anaesthesia with propofol and remifentanil with those of spinal or peripheral nerve blocks for outpatient knee arthroscopy.

A total of 120 patients undergoing elective outpatient knee arthroscopy were randomly allocated to receive total intravenous anaesthesia with propofol and remifent-anil (n=40), combined sciatic-femoral nerve block (n=40) or spinal anaesthesia (n=40). Preparation times, surgeon’s satisfaction, discharge times and anaesthesia-related costs with the three anaesthesia techniques were analysed.

Preparation time was shorter with general anaesthesia (13 min) than with spinal anaesthesia or sciatic-femoral block (15 min; p=0.006). Surgeon’s satisfaction was similar in the three groups. Furthermore, 17 patients receiving peripheral nerve block (42%) and 12 receiving spinal anaesthesia (30%) by-passed the post-anaesthesia care unit after surgery as compared with only two general anaesthesia patients (5%; p=0.01). Discharge from the post-anaesthesia care unit was more rapid after peripheral block; however, stay in the Day Surgery Unit was shorter after general anaesthesia than peripheral or spinal blocks (p=0.026). Urinary retention was reported in three spinal anaesthesia patients only (8%; p=0.03).

Regional anaesthesia techniques reduce the rate of admission and the duration of stay in the post-anaesthesia care unit as compared with general anaesthesia. Peripheral rather than spinal nerve blocks should be preferred to minimise the risk of urinary retention.