Primary total hip replacement (THR) in patients with abnormal/altered proximal femoral anatomy/narrow canals presents a technical challenge. There are only limited standard prosthetic stems available to deal with narrow canals or abnormal morphology. Many prefer to use expensive custom implants which often have a lag time to manufacture and do not always have long term published outcomes.

We present results of the Asian C-stem (which is a standard implant available on the shelf) used in patients predominantly of Caucasian origin with abnormal proximal femoral anatomy.

We retrospectively reviewed clinic-radiological results of 131 patients (131 stems) who underwent primary THR using Asian C-stem at Wrightington Hospital till their latest follow up. Revision for any reason was considered as primary end point.

Mean age at surgery was 50.8 years (16 – 80). The 2 commonest indications were primary osteoarthritis (66 patients) and hip dysplasia (54 patients). Mean follow up was 43.5 months with a minimum follow up of 12 months and maximum follow up of 97 months. There were 2 recurrent dislocations and 1 hip subluxed twice. One dislocation needed revision surgery. 1 patient underwent acetabular revision for loosening. There was no stem failure, obvious loosening or loss of fixation in any patients in our series with regards to the Asian C-stem. There were no infections and intra-operative perforations or fractures.

C-stem Asian is a reliable implant for patients undergoing THR with abnormal proximal femoral anatomy or narrow canals. Long term follow up is essential.

Aim: This study aims to quantify pain relief and quality-of-life benefit from a diagnostic SIJ injection.

Methods: 50 consecutive patients were retrospectively recruited with unilateral low back pain, pain mapping compatible with a sacroiliac origin, tenderness over the SIJ, and no obvious source of pain in the lumbar spine. These were selected for a diagnostic SIJ injection. A structured questionnaire was completed both pre- and post-injection. Median patient age was 63. All patients were injected under fluoroscopic imaging with Triamcinolone 40mgs and 3mls Ropivacaine hydrochloride.

Results: Onset of lower back pain symptoms ranged from 1962 to 2007. 38 patients (76%) had some form of previous non-operative treatment. No patients had previous injection or surgery. 8 patients (16%) were smokers. 17 patients (34%) had a desk based job, 22 patients (44%) had a manual job, 7 patients (14%) had heavy manual jobs. 18 patients (36%) had sustained previous back injury. A visual assessment score was carried out for low back pain and pain in both legs, both pre- and post-injection. Overall, 16 patients (32%) reported no change in their symptoms, 7 (14%) reported worsening, but in 27 (54%) improvement was recorded. When considering the Oswestry Disability Index score, 18% reported no symptom change, 24% worsened and 58% improved.

Conclusion: History and physical examination can enter SIJ syndrome into the differential diagnosis, but cannot make a definitive diagnosis. Fluoroscopically guided diagnostic SIJ injection is the gold standard test for making the diagnosis whilst also conferring substantial pain relieve and quality-of-life benefit.

Conflicts of Interest: None

Source of Funding: None

Aim: To compare the in-vitro elution characteristics of CMW1 and Palacos R bone cements containing gentamicin or teicoplanin or a combination of both.

Materials & Methods: Four types of bone cement discs (28x22mm) were prepared.

Disc 1(control) contained Palacos R or CMW1 cement without any added antibiotic.

The discs containing teicoplanin were prepared by adding teicoplanin powder (2gm) to the respective cement powder (40 gm with or without 0.5gm of gentamicin) and then adding the monomer (vacuum mixing).

All the discs were immersed in 50 ml normal saline bath in a sterile pot and maintained at temperature of 37 deg Celsius. 24 hours later a 5ml sample was taken from each pot for assay, to measure the amount of antibiotic eluted, using fluorescence polarization immuno-assay technique. The discs were then removed from the pots, washed with normal saline and reimmersed in a fresh 50 ml saline pot. This procedure was repeated at hours 48, 72, 120 and week 1, 2, 3 & 6 for all discs.

Results: All discs and assays were done in triplicate and average total value at 6 weeks (μ gm/ml) taken for statistical analysis.

CMW1:

Gentamicin eluted from disc4 was higher than disc2 (94.9 v 34.37. p< 0.0003).

PALACOS R:

Gentamicin eluted from disc4 was higher than disc2 (144.17 v 86.43. p< 0.0004).

Conclusion: Palacos R cement elutes more antibiotic than CMW1 and antibiotic combination in bone cement resulted in, mostly, synergistic effect of increased elution of individual antibiotic.

We present a prospective trial examining the effect of posterior tibial slope at total knee arthroplasty (TKA) on the range of movement and functional outcome.

Current literature shows little difference clinically in TKA with increasing posterior tibial slope. Previous studies have been retrospective or involved small numbers and may represent poor ligament balancing or inaccurate alignment.

In a prospective, double-blinded, randomised controlled trial, 250 patients undergoing primary Profix TKA, were randomised to receive either a 0 or 4 degree posterior tibial cut. Range of movement (ROM) was measured pre-operatively, at 3 months and 1 year by a single clinical physiotherapist. SF-12 and WOMAC scores were calculated at the same visit. Both patient and physiotherapist were blinded to the angle of tibial slope.

Mean one year post operative ROM was greater by 2 degrees (p=0.470) in those with a 4 degree tibial slope. Post operatively both groups had significant improvement in functional outcome scores. A 0.2 (p= 0.892) and 0.51 (p= 0.707) greater improvement in SF12 physical score and mental scores respectively was found in the 0 degree group at one year. There was also a 1.09 (p=0.718) greater improvement in WOMAC score with a 0 degree slope.

In conclusion increased posterior tibial slope gives a marginally better but non-significant post operative ROM and makes no significant difference to functional outcome.