To explore whether the fundamental concepts of informed consent and patient autonomy are acceptable and practical from a surgeon’s point of view.

One hundred and fifty three questionnaires distributed to Orthopaedic Surgeons in NZ were analysed statistically.

Seventy six percent of the surgeons guided their patients towards a particular procedure. Fifty five percent spent between 10% and 25% of their consultation time on obtaining informed consent. Forty eight percent of the surgeons felt that the patient did not have sufficient autonomy to choose to undergo a particular procedure, while 76% felt that it was impractical to offer all necessary information needed for that patient to choose the procedure.

Although the length of time that a surgeon had been in practice did not influence the practice of obtaining consent or his/her opinion of the patient’s self autonomy, the degree of his/her specialisation did (P< 0.05). There was no correlation between the time spent on obtaining consent and the degree of specialisation. There was a very strong correlation between the surgeon’s belief in patient autonomy, the practicality of offering all the necessary information and the method of obtaining consent (P< 0.0001).

The majority of Orthopaedic Surgeons in NZ do not believe it was practical to offer all the necessary information to a patient and to expect that patient to be fully autonomous in choosing to undergo a particular procedure. This indicates that it is time for re-evaluation of the practice of modern day informed consent based on its original concept.

Our aim was to determine from the general community an understanding of the implications of informed consent, expectations in regard to self-autonomy, appreciation of risk in surgery, the implications of surgical complications, the degree of acceptability of risk for a given complication and views on surgeon liability.

One thousand questionnaires were distributed to members of the general public attending the Palmerston North Hospital as outpatients or visitors (inpatients were excluded).

Less than 20% of respondents appreciated the concepts of battery, negligence, self-autonomy and confidentiality. 59% wanted to know about potential complications in order to assist them in making a decision on whether or not to proceed with surgery. Given options and a discussion of the risks, 64% wished to take responsibility for which surgical procedure they would undergo. 9% were unaware that surgical procedures had risks of serious complications. 10% would not undertake surgery if the risk of a serious complication was one in a million, while 30% would undertake surgery regardless of the risk involved. 21% felt the surgeon would be liable in the event of an unmentioned rare complication.

The grasp of the perceived objective of informed consent is poor amongst the general population. The tolerance for medical negligence is low and expectations in regard to self-autonomy seem unrealistically high. We feel it is necessary to revisit ‘informed consent’ and for the public (and the legal profession) to make ‘informed consent’ a practical goal-orientated patient/doctor friendly process rather than the existing ‘legal obstacle’ that it is.

The purpose of this paper was to review the 8 to 11 year follow-up results of the Exeter Universal Hip in primary joint replacement in Palmerston North, New Zealand, where the prosthesis has been in use since 1989.

The first 216 Exeter Hips implanted in Palmerston North by six Orthopaedic surgeons, across four hospitals, were analysed. Each surgeon had varying experience with the implant used. A total of 88 primary hips were available for clinical evaluation, functional assessment and radiological review. The Orthowave software programme was used to collect data. Survivorship was determined by using revision as an endpoint.

Ninety percent of patients had an excellent functional outcome at time of follow-up. Infection rates were 2.3%. Dislocation rates were high at 14.7%. The survivorship of the Exeter Universal stem at 8–11 years was 95.5%. The overall survivorship of the hips including acetabular revisions was 92%.

We have found an excellent survivorship of the Exeter Universal stem at eight to eleven years. The most significant complication was dislocation. The small numbers of this study, and the large numbers lost to follow-up, influence the final results.