Trauma and elective orthopaedic demands in New Zealand are increasing. In this study, prospective and retrospective data has been collected at Nelson Hospital and across New Zealand to identify the percentage of elective theatre time lost due to cancellation for acute patient care. Data has been collected from theatre management systems, hospital data systems and logged against secretarial case bookings, to calculate a percentage of elective theatre time lost to acute operating or insufficient bed capacity.

Data was collected over a five-month period at Nelson Hospital, with a total of 215 elective and 226 acute orthopaedic procedures completed. A total of 95 primary hip or knee arthroplasties were completed during this trial while 53 were cancelled. The total number of elective operative sessions (one session is the equivalent of a half day operating theatre time) lost to acute workload was 47.9. Thirty-three percent of allocated elective theatre time was cancelled - an equivalent of approximately one-full day elective operating per week.

Over a five-week period data was collected across all provincial hospitals in New Zealand, with an average of 18% of elective operating time per week lost due to acute workload. Elective cancellations were due to acute operating 40% of the time and bed shortages 60% of the time. The worst effected centre was Palmerston North which had an average of 33% of elective operating cancelled per week to accommodate acute surgery or due to bed shortages.

New Zealand's provincial orthopaedic surgeons are under immense pressure from acute operating that impedes provision of elective surgery. The New Zealand government definition of an ‘acute case’ does not reflect the nature of today's orthopaedic burden. Increasing and aging populations along with staff and infrastructure shortages have financial and societal impacts beyond medicine and require better definitions, further research, and funding from governance.

PFFs are an increasing burden presenting to the acute trauma services. The purpose of this study is to show that cemented revision for Vancouver B2/B3 PFFs is a safe option in the geriatric population, allows early pain-free weight bearing and comparable to a control-group of uncemented stems with regard to return to theatre and revision surgery.

A retrospective review was conducted of all PFFs treated in a Level 1 trauma centre from 2015-2020. Follow up x-rays and clinical course through electronic chart was reviewed for 78 cemented revisions and 49 uncemented revisions for PFF. Primary endpoints were all cause revision and return to theatre for any reason. Secondary endpoints recorded mobility status and all-cause mortality.

In the cemented group there were 73 Vancouver B2, 5 Vancouver B3 PFF; the mean age was 79.7 years and mean radiological follow-up of 11.9 months. In the cementless group there were 32 Vancouver B2 and 17 Vancouver B3 PFFs; with all 49 patients undergoing distally bearing uncemented revision, the mean age was 72.7 years and mean radiological follow-up of 21.3 months.

Patients treated with a cemented prosthesis had significantly higher ASA score (2.94 -v- 2.43, p<0.001). The primary endpoints showed that there was no significant difference in all cause revision 3/78 and 5/49 p=0.077, or return to theatre 13/78 -v- 12/49 p=0.142.

Secondary endpoints revealed no significant difference in in-hospital mortality. The cementless group were more likely to be mobilising without any aid at latest follow-up 35/49 -v- 24/78 p<0.001.

The use of cemented revision femoral component in the setting of PFFs is one option in the algorithm for management of unstable PFFs according to the Vancouver classification. Evidence from this case-control study, shows that the all-cause revision and return to theatre for any cause was comparable in both groups.