Introduction: With the rising number of primary hip arthroplasties performed each year, patient selection criteria is becoming increasingly pertinent. There is growing concern that patients with a high body mass index (BMI) have worse outcomes following hip replacement surgery. However the evidence base is equivocal.

Our aim is to assess whether BMI has an impact on clinical and radiological outcomes of primary total hip arthroplasties

Methods: This is a prospective study of 92 patients, undergoing primary total hip arthroplasty, recruited from two hospitals. Data was collected by the operating surgical team and independent physiotherapists at the preoperative assessment clinic, intraoperatively and at six weeks post-operative follow up.

BMI was recorded. Patients were divided into 2 groups: those with a BMI less than 30 (considered nonobese) and those 30 or above (obese).

Outcomes assessed included blood loss and requirement blood transfusion, fat thickness, operation duration, complications and surgeon’s perception of the difficulty of operation (scored on a VAS). In addition functional capacity was assessed using the Oxford Hip scores pre and post-operatively. Radiographs were scored independently according to Dorr and Barrack.

Results: Of our 92 patients, 36 were obese and 56 were non-obese. There was no significant difference found in blood loss, blood transfusion requirements, operation duration and complications between the two groups, With regards to the Oxford Hip scores, the obese patients had greater differences between their pre- and post-operative scores but this difference was not significant (p=0.09). We found a significant difference (p=0.003) in surgeons’ perception of the difficulty of operation with VAS scores for obese patients being higher than non-obese patients. Our Dorr and Barrack scores revealed no significant difference in radiological outcome between our two groups.

Conclusion: Our study would suggest that obese patients do not have worse outcomes following primary total hip arthroplasty than non-obese patients.

Introduction: The aim of the study was to investigate the reproducibility and accuracy of templating total hip arthroplasty with on-screen digital radiographs using three commercially available software packages, and compare the results to templating on-screen using acetates.

Method: In twenty patients undergoing hybrid total hip arthroplasty, pre-operative templating for acetabular size, femoral offset and stem size were performed by three independent observers using on-screen digital radiographs by three different techniques. The magnification of the on-screen images were adjusted appropriately by using a metal coin marker of known size attached to the patient at time of acquiring the radiographs. These images were used to template for total hip arthroplasty using three commercially available digital templating software packages (Orthoview™ Workstation, Southampton, UK, Ferrania LifeWeb TraumaCad™, Berkshire, UK and mdesk™ software suite, RSA Biomedical, Sweden). The templated results were compared with the component sizes subsequently implanted and to templating on-screen using acetates. Intra- and inter-observer reproducibility were assessed using the Intraclass Correlation Coefficient (ICC).

Results: Intra-observer reproducibility was good for the three software systems with almost all ICC values > 0.70. Inter-observer reproducibility was less consistent, which may reflect familiarity and may improve with a “learning curve”. All three software systems tended to slightly undersize the acetabular size.

Discussion: For both reproducibility and accuracy, all the three commercial systems were comparable with templating using the acetate template method. Digital templating using software packages is an acceptable method of templating. Templating software packages are certainly an attractive proposition but until installation & maintenance costs are reduced, “traditional” templating with acetates remains the most effective option.

Radio-pacifiers in bone cements are an accepted part of every-day practice. They have, however, been shown to be a potential cause of an increase in third body wear and to excite bone resorption in vitro and in vivo studies.

We reviewed the results of 228 consecutive Stanmore Total Hip Replacements performed between 1981 and 1985 in 211 patients. All were inserted with radiolucent bone cement. Information regarding whether the prosthesis had been revised was available for all patients. 73 patients (83 hips) were still alive and 41 patients (44 hips) were sufficiently healthy to attend clinic. Information regarding pain level was obtained from the remaining 32 patients. When revision of the implant was taken as the end-point, there was 95% ten-year survival, 91% fifteen-year survival and 75% eighteen-year survival. These long-term results of Stanmore THRs, performed in a district general hospital, with radiolucent bone cement, compare favourably with the other published series for this implant. We did not find the inability to see the bone cement a particular disadvantage when reviewing x-rays for signs of loosening.