Purpose: The purpose of this study was to determine the greater than 20 year survivorship of the PCA total hip arthroplasty (THA) in patients with severe hip osteoarthritis.

Method: A prospective follow-up of 315 consecutive patients treated with a PCA cementless THA in patients with hip osteoarthritis was performed. Patients had postoperative assessments and radiographs every two years. Overall THA, femoral stem and acetabular cup revisions and Kaplan-Meier survivorship was determined. Revision rates and survivorship was also investigated across gender.

Results: The mean age of our patients was 61 years old (range 20 to 86) with 47% female patients. 226 cases used a 26mm articulation and 89 cases a 32mm articulation. At 23 years follow-up, 188(60%) patients were alive with retained implants while 85(27%) were deceased with still implants that were functioning well. Forty-two cases (13%) were revised (30 sockets, 13 stems), five of which later deceased. The 20 year Kaplan Meier survivorship for the overall THA, stem component and acetabular cup were 86%, 97% and 90% respectively. Survivorship of the acetabular cup for 26mm and 32mm articulations was 92% and 85% respectively (p=0.016). Females had a worse THA survivorship than males, 82% and 91% respectively (p=0.036).

Conclusion: The PCA cementless THA has performed well beyond 20 years with 26 mm articulations doing better than 32 mm, and male gender associated with better outcomes. The authors postulate that polyethylene thickness is key to predicting failure.

Purpose: High contact stresses and wear after total knee replacement (TKR) has been a problem. Mobile bearing TKRs have been advocated as a means to increase load bearing area, reduce contact stresses and minimize wear. The purpose of this study was to compare two, large, consecutive cohorts of TKR patients with greater than 10 years follow-up, one with a fixed bearing and one with a mobile bearing design.

Method: One hundred and three SAL II mobile bearing TKR’s were compared to a gender, age, BMI and time from surgery matched fixed bearing Genesis II cohort of equal size. All surgeries were performed between September 1993 and December 2000 (average follow-up, 11.64±1.64 years). Inclusion criteria included patients with osteoarthritis of the knee. Exclusion criteria included revision arthroplasty, inflammatory arthritis, a prior osteotomy or a prior patellectomy. The > 10 year Kaplan-Meier survivorship, health-related outcomes (Knee Society scores, WOMAC and SF-12), radiographs and retrieved implants for the fixed and mobile bearing TKR cohorts were compared.

Results: Fixed bearing TKRs demonstrated better 10 year Kaplan-Meier survivorships for any re-operation, 1.000±0.000 compared to 0.969±0.018 for mobile bearings (Genesis II and SAL I/II respectively). Revision rates were significantly different between groups with fixed bearing having no revisions and mobile four revisions (3.9%). No cases were revised for sepsis. Mobile bearing revisions were for pain (1), patellar maltracking (1), polyethylene wear (1) and aseptic loosening (1). At 10 years, health-related outcomes were similar between the two cohorts. Fixed bearing TKRs demonstrated more range of motion (111.42±12.76 vs 107.19±14.74 degrees) although not significant (p=0.052). Wear was more frequently noted in mobile bearing TKRs on > 10 year radiographs.

Conclusion: In this comparison of two contemporary TKRs, the fixed bearing TKR outperformed the mobile bearing TKR.

Object: To assess the benefit of prescribed Iron supplementation on the recovery of patient’s Haemoglobin level after elective joint replacement.

Design: A Prospective, Randomised Trial was undertaken. All patients undergoing elective arthroplasty (Hip, Knee, and Revision Hip) at our unit were considered. Qualifying parameters included: a normal store of Iron (Fe) prior to surgery (based on the serum Ferrittin level) and normal markers of inflammation (serum C - reactive protein [CRP] and erythrocyte sedimentation rate [ESR]). Elevated CRP and ESR are known to be factors affecting the serum Ferrittin level.

Method: 318 patients undergo joint replacement from May 2004 to Oct 2004 were considered for the study. 208 patients were excluded for the following reasons: 52 patients had low serum Ferrittin level or elevated ESR and CRP levels pre-operatively. 156 patients was normal post operative Haemoglobin (> 11 mg %). This left 110 patients with normal pre-operative inflammatory markers and Iron stores. This cohort formed the basis of the study and was randomised to either receiving prescribed Iron Supplementation (Oral Ferrous Sulphate) twice a day for 8 week or no supplementation. Randomisation was performed based on the month of surgery. Even numbered months received the intervention, odd numbered did not. Post-operatively all patients had serum Haemoglobin checked at intervals 2^nd–7^th day and 8 weeks

Results: There was no significant different in mean Haemoglobin level between treatment group i.e. 12.72 mg% (10.8–15.4) and controlled group 12.71 mg% (11–15.3) at 8 weeks follow up.

Conclusion: The prescription of oral Iron in healthy postoperative joint replacement patients did not hasten the recovery of Haemoglobin level provided adequate tissue Iron stores were present. The use of Fe supplementation provides no benefit in these patients and our study confirms this. Iron supplementation therapy should be reserved for patients identified pre-operatively with either low Iron stores or elevated serum inflammatory markers.