Aims

We assessed the value of the Clinical Frailty Scale (CFS) in the prediction of adverse outcome after hip fracture.

Purpose of study: Long bone chronic osteomyelitis may result in limb length discrepancy by shortening of the affected bone when the physis is damaged. Little is known about the rates of overgrowth of infected long bones. This study documents the relative rates of overgrowth and undergrowth in a large series of chronic osteomyelitis patients.

Methods: Forty-two consecutive patients presenting to our unit with chronic osteomyelitis of a long bone were included. There were no exclusion criteria. The mean age at presentation was 10.3 years. The mean duration of symptoms was 18.2 months prior to presentation. For 37 (88%) of patients the cause of osteomyelitis was haematogenous.

Results: Three (7%) patients had shortening of the long bone compared to the unaffected side (average 2.5cm), whilst 13 (31%) patients had overgrowth of the affected bone (average overgrowth 2.2cm). The tibia was most commonly affected (20/42, 48%), followed by the femur (8/42, 19%) and the humerus (6/42, 14%). The average proportion of long bone involved on X-ray was 59%. At least one physis was affected in 8/42 (12%) patients (2 had undergrowth, 1 overgrowth).

Conclusions: This large prospective series of patients shows the effect of osteomyelitis on the growth of long bones, in particular an overgrowth rate of 31%. The mechanism for this is probably related to the duration of symptoms. In areas of the world with poor access to health care, there is consequently a prolonged period of increased blood supply as a result of inflammation.

This increased blood supply may make overgrowth limb length discrepancy more likely than undergrowth.

Resurfacing arthroplasty of the hip is currently enjoying a resurgence in popularity. There are many reasons why resurfacing may be indicated, but one is that the absence of proximal femoral reaming at surgery may reduce the occurrence of heterotopic ossification (HO) after surgery. The objective of this study was to compare the prevalence of postoperative HO for patients undergoing two different types of hip surgery, resurfacing arthroplasty or total hip replacement. Data were gathered from 43 consecutive patients undergoing metal on metal hip resurfacing (MoM-R) and 37 consecutive patients undergoing metal on metal total hip replacement (MoM-THR) with a minimum of six months’ follow up. The Brooker classification was used to grade HO from postoperative radiographs1. We found that, when undergoing MoM-R, women had a lower chance of developing HO than men (p=0.04). In addition, women who received a MoM-R had a reduced incidence of developing HO than women who received a MoM-THR (p=0.04). There were no differences in the incidence of postoperative HO between men undergoing either MoM-R or MoM-THR. It can be concluded from this study that resurfacing does reduce the incidence of HO in women and that care must be taken when selecting women to undergo total hip replacement in preference to hip resurfacing. This study has highlighted the need to inform patients of HO as a common complication when consenting for hip arthroplasty, and has established an 18% rate of postoperative HO for hip resurfacing arthroplasty.