Hip osteoarthritis is uncommon in active military personnel but can be extremely debilitating. Previously in such cases total hip replacement was usually delayed as long as possible. The two main reasons for such reluctance were that these persons would be graded P7 Permanent after total hip replacement and that the amount of physical activity an active military person does would lead to early loosening of implant and revision surgery. Resurfacing Arthroplasty has allowed us to take an earlier and more interventional approach in younger active patients.

We describe our early results of 18 hip resurfacing operations in active serving military personnel. Average age was 48 years. All 18 were done in MDHU Northallerton by one in-service orthopaedic consultant in 2004 and 2005. There were no serious complications; average length of stay was 5.5 days. Specifically there were no fractured necks of femur and there were no early signs of component loosening. Final grading after six months was P3.

Hence we now recommend that in selected active military personnel where anatomy permits early hip resurfacing should be considered rather than a conventional hip replacement.

Satisfactory military orthopaedic service provision in the UK suffers significantly from a lack of basic resources, notably overall consultant numbers and host trust support. The waiting time to see an appropriate consultant (uniformed or contracted) can be as long as nine months. Many of these referrals from the primary care sector do not, in fact, need to see a consultant. Appropriately trained individuals such as; GP’s with special interests, Nurse Practitioners and Extended Scope Practitioners may all have a role to play in patient management. Military Physiotherapists are uniquely qualified to deal with these referrals. They can provide military input, advice on grading, order appropriate investigations (including MRI scans and X-rays) and give guidance on further management and arrange follow-on treatment. Although popular in spinal assessment clinics, we are unaware of this facility being formally used in a general military orthopaedic setting. We have now reviewed the results of our first 100 patients. The average waiting time to first appointment was 2 weeks. 75 patients were dealt with solely by the screening clinic. 21 MRI scans, were ordered. Only 25 patients required review by the orthopaedic team. 7 patients required surgery. Our conclusion is that such clinics represent a clinically beneficial and cost-effective screening tool at the primary/secondary care interface. A high patient satisfaction at the short waiting times and outcomes was also noted.