Management of hip osteoarthritis in young active patients is made more challenging by the longevity required of the prostheses used and the level of activity they must endure. The aim of this study was to compare the functional outcomes and activity levels following hip resurfacing (HR) and uncemented total hip arthroplasty (UTHA) in young active patients matched for age, gender and activity levels.

255 consecutive hip arthroplasties performed in a teaching hospital were retrospectively reviewed from which were identified 58 UTHA patients and 58 HR patients, matched for age, gender and pre-operative activity level. Mean age of patients within UTHA was 58.5 years (34 – 65) and in HR was 57.9 years (43 – 68).

No patients within the study were lost to follow-up. Mean follow-up was five years.

Within each group there was a statistically significant improvement in the mean UCLA score following surgery (p=0.00). In the HR Group, mean UCLA score improved from 4.2 (1–8) to 6.7 (3–10) while in the UTHA group the mean UCLA score improved from 3.4 (1–7) to 5.8 (3–10). Mean OHS improved from 44.4 (31–57) to 16.6 (12–31) in the HR group and from 46.1 (16–60) to 18.8 (12–45) in the UTHA group, p = 0.00 each group.

This study found no statistically significant difference in the levels of function (p= 0.82) or activity pursued (p= 0.60) after surgery between UTHA and HR in a population of patients matched for age, gender and pre-operative activity levels.

This study has shown comparable outcomes with hip resurfacing and uncemented THA in terms of both functional outcomes and activity levels in a group of young active patients. The potential complications unique to hip resurfacing may be avoided by the use of uncemented THA. In addition, uncemented THA has a longer track record.

The management of osteoarthritis of the hip in young active patients has always been challenging. This can be made more difficult because of the longevity required of the prostheses used and the level of activity they must endure.

The aim of this study was to compare the functional outcomes and activity levels following hip resurfacing and uncemented THA in young active patients matched for age, gender and activity levels.

A retrospective review of 255 consecutive hip arthroplasties performed in a teaching hospital was carried out. From this series we identified 58 patients who had undergone uncemented THA (Group A) and 58 patients who underwent hip resurfacing (Group B), matched for age, gender and pre-operative activity level.

The mean age of patients within Group A was 58.5 years (34–65) and in Group B was 57.9 years (43–68). Mean pre-operative University of California at Los Angeles (UCLA) score in Group A was 3.4 (1–7) and in Group B was 4.2 (1–8). The mean pre-operative Oxford Hip Score (OHS) was 46.1 (16–60) and 44.4 (31–57) in Groups A and B respectively.

Mean follow-up period was five years (4–7 years). In the hip resurfacing group, the mean UCLA score improved from 4.2 (1–8) to 6.7 (3–10), while in the uncemented THA group this improved from 3.4 (1–7) to 5.8 (3–10). Similarly, the mean OHS improved from 44.4 (31–57) to 16.6 (12–31) in the hip resurfacing group and from 46.1 (16–60) to 18.8 (12–45) in the uncemented THA group.

This study found no statistically significant difference in the levels of function (p= 0.82) or activity pursued (p= 0.60) after surgery between uncemented THA and hip resurfacing in a population of patients matched for age, gender and pre-operative activity levels.

Although there was statistically significant improvement in UCLA and OHS within each group, it was found that no group was better than the other.

This study has shown comparable outcomes with hip resurfacing and uncemented THA in terms of both functional outcomes and activity levels in a group of young active patients. The potential complications unique to hip resurfacing may be avoided by the use of uncemented THA. In addition, uncemented THA has a longer track record.

Introduction: Early plaster immobilisation is important in fracture management to control pain and maintain alignment. In our institute, the initial plaster is routinely applied by junior trainees directly or is applied by Accident & Emergency (A& E) staff under the supervision of the junior trainees. In the U.K., plaster application technique has not been routinely and formally taught to the junior trainees in the hospital.

Method: We aimed to review the adequacy of plaster applied or supervised by junior trainees. The criteria for an adequate of plaster immobilisation for tibial diaphyseal fractures have not been reported in the literature. We had chosen 3 simple parameters, namely, change in alignment of fracture fragments, position of the ankle and a gap index of less than 0.15, which in our view are important in terms of initial management of tibial fracture in the A& E. The gap index reflects the amount of padding applied in the plaster. These parameters were merely chosen to assess the adequacy of initial plaster immobilisation by junior trainees and should not predict the long term success or failure of the management of fracture with plaster. Sixty-five patients with tibial diaphyseal fractures were retrospectively included in the present study. The initial and post-plaster application radiographs were assessed by two senior trauma & orthopaedic specialist registrars separately.

Result: Only forty-six percent (45%) of the cases had fulfilled all the three criteria. In subgroup analysis, position of the ankle is the most frequently neglected factor with 31% of the ankles held in equinus. Twenty eight percent (28%) of cases had worsening of the alignment of the fracture fragments. Fourteen percent (14%) of the cases had excessive padding applied as reflected by Gap Index of > 0.15.

Conclusion: This study highlighted that the basic plastering technique by the junior trainees is inadequate. We suggest that every trainee rotating to Trauma & Orthopaedic Surgery must be taught this fast-fading away basic plaster application technique during the induction period.

Background: Total knee replacement remains one of the most common knee surgery practices worldwide. The operative procedure universally requires the use of cutting jigs to resect predetermined amounts of bone irrespective of the preoperative anatomy and morphology of the femur and tibia.

Aims: The aims of this study were to elucidate anatomical morphological differences between ethnicities pre-operatively and to assess whether any change elucidated was preserved post-operatively.

Method: This was a retrospective study comparing the pre and postoperative lateral view X-Rays of TKRs performed. Distances measured from most prominent anterior point to midline and the most prominent posterior point to midline and their ratio was compared between two ethnic groups. Each x-ray measurement was triple checked.

Results: The study groups comprised of 60 Caucasian knees and 40 Asian knees. Preoperatively the mean ratio was 0.55 in Caucasians and 0.44 in Asians, with this difference being statistically significant (p value < 0.005). Post operatively the mean ratio was 0.59 in Caucasians and 0.55 in Asians and this difference was not statistically significant (p value =0.166). These findings were also cross-checked with range of movement measurements post-operatively in the same group of patients. There was no comparable improvement in range of movements (ROM) post-operatively in the Asian group.

Conclusion: We infer that the present TKR cutting jigs are not taking into account the anatomical differences within the knee of Asians individuals. This is converting the post operative distal femurs of this group to become morphologically comparable to the Caucasian knee and this is possibly affecting the kinematics of those knees leading to no significant improvement in the post operative ROM and affecting satisfaction with surgery.

Purpose: We report our surgical management of a series of primary and metastatic tumours of the lumbosacral junction, highlighting different methods of fixation, outcome and complications.

Method: Seven patients with primary and four with secondary tumours involving the lumbosacral junction underwent surgery. After tumour resection, iliolumbar fixation was performed in all but one case, using Galveston rods (4) or iliac screws (6). All constructs were attached proximally with pedicle screws. Cross links were used in all instrumented cases and autologous and allogenic bone graft applied.

Results: There were no perioperative deaths. Mean operating time was 7.3 hours (range 3–18) and there was extensive blood loss (mean transfusion requirement 7.5 units, range 0–20). We estimate a transfusion requirement of approximately one unit per hour operating time. However, we noted no complications attributable to either blood loss or transfusions.

Ambulation improved in 5, was unchanged in 5 and deteriorated in one. Neurological status deteriorated in 4 and remained static in the others. However in all but one case the neurological deficit was defined by the nature of proposed surgery. Mean survival from surgery for patients with metastatic disease was 9.5 months (3–18). At mean follow up of 10 months (1–19 months), all patients with primary tumours were still alive without evidence tumour recurrence.

Extralesional excision, and therefore potentially curative surgery, was achieved in 4 cases where this was the primary goal of surgery (osteosarcoma, osteoblastoma, chordoma, embryonic rhabdomyosarcoma). There were no cases of metalwork failure. One patient has undergone revision surgery for pseudathrosis.

Conclusion: Sacral resection and iliolumbar reconstruction is a feasible treatment option in selected patients, offering potential cure. The fixation methods used by the authors restored lumbosacral stability, sufficient for pain relief and preserving ambulation and usually the predicted level of neurological function.