We undertook a comparative audit of 171 consecutive Hip and Knee Arthroplasties performed by an overseas team at an Independent Hospital (Group 1) between August 2005 and December 2005 and compared them to a corresponding number performed by all grades of surgeons at the local NHS Trust (Group 2). We examined patient selection criteria such as BMI and ASA grade and compared the early radiological outcome, complication rate, length of hospital stay and the patient satisfaction rate between the two groups.

We found that patients in Group 1 had a lower average BMI (27.13) and a better ASA grade (95% grade 1 and 2) as compared to Group 2 (BMI - 29.69 and 80% ASA Grade 1 and 2). The average hospital stay was 6.1 days in Group 1 and 8 days in Group 2.

Only 74% of the patients in Group 1 were completely satisfied with their treatment outcome as compared to 91% in Group 2. (Trent Arthroplasty Questionnaire)

There were 7 early dislocations (9.1%) in Group 1 (76 THRs), two requiring revision, as compared to one in Group 2 (1.3%, 84 THRs). Three other patients from Group 1 (TKRs) required a revision procedure within the first year.

There was an increased incidence of adverse features (mal-alignment and mal-positioning of components) on the post operative X rays of patients in Group 1 as compared to Group 2 leading to adverse clinical events. 11 patients (95TKRs) showed substantial femoral notching in Group 1 as compared to 3 in Group 2.

This study shows that patients selected for surgery by the overseas team were the fitter of the two groups, but had a significantly higher complication rate and a much lower satisfaction rate. The study underlines the potential risks of commissioning work to overseas teams in order to reduce waiting times.

Study Design: A prospective cohort study of patients undergoing surgery for prolapsed intervertebral disc.

Objective: To assess a patient’s ability to recall information discussed pre-operatively at the time of informed consent six weeks following surgery.

Subjects: Sixty-one consecutive patients undergoing discectomy for prolapsed intervertebral disc with follow up six weeks after surgery.

Outcome measures: Patients were assessed, using a pre-prepared questionnaire, to establish their understanding of disc surgery prior to signing a consent form. All information on the questionnaire had previously been given to the patient at the time of being put on the waiting list via a copy of the clinic letter to the general practitioner. If patients were unable to complete the questionnaire, they were then tutored using visual aids such as posters and models until they were able to answer the questions correctly. The consent form was then signed. Six weeks following surgery, patients were then asked the same questionnaire to establish their ability to recall the information discussed pre-operatively about disc surgery.

Results: Prior to tutoring, 20 % of patients were unable to recall that their symptoms were due to disc pathology and that surgery to remove the disc would relieve their symptoms. They were also unable to recall the success rate of surgery. Following surgery, only half of this group of patients could recall these facts. Only 32% of patients were able to recall two or more risk factors of surgery prior to tutoring. This improved to 45% following surgery. Pre- and post-operative questionnaire scores were analysed using a paired t-test. There was no statistical improvement in questionnaire scores long term following tutoring.

Conclusion: In this group of patients, extensive tutoring with the use of visual aids as an adjunct, does not statistically improve their ability to recall important information about surgery for prolapsed intervertebral disc and the risks associated with it.

The management of periprosthetic femoral fractures around a total hip replacement can often be difficult and challenging; especially as they often occur in elderly patients with marked osteolysis and thin cortices.Various non-surgical and surgical treatment modalities have been described.

We reviewed 24 patients with type B fractures (Vancouver classification) managed with a cementless, tapered, fluted and distally fixed stem utilising a trans-femoral approach.There were 15 female and 9 male patients.The average age was 74 years.The average interval between the index operation and surgery was 10.8 years. The majority of the fractures occurred following trivial trauma. The average duration of the surgical procedure when both the cup and the stem were revised was 3 hours 14 minutes and 2 hours 14 minutes when only the stem was revised. The average operative blood loss was 1700 mls and 940 mls respectively. There were five dislocations. Three were managed conservatively without further problems. Two patients were treated surgically. There were two cases of nonunion one of which was secondary to infecton.

The average Harris hip score at follow-up was 69.The majority of the fractures united (91%). The average radiological subsidence was 5 mm post-operatively. Subsidence occurred within the first 6 months prior to fracture union with no further subsidence thereafter. Subsidence was notably absent in those patients in whom the fracture failed to unite. The majority of the patients showed a relatively good health status at follow-up.

This technique for the management of this difficult problem offers the advantage of providing a relatively short operative time with reduced patient morbidity.It allows early mobilization and the majority of the fractures unite uneventfully.

The biggest uncertainty surrounding this type of stem is the long-term survivorship in the younger patient.