Introduction The aim of the study was to review the results of total hip arthroplasty (THA) in relatively fit and mobile patients with Garden 3 and 4 fractures of the neck of femur.

Materials and methods 42 patients with displaced hip fractures who underwent THA ≥ 3years ago were reviewed. One was lost to follow-up.

Results Average age was 67.17 years (SD-9.4, range 37–80 years) with Male:Female ratio 6:35. Average follow-up was 5.8 years (3–9.6 years). Average Modified Barthel index before the fracture was 18.63 (SD-2.08, range 13–20). Majority were ASA grade II (22 patients). 33 hips were cemented, 1 uncemented and 7 hybrids. Canulated CF-30 femoral stem was most commonly used (33 patients) and acetabular component was Weber cup in most cases (34 patients). 35 hips had metal-on-metal bearing surface and the rest had metal-on-polyethylene. Average hospital stay was 12.5 days (SD-7.84, range 6–43); majority (36) of the patients were discharged home and the rest needed additional rehabilitation. Average post-operative drop in Hb was 2.78 (SD-1.34) and 15 (36.5%) patients needed blood transfusion. Average transfusion was 0.85 units per patient. Complications included: minor wound dehiscence (1), DVT (3), pulmonary embolism (1), dislocation (1), per-operative femur fracture (1), peri-prosthetic fracture (2) and stem loosening (1). 3 hips (7.3%) were revised (loosening 1, peri-prosthetic fractures 2). Average harris hip score at follow-up was 91 (66–100). At final follow-up 24 patients were independently mobile without support, 12 used 1 stick, one used 2 sticks, 3 used a frame and 1 patient was wheelchair bound due to stroke.

Conclusion In relatively fit and mobile patients, we recommend total hip replacement as the primary treatment since it promises better function and pain relief and avoid the drawbacks of internal fixation and hemiarthroplasty.

Introduction We conducted a prospective study to compare the early post-operative recovery following the two different incisions.

Materials and Methods 40 patients with BMI ≤ 30 were prospectively randomised (20 patients in each group) by use of envelopes. Conventional incision was 12 cm postero-lateral in all cases and minimal incision was diameter of the femoral head plus 2 cm. The patients, and assessors (physiotherapists and nurses on ward) were unaware of the treatment group.

Results Average age was 66.95 years for MI group and 68.55 for conventional group (p-0.51). Average BMI for MI and conventional group was 26.5 & 24.4 respectively (p-0.029). Average pre-operative Oxford hip score was 41.75 for conventional group and 42.15 for MI group (p-0.87). There was no statistically significant difference as regards the operating times (p-0.207); post-operative day the patients were mobilised with zimmer frame (p-0.71); drop in hemoglobin (p-0.197) and hematocrit (p-0.208) or the need for blood transfusion (p-0.56). However there was a statistically significant difference in the two groups as regards post-operative pain (on a 10 point visual analogue scale) and the number of postoperative days the patient was fit for discharge. Average pain score on day 1 was 4.05 for MI group and 6.25 for conventional group (p-0.0089) with similar difference on day 2 and the day of discharge. Patients in MI group were fit for discharge on an average 1.65 days earlier than those in conventional group (p-0.042). There was no superficial or deep wound infection, dislocation or per-operative fracture in either group. Transient sciatic nerve neuropraxia occurred in one patient in the minimal incision group which recovered within 6 weeks.

Conclusion Minimal incision posterior approach for total hip replacement may be useful in decreasing the post-operative pain and duration of hospital stay. However the incidence of complications is an area of concern and needs to be studied on a larger study group.

Introduction Hip arthritis in the young has been a problem area in orthopaedics and thrust plate prosthesis (TPP) was developed as an option. TPP is an implant with fixation in proximal femur metaphysis transmitting hip forces to the resected neck. In young patients undergoing a hip replacement such prosthesis preserves proximal femoral bone stock, which is vital for a revision procedure.

The purpose of the study was to evaluate the results of the Thrust Plate Prosthesis as a treatment option for osteoarthritis of the hip in young patients.

Patients & Methods Of the fifty patients (63 hips) reviewed, 31 (62%) were males and 19 (38%) females. Pre-operative diagnosis included primary osteoarthritis (23), developmental dysplasia (8), avascular necrosis (7), Perthes (4), post-traumatic arthritis (3), rheumatoid arthritis (2), ankylosing spondylitis (1), psoriatic arthropathy (1) and slipped upper femoral epiphysis (1). All components were implanted uncemented with metal-on-metal articulation. The average follow-up was 4.04 years (range 12 months–8.5 years).

Results The mean age of the patients was 42.3 years (range 21–57 years). The mean pre-operative Harris Hip Score was 41.9 (range 12–89) and at final follow-up 89.91 (range 41–100). In 25 hips with ≥ 5yr follow-up, the average HHS at final follow-up was 84.5 (range 50–100). Complications included dislocation (2), transient sciatic nerve palsy (1), discomfort from lateral strap (2), implantation of wrong femoral head (1), revision 3 (4.76%) and implant loosening (4) (6.35%).

Conclusion The thrust plate prosthesis is a useful alternative in young patients with hip arthritis and the results are comparable with other uncemented hip replacements. The added advantage is preservation of the proximal femoral bone stock, which can prove useful in future revisions.