Introduction

Over the past 30 years multiple wars and embargos have reduced healthcare resources, infrastructure, and staff in Iraq. Subsequently, there are a lack of physiotherapists to provide rehabilitation after an anterior cruciate ligament reconstruction (ACLR). The implementation of home-based rehabilitation programmes may provide a potential solution to this problem. This study, set in in the Kurdistan region of Iraq, describes the epidemiology and outcomes of anterior cruciate ligament reconstruction (ACLR) followed by home-based rehabilitation alone.

Aim: Isotope bone scan has become a part of the routine workup for a painful arthroplasty. A retrospective analysis was performed to analyse the significance of isotope bone scan results in the management of painful arthroplasty.

Methods and Materials: The study group included all the 58 consecutive patients who underwent an isotope bone scan for a painful arthroplasty over a one year period. The data collected included: age, sex, date and nature of primary arthroplasty, inflammatory markers, indication, date and result of the bone scan, and the final outcome.

Results: The primary arthroplasty was a TKR (29 patients) and THR (29 patients). The average duration between primary arthroplasty and the bone scan was 44.3 months (Range 5 – 195 months). The duration was less than 1 year for 6 patients. The average age of the patients was 62 years. The male: female ratio was 31:27. 4 of the arthroplasties were uncemented and 54 were cemented. The bone scan results were normal in 32 patients, unclear in 17 patients and abnormal in 9 patients. There was no statistical correlation found between the inflammatory markers and the results of the bone scan.

Discussion: The results of the bone scan made a significant contribution in the management decision of the patient in 8 of the patients and served to reassure the patient/surgeon in most of the rest 50. In 6 patients it was performed within a year of the primary arthroplasty, during which period the results are not very specific. An isotope bone scan involves a significant radiation exposure to the patient as well utilization of time and resources, hence always ask the million dollar question: “Is it going to alter my management plan”

Aim: Isotope bone scan has become a part of the routine workup for a painful arthroplasty. A retrospective analysis was performed to analyse the significance of isotope bone scan results in the management of painful arthroplasty.

Methods and Materials: The study group included all the 58 consecutive patients who underwent an isotope bone scan for a painful arthroplasty over a one year period. The data collected included: age, sex, date and nature of primary arthroplasty, inflammatory markers, indication, date and result of the bone scan, and the final outcome.

Results: The primary arthroplasty was a TKR (29 patients) and THR (29 patients). The average duration between primary arthroplasty and the bone scan was 44.3 months (Range 5 – 195 months). The duration was less than 1 year for 6 patients. The average age of the patients was 62 years. The male: female ratio was 31:27. 4 of the arthroplasties were uncemented and 54 were cemented. The bone scan results were normal in 32 patients, unclear in 17 patients and abnormal in 9 patients. There was no statistical correlation found between the inflammatory markers and the results of the bone scan.

Discussion: The results of the bone scan made a significant contribution in the management decision of the patient in 8 of the patients and served to reassure the patient/surgeon in most of the rest 50. In 6 patients it was performed within a year of the primary arthroplasty, during which period the results are not very specific. An isotope bone scan involves a significant radiation exposure to the patient as well utilization of time and resources, hence always ask the million dollar question: “Is it going to alter my management plan”

Introduction: Intra-articular injection (IAJ) with cortico-steroid and local anaesthetic has been used as both diagnostic and therapeutic intervention in osteoarthritis of the hip. Doubt remains about its efficacy in confirming the source of symptoms in patients with both hip and spinal arthritis. There are also concerns about the introduction of infection for patients undergoing surgery.

Methods: All patients undergoing Hip IAJ for osteoarthritis within a 6-month period in 2007 were reviewed for three surgeons at one institution retrospectively. Data was collated and analysed using a set protocol allowing 18 months follow-up period.

Results: 41 procedures (38 patients) had injections within the study period. Male: Female ratio was 17:24. Average age was 52 years. There were 54% right-sided procedures.

25/41 patients had full response to the injection. 80% were listed for surgery as a result (documented reasons in those not listed). 6/41 patients had a partial response to the injection – 66% were managed conservatively (due to co-morbidities elicited at review, or spinal pathology). 10/41 patients had no benefit – 3 were offered surgery (one after MRI confirmation, one after prolonged physiotherapy and one after discussion about diagnostic overlap).

Hip replacement completely reduced symptoms in 19/21 (90%) and partially in 2/21 (10%) (1 had undergone a successful pre-operative IAJ).

There were no deep infections in patients undergoing surgery after injection. 1 patient had a superficial infection (resolved at review).

Discussion: Diagnostic IAJ can be of value in patients when there are concerns whether the origin of symptoms is truly ascribable to the hip. Patients where injections are successful go on to undergo successful surgery without an increased risk of infection.

Intoduction: There is a general consensus with regard to the treatment of extacapsular fractures of the hip, however the surgical treatment and the choice of implant in displaced intracapsular fractures remains controversial. Evidence has not definitively established the relative merits of the optimal device for internal fixation. The management of displaced intracapsular femoral neck fractures depends on surgeon’s preference.

Methods: We have done a study using synbone (Corticocancellous with similar properties of natural bone) comparing three methods of fixation (three parallel cannulated screws, two hole dynamic hip screw with and without a derotation screw, four constructs of each fixation). We looked at the ultimate peak loads that a construct can withstand before failure.

Results: There is a significant difference between the cannulated screws and two hole Dynamic hip screw, the latter being stronger of the two. However there is no biomechanical advantage of using the derotation screw.

Discussion: Although this study provides evidence of superiority of dynamic hip screw over cannulated screws, this is limited to the biomechanical properties of the construct. The ultimate clinical failure can depend on numerous other factors. Based on our study we recommend two-holed Dynamic Hip Screw fixation for displaced intracapsular fractures of proximal femur.

Introduction. Leg length inequality post total hip arthroplasty is a source of patient dissatisfaction. In adult DDH femoral length equality is assumed. Empirically, a longer femur has been observed on the affected side in the presence of unilateral DDH; restoration of the hip centre in this situation may lengthen the affected leg.

Aim. Assessment of femoral length variation in adults with unilateral and bilateral DDH.

Method. Retrospective observation study of 17 adults with unilateral and 7 adults with bilateral DDH. Femoral lengths assessed using CT measurements.

Results. Unilateral DDH. The ipsilateral femur was longer in 11 patients (63%) The degree of femoral lengthening was between 5 and 10 mm. Bilateral DDH. The femur with the greater degree of DDH was longer by a mean of 7.5 19.3 mm .

Conclusion. In the presence of DDH, asymmetry of femoral lengths is common and unpredictable. Careful femoral length assessment ( with CT leg lengths) is advised preoperatively in patients with DDH. This will alert the surgeon and patient to the possible risk of post operative ipsilateral leg lengthening.