Background

Highly porous acetabular components are widely used in revision hip surgery. The purpose of this study is to compare the mid-term survivorship, clinical and radiological outcomes of a hemispherical cup (Stryker Tritanium Revision component) and a peripherally expanded cup (Zimmer TM modular component) in revision hip surgery.

We report the 15 year follow-up of displaced intra-articular calcaneal fractures from a randomised controlled trial of conservative versus operative treatment. Of the initial study, 46 patients (82%) were still alive and 26 patients (57%) agreed to review.

The clinical outcomes were not different between operative versus conservative treatment. American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scale: p = 0.11; Foot Function Index (FFI): p = 0.66; and calcaneal fracture score: p = 0.41. The radiological outcomes also were not different between both groups. Böhler’s angle: p = 0.07; height of calcaneum: p = 0.57; and grade of osteoarthritis of the subtalar joint: p = 0.54. There was no correlation between Böhler’s angle and the outcome measures in either group.

The results of this 15 year follow-up of displaced intra-articular calcaneal fracture randomised controlled trial demonstrate similar findings to those at one year follow-up.

Aim: The purpose of this study was to report the long-term follow-up (mean of 15 years) of patients with displaced intra-articular calcaneal fractures from a randomised controlled trial published in 1993.

Patients and Methods: 46 patients (82% of patients in the initial study group) were alive at a mean of 15 years post injury. The patients had been randomly allocated to either conservative or operative (Soeur and Remy technique) treatment in the original study. Clinical (AOFAS, FFI and calcaneal fracture score) and radiological (Böhler’s angle and calcaneum height) outcome measures were used. The grade of osteoarthritis was also assessed at long-term follow-up.

Results: 26 patients (57%) were reviewed and these patients served as the focus of the study (11 conservative and 15 operative). The clinical outcomes after conservative treatment were not found to be different from those after operative treatment, scores of the AOFAS were 78.5 and 70 respectively (p = 0.11); scores of the FFI were 24.4 and 26.9 respectively (p = 0.66) and calcaneal fracture scores were 70.1 and 63.5 respectively (p = 0.41). The radiological outcomes after conservative treatment were not found to be different from those after operative treatment, Böhler’s angles were 10° and 16° respectively (p = 0.07) and the height of the calcaneum were 37mm and 36mm respectively (p = 0.57). There was no difference in the grade of osteoarthritis between the groups.

Conclusion: The functional and radiological long-term outcomes after conservative treatment of displaced intra-articular calcaneal fractures were equivalent to those after operative treatment. The operative technique showed no benefit compared to conservative treatment at long-term follow-up. There was a trend for higher scores on clinical outcomes with conservative treatment

Economic evaluation of surgical procedures is necessary in view of emerging, often more expensive newer techniques and the budget constraints in an increasingly cost conscious NHS. The purpose of the study was to compare the cost effectiveness of open cuff repair with arthroscopic repair for moderate size tears. This was a prospective study involving 20 patients. Ten had an arthroscopic repair and 10 had an open procedure. Effectiveness was measured by pre and post-operative Oxford scores. The patients also had Constant scores done. Costs were estimated from the departmental and hospital financial data. Rotator cuff repair was an effective operation in both the groups. At the last follow up there was no statistically significant difference in the patients Oxford and Constant scores between the two methods of repair. There was no significant difference in the time in theatre, inpatient time, post-operative analgesia, number of pre and post-operative outpatient visits, physiotherapy costs and time off work between the two groups. The arthroscopic cuff repair was significantly more expensive than open repair. The incremental cost of each arthroscopic repair was £610 higher than open procedure. This was mainly in the area of direct health-care costs (instrumentation in particular). Health care policy makers are increasingly demanding evidence of cost effectiveness of a procedure. Such data is infrequently available in orthopaedics. To our knowledge there no published cost-utility analysis for the above said two types of interventions for cuff repair. Both methods of repair are effective but in our study open cuff repair is more cost effective and is likely to have better (lower) cost-utility ratio.

The proportion of very elderly people within the general population is steadily increasing.

These people, who often have coexisting medical problems and a limited life expectancy, may pose a dilemma for Orthopaedic Surgeons when referred for elective Orthopaedic procedures. The purpose of this study is to review the outcome of primary hip and knee arthroplasty in patients aged 90, and over, who are registered with the Trent Regional Arthroplasty Database.

Between 1990 and 2000, prospective data was collected on patients aged 90, and over, undergoing primary total hip and knee arthroplasty. Data collection was carried out on behalf of the Trent Regional Arthroplasty Audit Group. The present living status of these patients was confirmed using patient administrations systems of the hospitals involved.

Missing data was obtained from the Office for National Statistics. Those patients alive at one year were sent a simple satisfaction questionnaire regarding their operation.

144 patients underwent 149 hip or knee arthroplasty procedures over this eleven year period. The group comprised 122 (85%) females and 27 (15%) males. There were 93 (62%) total hip replacements and 56 (38%) total knee replacements. Ostcoarthritis was the predominant reason for surgery. There was only one intra-operative complication, comprising a fractured femur during a total hip replacement. 78 patients have died since their surgery. The crude mortality rate at one year was 11. 5%. The median survival was 34 months. 51% of the patients returned satisfaction questionnaires one year after the operation. From this group the satisfaction rates for hip and knee arthroplasty were 93. 6% and 92. 6% retrospectively.

With suitable pre-operative assessment, primary total hip and knee arthroplasty can be a successful operation with a high satisfaction rate. This is an age group with a high mortality regardless of surgery, and age alone should not be a determining factor in deciding whether a patient will benefit from primary hip or knee arthroplasty.

We report the results of the Charnley Elite Plus femoral stem (Ortron 90; Depuy, Leeds, United Kingdom) in multiple surgeon’s hands at a minimum of three years post implantation.

The long term results of the Charnley femoral stem have been widely documented . There have been numerous changes to the design and instrumentation of this original stem since its introduction in 1962, and the Charnley Elite Plus represents the fifth generation of this highly successful implant.

Between March 1994 and March 1998, 244 patients underwent 268 primary hip arthroplasty procedures using this particular stem. Patients were reviewed at a mean of 4.5 years (3.0 – 6.8 years) following their arthroplasty using the Oxford Hip Score and plain radiographs.

There were five revision procedures for aseptic loosening (5/268; 1.9%). Radiological assessment revealed gross radiological failure in a further 12 femoral stems (12/208; 5.8%). There was evidence of focal osteolysis with an apparently stable implant in 36 hips (17.3%).

In the best case scenario, using revision for aseptic loosening as the endpoint, the survivorship for this period is 98.1%. If radiographic failures are incorporated into this endpoint, survivorship is 93.1%. Of potential concern however, is the number of adverse features noted on the radiographs, with only 76.9% being categorised as ‘normal.’

The Charnley Elite Plus stem has undergone some fundamental design changes from the original Charnley stem and therefore clinical success should not be automatically assumed. In such circumstances we recommend regular clinical and radiographic follow-up of patients who have have undergone total hip arthroplasty with this particular femoral stem.

Purpose: To evaluate the outcome of the Elite Plus femoral stem in multiple surgeons’ hands at a minimum of three years post implantation, in accordance with guidelines published by the National Institute for Clinical Excellence.

Methods: Between March 1994 and March 1998, 199 patients underwent 224 primary total hip replacement procedures using the Elite Plus femoral stem at the Glenfield Hospital, Leicester. Seven different Consultant Orthopaedic Surgeons implanted these stems during this period. Patients were reviewed at a mean of 4.75 years following surgery using the Oxford Hip Score and plain radiographs. The mean age at operation was 62.3 years. Between March 1994 and March 2001, 12 patients underwent re-operation for all reasons, and 13 died. Oxford Hip Scores were returned from 159 patients (177 stems; 88.9%) and an AP and lateral radiograph obtained on 145 patients (162 stems; 81.4%)

Results: There were five known revision procedures for aseptic loosening (5/224; 2.2%). The mean Oxford Hip Score was 24 (range 10–54). Radiological assessment revealed gross failure in a further 11 femoral stems (11/162; 6.8%), and adverse radiological features in a further 28 stems (28/162; 17.3%)

Discussion: In the ‘best case’ scenario, a combined revision and radiographic failure rate of 9% is higher than expected. Antero-posterior positioning of the stem, resulting in bony cortical contact, appeared to produce a characteristic progressive osteolytic lesion which resulted in early implant failure. Additional possible modes of failure are discussed.