Total hip replacement (THR) and total knee replacement (TKR) are the most successful operations in orthopaedics. In the US, there is a marked difference between black patients and white patients in the utilization of joint replacement therapy. An attempt has been made to study total joint replacement comparing Maoris’ and Caucasians in Gisborne.

Prospective study, 100 consecutive total joint replacements for osteoarthritis performed by a single surgeon [VSP] from Feb 2007 to July 2008 attending Gisborne Public Hospital. These cases have been studied independently by [RM, EW, VP]. T hose with arthritis other than osteoarthritis, a fracture neck of femur or secondaries or revision joint replacements or those who refused to give informed consent were excluded.

Medical notes were carefully scrutinised: surgeons pre-op notes, anaesthetic assessment, pre-operative and post operative information, early post operative complication.

Outcome assessment is obtained at 6 months in 50% of patients:

fifty-five percent were females; 40% Maori; 60% had THR and 40% TKR

Because of high co morbidity, Maori were more likely than white patients to expect longer hospital course With anaesthetic stratification, complications can be minimised despite high ASA grade. There is no increase complication in Maori population

This is a retrospective study of patient out-come after spondylolytic repair using a Scott¦s or a Van Dam Procedure (tension band repair). We also looked at the use of plain static radiographs, and a reverse gantry computed tomography scanning in the assessment of healing of the spondylolytic defect.

Tension band repair of spondylolysis has proved to be a useful procedure for refractory spondylolysis. However, there is no universally accepted method or determining fusion of the spondylolysis, and the definitive criteria for diagnosing a successful fusion remains controversial.

The Oswestry Disability Index was measured in 2000 and in 2004. Plain static radiographs and computed tomography scans were performed on 14 patients one year after fixation of the spondylolysis. A radiologist and an independent orthopaedic surgeon assessed the presence of bridging trabecular bone in the scan and X rays.

Results in 14 patients were rated as excellent and in 4 as good in year 2000 and results remained excellent to good in 16 of 17 patients followed up in year 2004. The fusion rate was 90%[18/20] on the plain radiographs. Fusion on the computed tomography scans was observed in 50% [7/14]

A high rate of good-excellent clinical results can be obtained following a Scott or Van Dam Procedure. Radiological fusion rate was higher than assessment with thin-section computed tomography scans. CT tomography studies clearly demonstrated the presence or absence of bridging bone, a property not easy to see in plain static radiographs. However, clinical significance of CT non-union is not clear.

We report early major complications encountered following TEN fixation of femoral fractures in children.

A case series of four children aged 8– 16 years who had primary TEN fixation of isolated femoral diaphyseal fractures.

Three of the four patients had major complications. These were: significant knee stiffness requiring manipulation, haemarthrosis requiring washout and nail removal, loss of position and refracture. Two required revision to locked intramedullary nails without early complication.

In the skeletally immature child TEN fixation of femoral fractures has a significant major complication rate. This needs to be recognised when comparing TEN fixation with other treatment options.

This is a report of a retrospective clinical review of atypical Achilles tendon rupture. The main purpose to describe pathoanatomy and outcome of these ruptures.

Typically an Achilles tendon rupture is noted 4 to 6 cms above the insertion into the calcaneus and is usually related to a sporting event. However, atypical ruptures are different from the typical ruptures: site of rupture; type of rupture and presentation. In the authors experience, atypical ruptures are not common but probably underreported. The author discusses clinical findings, pathogenesis, operative findings and treatment.

Since 1998, 5 cases of atypical Achilles ruptures were seen at Hawkes Bay Hospital. There were 2 coronal Z ruptures and 3 sagittal ruptures All were treated surgically.

At minimal 18 months follow-up all Z ruptures did very well.

This study highlights atypical Achilles tendon ruptures. Their exact incident is not known but these 5 cases were seen among 104 Achilles tendon ruptures operated on by the author.

This is an outcome study of the use of plate fixation for treatment of comminuted fractures of the distal third of tibia to determine prognostic factors such as age, sex, type of fractures, soft tissue injury and type of implant on healing.

Since 1999, a single surgeon (VP) has performed minimally invasive fixation in 18 patients for complex transitional fractures of the tibia. Follow up has been achieved by a combination of clinical and radiological assessment and notes review.

An overall excellent-good result was obtained in 17 of 18 patients. In one patient, the fixation was revised due to a 20 degree external rotation mal position. In two cases there was mild external rotation of 10 degrees. There were no infections.

The treatment of difficult juxta-articular fractures with a minimally invasive fixation is a useful management option. Peri-articular plates are easy to insert and give better results with respect to alignment correction.

The author reviewed 10 patients with irreducible or unstable Total Hip Arthroplasty (THA) dislocation. After clinical and radiological assessment an attempt was made to classify these cases based on the radiological findings and anatomical derangement and review of the literature. The purpose of this study was to correlate the cause of dislocation and the treatment.

The material consisted of ten cases of irreducible or unstable THA dislocation seen in the Healthcare Hawke’s Bay Hospital, Hastings, between 1995 and 2000. The mechanism of dislocation was either bending to put on socks or shoes, twisting injury pivoting on the leg or slipping in the shower. These patients had been treated by different surgeons and had various types of implants. All 10 were female and presented with pain, limp, shortening or deformity. Patients were categorised into:

Irreducible dislocation:

Dislodgement of the stem

The incidence of dislocation, not an uncommon complication, has been reported to be 1.5% following primary THA. One-third may develop recurrent dislocation. Most of the reports in the literature are on the incidence and causes of dislocation. They include cup malposition, trochanteric migration, decreased femoral offset, inappropriate head size, leg length discrepancy, surgical approach and postoperative mobilization. Closed reduction can usually be easily achieved under sedation or general anesthesia. Very rarely, the hip joint cannot be reduced.

The author discusses his experience with irreducible dislocation and tries to classify its different causes and to the best of his knowledge, there is no classification of irreducible dislocation according to the anatomic-radiological findings in the literature. The treatment depends on the type of dislocation and is discussed under the specific types of irreducible dislocation.

Aim: To identify the significant risk factors that influence patient mortality and morbidity in the management of displaced subcapital neck of femur fractures in independent elderly patients (aged > 70 years) managed with total hip arthroplasty through a modified Hardinge approach.

Methods: Thirty-seven primary hip arthroplasties performed for displaced fractures of the neck of femur in “Healthcare Hawkes Bay” between 1998 and 2000 were reviewed. The surgery was carried out by one surgeon (VP), using a modified lateral approach. The patients’ records were screened for outcomes and complications. An independent review was made (DA, NW) using the modified Harris hip score.

Results: The average age of the patients was 85 years (range: 70 to 92 years). At an average of 1.8 years (12 months to 24 months), no patient had suffered a dislocation or had needed another operation on the hip. The majority of the patients were satisfied with the outcome. However, there were significant medical complications (total of 38 complication in 22 patients). There were two deaths in the first 12 months.

Conclusions: The incidence of dislocation and a reduced revision rate can be achieved with a modified lateral approach (Hardinge). However, aggressive treatment is necessary before and after the surgery, as there is high incidence of medical complications. The number of existing medical conditions at the date of admission to hospital was a significant factor influencing patient morbidity.