This study was performed to assess the relationship between patients’ pre-operative symptoms and their expectations at the time of revision hip arthroplasty. The WOMAC (Western Ontario and McMaster Osteoarthritis Index) scale for osteoarthritis of the hip and the Short Form 36 (SF-36) general health status scale have both been validated for the assessment of the outcome of hip arthroplasty. We prospectively assessed 60 patients using these scales as well as the “expectation WOMAC” that asked the patients to estimate how they expected to feel 6 months after revision hip replacement. All the questions were completed prior to informed consent, and were scored form 1 to 5 with increasing severity with a Likert scale. The maximum possible scores for pain, stiffness and difficulty with physical activity were therefore 25, 10 and 85 respectively.

The mean preoperative WOMAC score for pain was 13.4 (CI 12.2.-14.6), for stiffness 5.9 (CI 5.6-6.2) and for physical activity 50.9 (CI 47.2-54.6) The mean expectation WOMAC scores for these modalities were 7.4 (CI 6.2-8.6), 3.5 (CI 3.0-4.0) and 28.1 (CI 24.0-32.2.) respectively. Although there was a wide spread of expectations, we were unable to find any significant correlation between the patients’ preoperative pain and The abstracts were prepared by Mr Simon Donell. Correspondence should be addressed to him at the Department of Orthopaedics, Norfolk & Norwich Hospital, Level 4, Centre Block, Colney Lane, Norwich NR4 7UY, United Kingdom. stiffness levels and their expectations for pain and stiffness after revision hip arthroplasty. There was however a statistical association between their preoperative difficulty with physical activity and their expectations for physical activity (r=0.38; p=0.02) There was no significant correlation between the SF-36 scores and the patients’ expectations.

The expectations of patients awaiting revision hip replacements are high, and do not appear to be closely related to their level of pre-operative disability. Even patients with severe symptoms have high expectations that in some cases may be unrealistic. The use of the “expectation WOMAC” may help us to identify such patients, and to improve patient education and satisfaction.

This study constitutes the minimum 5-year follow-up (mean 8.8 years; range 5 – 11.5 years) of a consecutive series of 40 proximal femoral allografts performed for failed total hip arthroplasties using the same technique. Nine of these cases had been two stage reconstructions for the management of infected total hip replacements with bone loss. In all these cases the stem was cemented into both the allograft and the host femur. The host bone was resected in 37 cases, and the greater trochanter reattached with a cable grip in 33 cases and with wire and mesh in 3 cases.

The patients were reviewed by an independent observer. There were 4 early revisions (10%): one for infection, one for non-union of the allograft host junction, and two following revision of a failed acetabular reconstruction. Three further acetabular revisions have since also been performed. Junctional nonunion was seen in 3 cases (8%), two of which were managed successfully with bone grafting and bone grafting and plating respectively. Instability was observed in 6 cases (15%). Trochanteric non-union was seen in 17 cases (42.5%) and trochanteric escape in 10 of these (25%). The mean Harris Hip Score improved from 39 to 79. Severe resorption involving the full thickness of the allograft was seen in 7 cases. This progressed rapidly and silently but has yet to lead to the failure of any of the reconstructions.

Although there was a high early complication rate, the medium term survivorship is excellent, and the clinical outcomes highly satisfactory. The striking observation of severe allograft resorption may be related to a combination of factors. These include the absence of any masking or protective effect that the host bone may have proximally, and surface revascularisation with stress shielding secondary to solid cemented distal fixation. Although continued surveillance is warranted, these results justify the use of structural allografts for selected cases.