Introduction: Deep infection in total hip replacement can be devastating. We report the outcomes 10–15 years after two stage revision for hip infection in 103 patients using the PROSTALAC (prosthesis of antibiotic-loaded acrylic cement) hip.

Methods: All patients or their next of kin were contacted to determine their current functional status and whether they had required repeat surgery or had recurrent infection. The Oxford-12, SF-12, and WOMAC questionnaires were administered. A comprehensive chart review was undertaken to review the infective organisms, surgery, approach, complications, and need for further revision surgery.

Results: 11 patients had re-infection, 7 of whom responded to repeat surgery with no further sequelae. Two patients required resection arthroplasty, one patient underwent hip disarticulation after eventual failure of treatment and bone loss, and one immuno-compromised patient developed osteomyelitis and was subsequently lost to follow-up. Long-term success rate for two stage-revision is thus 89%, or 96% with additional surgery. Since then, 3 patients required revisions for aseptic loosening, 1 for recurrent dislocation. We were able to follow up 45 patients, 75 % of whom provided health-related quality of life outcome scores. 39 patients were deceased, with their outcome confirmed via their last follow-up or with family members, for a total follow-up rate of 85 %. 15 patients were lost to follow-up, but did not undergo further surgery or have reinfections treated at our centre.

Discussion: Two-stage revision for hip infection, which includes an interim prosthesis of antibiotic loaded cement, offers a predictable and lasting solution for patients with this difficult problem.

Introduction: The aims of this study were to

determine predictors of pain, function and activity level 1–2 years after revision hip arthroplasty and

Methods: A prospective cohort of 222 patients who underwent revision hip arthroplasty were evaluated. Predictive models were developed and proportional odds regression analyses were performed to identify factors that predict quality of life outcomes at 1 and 2 years post surgery. The dependent outcome variables were WOMAC function, pain and UCLA activity. The independent variables included patient demographic, surgery specific and objective parameters including baseline Western Ontario McMaster Universities (WOMAC) osteoarthritis index, and the Short Form-12 mental component. The Loess method was used to plot the change of WOMAC and SF-12 scores over time.

Results: There was a significant improvement (p< 0.001) in all patient quality of life scores from baseline with results plateauing at 1 year. UCLA activity remained static between 1 and 2 years. In the predictive model, higher baseline WOMAC function (p < 0.001), age between 60–70 (p< 0.037), male gender (0.017), lower Charnley class (p < 0.001) and diagnosis of aseptic loosening (p < 0.003) were significant predictors of improved function.

When considering WOMAC pain as an outcome variable, factors predictive of improving category outcome included baseline WOMAC function (p= 0.001), age between 60–70 (p< 0.004), male gender (p= 0.005), lower Charnley class (p< 0.001) and no previous revisions (p < 0.023). Baseline WOMAC pain did not predict final pain outcome. Baseline WOMAC function (p=0.001), the indication for the operation (p=0.007), and the operating surgeon were significant predictors of UCLA activity at follow up. Peri or post-operative complications were not an adverse predictor of physical function, pain or activity.

Conclusions: Predictors of quality of life outcomes after revision hip replacement-showed that although some patient specific and surgical specific variables were important, age, gender, Charnley class and baseline WOMAC function had the most robust associations with outcomes.

Introduction: This single incision, anterolateral intermuscular approach (AL-IM) utilizes the interval between gluteus medius and tensor fascia lata. The aims of the study were to compare the quality of life, satisfaction and complications of this approach with two of the most commonly used limited incision transmuscular (TM) approaches, namely the mini-posterior (P-TM) and the mini-direct lateral (L-TM).

Methods: 199 patients receiving MIS THA surgical procedures were evaluated prospectively (63 AL-IM, 68 P-TM and 68 L-TM). The outcome variables were WOMAC function, pain, stiffness, SF-12 (physical & mental), Oxford-12, satisfaction and radiological outcome. Parametric and non-parametric analyses were performed.

Results: There were no significant differences between groups in baseline characteristics including age, sex, BMI, co-morbidity, or pre-op WOMAC, SF-12, Oxford-12 (p> .05). However, the AL-IM group was associated with superior outcomes (p< .05) in WOMAC function, WOMAC pain, global WOMAC, Oxford-12 and SF-12 physical component.

Conclusion: In the short term the AL-IM approach provides significant improvements in quality of life scores over other limited incision approaches. It provides minimal soft tissue disruption and maintains the abductor musculature and posterior soft tissue envelope, with similar complications and radiological outcomes.

The clinical results of carbon matrix support prostheses for treatment of articular cartilage defects of the femoral condyle and patella were assessed in 97 patients (100 prostheses) between 1989–99. Patients were independently reviewed by subjective and objective criteria. Pre-operative and current visual analogue scores for pain (VAPS); Stanmore and modified Cincinnati functional rating scores were obtained. Forty-nine patients had lesions of the patella, forty-four patients of the medial femoral condyle and seven patients of the lateral femoral condyle.

Patella group – subjectively 49% reported they were improved, 8% unchanged and 43% worse. Stanmore score: 6 excellent and 17 good (47%), 5 fair and 21 were poor. The Cincinnati score increased from 26. 5 pre-operatively to 47. 5 currently (p< 0. 001). The mean VAPS decreased from 8. 1 to 5. 0 (p< 0. 001).

Medial femoral condyle group – subjectively 60% reported they were improved, 14% unchanged and 26% worse. Stanmore score: 8 excellent and 16 good (55%), 8 fair and 12 poor. The Cincinnati score increased from 22. 3 pre-operatively to 48. 5 currently (p< 0. 001). The mean VAPS decreased from 8. 6 to 5. 1 (p< 0. 001).

Lateral femoral condyle group – subjectively 42% reported they were improved, 29% unchanged and 29% worse.

Stanmore score: 2 excellent and 1 good (43%), 2 fair and 2 poor. The Cincinnati score increased from 35. 0 pre-operatively to 52. 0 currently (p< 0. 25). The mean VAPS decreased from 6. 5 to 4. 0 (p< 0. 25).

There were no statistical differences in outcome based upon gender, site, pre-operative functional rating score, diagnosis, or any correlation with age or length of follow up, or when comparing excellent/good with fair/ poor subgroups in patellae or femoral condyles in relation to these variables.

This study demonstrated that 49% improved in the patella group, 60% in the medial femoral condyle and 43% in the lateral femoral condyle groups. The use of these prostheses was effective on the medial femoral condyle for periods up to 10 years but the use in the patella and lateral femoral condyle was less successful.