Background: Although hip fracture is often the first presentation of osteoporosis, prophylactic measures are not routinely prescribed. Aims: To investigate whether the second hip fracture has a significant further impact on walking and social independence and to identify which patients are most likely to benefit from currently available prophylactic measures. Method: Information on walking ability and social independence was obtained approximately 3 months following discharge for 49 consecutive patients admitted with a second hip fracture. Results: Fewer patients maintained their ability to walk without the help of an able-bodied assistant after the second fracture compared with the first fracture (53% and 91% respectively p< 0.0005). A similar proportion of patients admitted from their own homes remained socially independent after the first and second fractures (64% and 54% respectively). Social independence was determined by mental status after the first fracture but by ability to walk unassisted after the second fracture. The median time to second fracture was 31 months (3–302). The median time to second fracture for patients aged 80 and below and patients without a history of recurrent falls was more than 2 years. Conclusion: The second fracture had a significant further impact on patients. Bisphosphonates given over a 2 year period can decrease the rate of hip fracture and should be given to patients who sustain a hip fracture aged 80 or less and patients who do not have a history of multiple falls. Hip protectors should be considered in other patients.

The value of arthroscopic partial meniscectomy in the severely arthritic knee has been questioned. Some authors suggest that it may result in progression of osteoarthritis precipitating the need for joint replacement and that symptomatic improvement may occur from lavage alone.

126 patients with a torn meniscus and Outerbridge grade IV changes in the same compartment underwent arthroscopic partial meniscectomy and limited debridement of unstable articular cartilage. The indication for surgery was a symptomatic meniscal tear not osteoarthritis. A control group consisted of 13 patients with grade IV changes and intact but frayed menisci who underwent washout alone. Mean age and follow up were similar in the two groups.

Initially meniscectomy improved symptoms in 82 cases (65%). Symptoms were unchanged in 26 cases (21%) and were made worse in 18 cases (14%). At a mean follow up of 55 months, 50 patients (40%) felt their knees were better than they were preoperatively. Their mean Lysholm score was 75. 5. 35 knees (28%) were not improved (mean Lysholm socre 59). 41 patients (32%) had undergone further surgery: 39 total knee replacements, 1 unicompartmental knee replacement and 1 tibial osteotomy. Older patients, those with varus/ valgus malalignment, and those with exposed bone on both articular surfaces fared worse.

Outcome following meniscectomy was better than outcome following washout alone: more patients reported an improvement after meniscectomy and fewer had undergone further surgery on their knees (p=0. 04). The median time between arthroscopy and the decisions for joint replacement was the same in both groups (8 months in the meniscectomy group and 7. 5 months in the washout group) indicating meniscectomy did not precipitate joint replacement.

These results suggest that arthroscopic partial men-iscectomy in the presence of Outerbridge grade IV changes can result in satisfactory long term outcomes for many patients, is more effective than washout alone and does not precipitate the need for joint replacement.