Introduction: There has been a renewed interest in metal-on-metal articulation in hip joint Arthroplasty. The reason for having metal-on-metal articulation is to reduce the volume of wear particles that are produced with THR. The outcome of reduced particle formation will hopefully be reduced osteolysis.

Methods: We reviewed the results of 139 primary hip arthroplasties (130 patients) performed using Metasul articulation and cemented Weber cup. Six patients were lost to follow-up leaving 133 hips (124 patients) for review with at least 5-year follow-up. The acetabular socket was the cemented Weber cup and Bone grafting of the acetabulum and application of a reinforcement ring was done where necessary. Cemented CF-30 femoral stem was used in all patients but one (PFMR). The study was conducted retrospectively based on the information collected from hospital notes and Orthocom database. Immediate post-operative films were seen to measure the cup and stem inclination and quality of cementing using the Barracks grading system.

Results: There were 102 females and 22 males in the cohort. Mean age was 73 years (SD-7.46, range 58–86). Left to right hip ratio was 52:81. Most common Pre-operative diagnosis was Osteoarthritis (103) followed by Intracapsular fracture neck of femur (20). The average follow-up was 7.23 years (range 5–10.9). Mean pre-operative Harris hip score was 42.09 and mean post-operative hip scores were 90.01, 86.84, 87.42 and 84.63 at 1-year, 3-year, 5-year and final follow-up with the corresponding pain scores were 42.9, 41.84, 41.56 and 41.56 respectively. Only two hips were revised for aseptic loosening of the cup with a 93.4% implant survivorship at 12 years. There was no case of aseptic stem loosening. No untoward systemic effects were noted in the cohort.

Discussion: We believe that in our study Metasul metal-on-metal articulation has shown satisfactory results with regards to aseptic loosening and reduction in osteolysis in medium-term.

Introduction: Osteoarthritis has historically been thought of as a degenerative joint disease, but inflam-mation and angiogenesis are increasingly being recognised as contributing to the pathogenesis, symptoms and progression of osteoarthritis. Beta-dystroglycan is a pivotal element of the transmembrane adhesion molecule involved in cell-extracellular matrix adhesion and angiogenesis. Matrix metalloproteinases are the main enzymes responsible for cartilage extracellular matrix breakdown and are also implicated in both angiogen-esis and beta-dystroglycan degradation in a number of malignancies. We aimed to investigate the expression and localisation of beta-dystroglycan and matrix metal-loproteinase 3, 9, and 13 within cartilage, synovium and synovial fluid and establish their roles in the pathogenesis of osteoarthritis.

Methods: Following ethical committee approval, cartilage, synovium and synovial fluid were obtained from the hip joints of 5 osteoarthritic (patients undergoing total hip replacement) and 5 control hip joints (patients undergoing hemiarthroplasty for femoral neck fracture). The samples were analysed for beta-dystroglycan expression using Western Blotting and for the distribution of beta-dystroglycan, matrix metalloproteinase 3, 9, and 13 using immunohistochemistry on paraffin embedded tissue.

Results: Whilst no significant expression of beta-dystro-glycan was found in cartilage or synovial fluid, beta-dys-troglycan was expressed in the smooth muscle of both normal and osteoarthritic synovial blood vessels. Moreover, beta-dystroglycan was expressed in endothelium of blood vessels of osteoarthritic synovium, but not in the normal endothelium. In the endothelium of osteo-arthritic synovial blood vessels, beta-dystroglycan co-localised with matrix metalloproteinase 3 and 9. Discussion: Our results demonstrate that beta-dystro-glycan does not act as a cell adhesion molecule binding chondrocytes to the extracellular matrix. However, specific immunolocalisation of beta-dystroglycan within endothelium of inflamed osteoarthritic blood vessels suggests that beta-dystroglycan may play a role in angiogenesis associated with osteoarthritis. Its co-localisation with matrix metalloproteinase 3 and 9, previously reported to also have pro-angiogenic roles, may be linked. Further research is required to understand these roles more fully.

Introduction: Aseptic loosening is the major cause of implant failure. In cemented hip Arthroplasty it is well known that the acetabular side fails earlier due to lysis caused by wear particles. This is the rationale for Hybrid hip Arthroplasty. It might be advantageous to use a bearing which has a low wear rate. The purpose of this study is present the medium term results of this Uncemented cup with a metal-on-metal bearing.

Methods: We reviewed the results of 119 hips (101 patients) who had the Uncemented Fitmore® cup (Sulzer/Zimmer Orthopaedics, Inc). In 66 out of the 101 patients the femoral component used was CF-30® (Sulzer/Zimmer Orthopaedics, Inc) used with cement. In 35 patients Thrust plate prosthesis TPP® (Sulzer/Zimmer Orthopaedics, Inc) was used. This is a bolt type device which is fixed on to the neck; the femoral canal is not violated. Of the 101 patients, 90(108 hips) were available for study. All had minimum of 5 years follow-up.

Results: Mean follow-up of the 90 patients is 87.4 months (range 60 – 129 months). The mean pre-op Harris hip score is 38.2. The mean post-op Harris hip score is 89.6 at the last follow up. Taking aseptic loosening as the end point the survival rate of the Fitmore cup is 100% at 11 years. Four cups were revised for other causes.

Discussion: Histological studies of retrieved metal-on-metal implants have always shown low volume of inflammatory tissue. Wear rate of metal-on-metal hips is 60–100 times lower than metal-on-polyethylene hips. In the medium to long term Uncemented cups fare better than cemented cups. It might be advantageous to use an Uncemented cup with a metal-on-metal bearing. This follow-up study which has a 100% survival rate at 11 years proves that.

The purpose of this study was to demonstrate the beneficial effects of elbow arthrolysis.

This was a prospective study on 88 patients with post-traumatic elbow stiffness with a mean follow-up of 51 months (1 year - 11 years), who had failed to improve their range of movement at a mimimum period of 6 months after their injury. All patients had an open arthrolysis. Post-operatively patients received continuous passive movement (CPM) for 48 to 72 hours. This was facilitated by good analgesia afforded by a continuous brachial plexus block. All patients received no physiotherapy thereafter and were advised to actively mobilise their elbow. ROM was assessed using a goniometer and function assessed using the Mayo elbow performance index.

The ROM improved from a mean of 56 degrees pre-operatively to 106 degrees post-operatively. This improvement in ROM was reflected in the improvement of pre-operative flexion from 107 to 138 degrees and improvement of extension from 60 to 31 degrees. Function improved from a mean of 65 to 85 on the Mayo elbow performance score. 95% of the patients were satisfied with the outcome. Complications included ulnar nerve paraesthesia in 3 patients, 1 triceps avulsion and 1 superficial infection. 3 patients required a manipulation of the elbow in the postoperative period. This was performed within 2 weeks of the operation. There were no cases of elbow instability or heterotopic ossification in this series.

Conclusion: Open elbow arthrolysis combined with continuous brachial plexus block and CPM in the postoperative period is a safe, reliable and durable procedure for improving ROM and function in patients with post-traumatic elbow stiffness.

Osteoporosis and fragility fractures in men constitute a considerable burden in healthcare. We have reviewed 2035 men aged over 50 years with 2142 fractures to clarify the epidemiology of these injuries and their underlying risk factors. The prevalence of osteoporosis ranged between 17.5% in fractures of the ankle and 57.8% in those of the hip. The main risk factors associated with osteoporosis were smoking (47.4%), alcohol excess (36.2%), body mass index < 21 (12.8%) and a family history of osteoporosis (8.4%). Immobility, smoking, self-reported alcohol excess, a low body mass index, age ≥72 and loss in height were significantly more common among men with fractures of the hip than in those with fractures elsewhere.

We present a retrospective study of 25 patients treated by open arthrolysis of the elbow for post-traumatic stiffness. The mean follow-up was for 7.8 years (5 to 10.8). The range of movement of the elbow, pain scores and functional outcomes were recorded pre- and postoperatively. An improvement in the mean range of movement from 55° (0° to 95°) to 105° (55° to 135°) was obtained in our patients at one year. This improvement was maintained over the mean follow-up period of 7.8 years (5 to 10.8). Improvement in pain, function and patient satisfaction was recorded in 23 of the 25 patients at final follow-up.

On the basis of this study, we believe that the results of open arthrolysis for post-traumatic stiffness of the elbow are durable over the medium term.

Introduction: Slipped Upper Femoral Epiphysis (SUFE) is very rare in children less than 10 years of age but may be more common with increasing obesity in children. There are concerns with the presentation of SUFE in this age group regarding bilateral slips and prophylactic pinning, fixation with multiple pins to preserve growth, and complications.

Methods: We identified 12 cases of SUFE in 8 patients who presented aged less than 10 years to our institution between 1997 and 2004. Case note and radiographic review were carried out.

Results: There were 5 boys and 3 girls in this group, with an average follow-up of 48 months (6 – 90 months). Bilateral SUFE was present in 4 patients (50%). Only 3 slips were unstable. One child was found to be hypothyroid and another had oculocutaneous albinism. The remaining children had normal genetic and endocrine profiles. Six children were above the 90th centile for weight. The severity of slip was mild in 9 hips and moderate in 3 hips.

Multiple threaded pins were used in 10 hips and a cannulated screw in 2 hips.

Complications include revision surgery due to loss of fixation in 3 hips and a superficial wound infection. There were no cases of avascular necrosis and chondrolysis.

Discussion: Gross obesity is the commonest predisposing factor. The high incidence of bilateral involvement is an indication for prophylactic pinning. Multiple threaded pins may need to be revised if the fixation is lost as the child grows. These should be left proud of the lateral femoral cortex to facilitate removal, although at the risk of producing a windscreen wiper effect.

Introduction: The aim of this paper was to test the hypothesis that for hips affected with Legg-Calve-Perthes’ (LCP) disease under the age of 8 years, surgery does not affect the outcome.

Methods: We performed a retrospective paired study of patients, who were diagnosed with LCP disease before the age of 8 years, to compare the radiological results after treatment between conservatively and surgicallytreated groups. One patient was selected from each group to create the pairs for this study. Each pair was strictly matched for gender, body mass index, age at onset, and stage at the first visit, Catterall and Herring grading and radiological at-risk signs. Each pair was assessed by comparing the values of five radiological measurements.

Results: From a cohort of 345 hips diagnosed with LCP disease 14 pairs (28 hips) fitted the criteria. The radiological measurements, which showed a statistically better result in the surgical groups, were Mose’s method (p = 0.019), the Acetabular-Head Index (p = 0.034). There were no statistical differences in the Slope of the Acetabular Roof (p = 0.37), Articulotrochanteric distance (p = 0.17) and Stulberg grading (p = 0.2). 5 pairs had a better Stulberg result in the operative group. Three of these 5 pairs were less than 6.5 years at the time of their surgical procedure. Three pairs had a better Stulberg result in the conservative group. Six pairs had no difference between the groups.

Discussion: We conclude that surgical treatment can improve the sphericity of the femoral head and provide greater acetabular cover than conservative treatment in hips of patients less than 8 years at the onset of LCP disease. However, the Stulberg grading was not affected. Our study supports the hypothesis that for hips affected with LCP disease under the age of 8 years, surgery does not affect the outcome.

Introduction: The aim of this paper was to present a profile of Legg-Calve-Perthes’ (LCP) disease and test the hypothesis of an association between LCP disease and poverty.

Methods: We examined demographic data on a group of 240 children (263 hips) presenting with LCP disease in Greater Glasgow, where the mean deprivation scores are substantially greater than in the rest of Scotland, to see if this association applies or whether other clues to the aetiology of LCP could be divined.

Results: There were 197 males and 43 females. The majority presented in the sclerosis phase with much smaller numbers in the other phases. 70 % (184 cases of LCP) were Catterall grades 3 or 4. 16.25% had a family history of LCP. Bone age in our series is heavily skewed towards the lower centiles. The number of siblings in the family averaged 1.9, with 13 % being an only child. The maternal age at birth of the index child showed no preponderance to older age. Maternal smoking during and after pregnancy was noted in 55 %, which compares with 52% reported in the population of Greater Glasgow in general. Bone age in our series was heavily skewed towards the lower centiles. Birth weight showed a definite shift to the left, height a weaker shift to the left. 25 % of the children in our series are in social class IV and V, although this accounts for more than 50 % of the population of the Greater Glasgow.

Discussion: There is no significant evidence of a preponderance of LCP disease in the most deprived groups (p=0.9). The aetiology of LCP disease is likely to be multifactorial and may include a genetic or deprivation influence causing low bone age, hyperactivity and a high pain threshold.

Stickler’s syndrome, also called Hereditary Progressive Arthro-Ophthalmopathy, is an autosomal dominant connective tissue disorder with strong expressivity, characterised by ocular, orofacial, skeletal, cardiac, and auditory features.

We describe a case of valgus slipped capital femoral epiphysis in a 13 year-old boy with Stickler’s syndrome. He presented at routine rheumatology clinic follow-up with a 1-month history of progressively worsening right hip pain, which radiated to the knee. He underwent insitu cannulated screw fixation of the right slipped capital femoral epiphysis.

Joint pains are a common manifestation in Stickler’s syndrome and this might delay the diagnosis of slipped capital femoral epiphysis. Valgus slipped capital femoral epiphysis is a rare entity. Obesity and the increased femoral anteversion are predisposing factors. Insitu fixation with a single cannulated screw is the treatment of choice.

Introduction There has been increasing interest and enthusiasm among both surgeons and patients for small incision for total hip joint replacement (THR). We conducted a prospective study to compare the early postoperative recovery following the two different incisions.

Materials and Methods 40 patients were prospectively randomised (20 patients in each group) by use of envelopes to undergo either conventional or minimal incision (MI) approach for THR between Sept. 2003 and Aug. 2004. Patients with BMI (body mass index) ≤ 30 were considered suitable for randomisation. Conventional incision was 12 cm standard posterolateral in all cases and minimal incision was defined as within 2 cm of the diameter of the contralateral uninvolved femoral head. Minimal incision was made over the posterior aspect of the greater trochanter. All procedures were performed by the senior author. The patients were assessed for operative time, blood loss, haematological parameters, wound healing, ease of mobilisation, post-operative pain, hospital stay and complications. The patients, and assessors (physiotherapists and nurses on ward) were unaware of the treatment group.

Results Average age was 66.95 years for MI group and 68.55 for conventional group (p-0.501). Average BMI for MI and conventional group was 26.5 & 24.4 respectively (p-0.029). Average pre-operative Oxford hip score was 41.75 for conventional group and 42.15 for MI group (p-0.87). There was no statistically significant difference as regards the operating times (p-0.207); post-operative day the patients were mobilised with zimmer frame (p-0.71); drop in hemoglobin (p-0.197) and hematocrit (p-0.208) or the need for blood transfusion (p-0.56). However there was a statistically significant difference in the two groups as regards post-operative pain (on a 10 point visual analogue scale) and the number of postoperative days the patient was fit for discharge. Average pain score on day 1 was 4.05 for MI group and 6.25 for conventional group (p-0.0089) with similar difference on day 2 and the day of discharge. Patients in MI group were fit for discharge on an average 1.65 days earlier than those in conventional group (p-0.042). There was no superficial or deep wound infection, dislocation or per-operative fracture in either group. Transient sciatic nerve neuropraxia occurred in one patient in the minimal incision group which recovered within 6 weeks.

Conclusion Minimal incision posterior approach for total hip replacement may be useful in decreasing the post-operative pain and duration of hospital stay. However the incidence of complications is an area of concern and needs to be studied on a larger study group.

Introduction The aim of the study was to review the results of total hip arthroplasty (THA) in relatively fit and mobile patients with Garden 3 and 4 fractures of the neck of femur.

Materials and methods 37 patients who underwent THA for displaced fractures of neck of femur between 1995 to 2001 were reviewed. Only those patients with 3 years or more follow-up were reviewed.

Results Average age was 67.7 years (37–80 years) with Male:Female ratio 5:32. Fracture involved left hip in 12 and right hip in 15 patients. Average Modified Barthel index before the fracture was 18.5 (13–20) and average Waterlow score was 12 (5–19). Majority were ASA grade II (22 patients). All patients were operated by the senior author. 31 hips were cemented, 1 uncemented and 5 hybrids. Canulated CF-30 (Sulzer, Switzerland) femoral stem was most commonly used (32 patients) and the acetabular component was Weber Metasul cup in most cases (33 patients).33 hips had metal-on-metal bearing surface and the rest had metal-on-polyethylene. Average hospital stay was 12.6 days; majority (33) of the patients were discharged home and the rest needed additional rehabilitation. Average post-operative drop in Hb was 2.63 and14 patients needed blood transfusion. Average transfusion was 0.86 units per patient. Average follow-up was 5.8 years (3–9.5 years). Complications included: wound leakage (5), minor wound dehiscence (1), DVT (3), pulmonary embolism (1), dislocation (1), per-operative femur fracture (1), peri-prosthetic fracture (2), stem loosening (1). 3 hips (8%) were revised (loosening 1, peri-prosthetic fractures 2). Average harris hip score at follow-up was 92 (66–100).

Conclusion In relatively fit, young and mobile patients, we recommend total hip replacement as the primary treatment since it promises better function and pain relief and avoids the drawbacks of internal fixation and hemiarthroplasty.

Introduction The aim of this study was to assess the comparability of telephone questionnaire interviews with outpatient attendance for assessing hip function after Total Hip Replacement (THR).

Materials and Methods 100 patients attending the orthopaedic clinic for follow-up after undergoing THR were recruited to this study. A modified Harris Hip Score (HHS) was used as the questionnaire. This modified score assessed pain and function with 8 variables and had a maximum score of 91. The score thus obtained was multiplied by a factor of 1.1 to derive a score out of 100. Patients attending follow-up clinics were contacted by telephone between 1–2 weeks prior to their scheduled appointment and the questionnaire was completed. The questionnaires thus completed were compared to those completed in the clinic.

Results The mean HHS obtained with the telephone interview was 85.22 as compared to 86.11 obtained at direct interview with a Pearson’s correlation coefficient of (0.906) and p-value for the difference of (0.111). Out of a total of 800 variables assessed 725 (90.37%) had the same scores by the two methods and only 75 (9.67%) showed a discrepancy. Only 3 patients had a significant difference (more than 20 points) between the two methods.

Conclusion The study shows that there is no significant difference between scores obtained by telephone interview or direct interview using a modified HHS. Telephone interview is an important adjuvant tool for patient follow-up after THR and a useful adjunct to lifelong review.

It has been reported that there is an association between Perthes’ disease and poverty. We examined the demographic data of a group of 240 children (263 hips) who presented with Perthes’ disease in Greater Glasgow, where the mean deprivation scores are substantially greater than in the rest of Scotland, to see if this association applied and whether other clues to the aetiology of Perthes’ disease could be found. There were 197 boys and 43 girls; 39 (16.25%) had a family history of Perthes’ disease. Bone age in this series was heavily skewed towards the lower percentiles. The mean number of siblings was 1.9, with 31 (12.9%) being an only child. Maternal age at the birth of the first child showed no preponderance of older mothers. Maternal smoking during and after pregnancy was noted in 132 (55%), which compared with the 52% reported in the population of Greater Glasgow in general. Of the children in our series, 60 (25%) were in social class IV and V. However, this applies to more than half of the population of Greater Glasgow. There was no significant evidence of a preponderance of Perthes’ disease in the most deprived groups. The aetiology of Perthes’ disease is likely to be multifactorial and may include a genetic or deprivation influence resulting in delayed bone age.

Introduction and Aims: The aim of this study was to assess the results of open elbow arthrolysis for post-traumatic stiffness.

Method: This is a prospective study of 89 patients (M: F 53:36) with a mean age of 34 years. All patients had open elbow arthrolysis followed by continuous passive motion (CPM) for 72 hours. CPM was facilitated by analgesia in the form of a continuous brachial plexus block. After CPM patients were advised to actively mobilise their elbow. The minimum follow-up was one year. (Mean follow-up 47 months). Range of movement (ROM) was recorded using a goniometer; function was assessed using the mayo score and pain using the visual analogue score.

Results: ROM improved from 60.9 to 104.2 degrees, flexion improved from 119.8 to 136.3 and extension improved from 58.9 to 32.1 degrees. Pain improved from 4.8 to 3.1 and the Mayo score improved from 60 to 85. In the sub-group of 25 patients with severe stiffness (pre-operative arc < 50 degrees), ROM improved from 29.6 to 89 degrees. Flexion improved from 99.2 to 132.2 degrees, extension improved 70 to 43.2 degrees. Pain improved from 5.6 to 4.0 and the Mayo score improved from 40 to 75. In the sub-group of 29 patients with a minimum follow-up of five years, ROM improved from 57.7 to 104.3 degrees at the year one post-operative assessment. ROM was maintained at their last follow-up, measuring 108.6 degrees. The pain score improved from 4.3 to 2.8 and was at 2.7 at their last follow-up. The Mayo score improved from 65 to 85 at year one, which was maintained at their last follow-up.

Conclusion: Open elbow arthrolysis for post-traumatic stiffness of the elbow is a durable procedure for improving ROM and function. Moreover the results of elbow arthrolysis are not influenced by the degree of pre-operative stiffness.

Introduction and Aims: Use of non-steroidals (NSAIDs) and additional factors such as advanced age, anticoagulants and co-morbid diseases, commonly found in patients with arthritis, increases the risk of upper gastrointestinal (UGI) bleeding. Our aim was to assess the incidence of peri-operative UGI bleeding in patients having hip and knee replacements for arthritis.

Method: A single centre, retrospective study was conducted on 100 consecutive hip replacements and 100 consecutive knee replacements performed at Victoria Infirmary, Glasgow, between 1998 and 2000.

Results: The mean age was 74 (41–86). Sixty-three percent of our patients were female. Seventeen percent of the patients had a previous history of UGI problems, of which only 50% were on gastro-protective medication. Fifty-four percent of the patients were on NSAIDs and all patients received anticoagulants (78 aspirin, 122 clexane) peri-operatively. Nine patients (4.5%) had UGI bleeding in the post-operative period. Five patients had endoscopies, which revealed bleeding from gastric ulcers (three), duodenal ulcer (one) and barretts oesophagus (one). Four patients, who had one episode of UGI bleeding, did not have endoscopies. All the nine patients with UGI bleeding were patients who had been on NSAIDs and anticoagulants (six clexane, three aspirin). These nine patients were from the group of patients who were not on any gastro-protective medication. Five of these patients requiring a hospital stay of more than two weeks.

Conclusion: We believe that the incidence of UGI bleeding in patients undergoing hip and knee replacements is underestimated. We propose gastro protective agents in the peri-operative period for patients on NSAIDs.

Introduction and Aims: The aim of this paper was to assess the 10 to 15-year clinical and radiographic results of uncemented LCS meniscal-bearing total knee replacements used to revise failed uni-compartmental knee replacements.

Method: Eleven (5 M: 6 F) cementless LCS meniscal-bearing total knee replacements were implanted in patients who had failed uni-compartmental knee replacements for medial compartment osteoarthritis. Mean time interval between the uni-compartmental knee replacement and the LCS total knee replacement was 18 months (12–72 months). Minimum follow-up of all patients reviewed was 10 years (mean 12.9 years). Average age of patients at the time of surgery was 60.1 years (47–74 years). Clinical and radiographic analysis was performed. American knee society pain and function scores were determined and Kaplan-Meier survivorship analysis was conducted. Failure was defined as revision due to any cause.

Results: At the time of the 10 to 15-year follow-up, all 11 patients were alive and were all reviewed. Four patients (three males, one female) had a revision of their LCS total knee replacement. The average time to revision of the LCS total knee replacement was 26 months (1–60 months). The average knee society pain and function scores were 80 and 45 at the final follow-up evaluation. The average range of movement was 95 degrees (80–100 degrees). The survival rate of 60% (95 % confidence interval) was noted at 12 years.

Conclusion: After 10 to 14 years of follow-up, the cementless LCS meniscal bearing total knee replacement for a previously failed uni-compartmental knee replacement was found to have a 37% revision rate.

We analysed the long-term clinical and radiological results of 63 uncemented Low Contact Stress total knee replacements in 47 patients with rheumatoid arthritis. At a mean follow-up of 12.9 years (10 to 16), 36 patients (49 knees) were still alive; three patients (five knees) were lost to follow-up. Revision was necessary in three knees (4.8%) and the rate of infection was 3.2%. The mean clinical and functional Knee Society scores were 90 (30 to 98) and 59 (25 to 90), respectively, at final follow-up and the mean active range of movement was 104° (55° to 120°). The survival rate was 94% at 16 years but 85.5% of patients lost to follow-up were considered as failures. Radiological evidence of impending failure was noted in one knee.

Total hip arthroplasty (THA) patients often require peri-operative blood transfusion. Variables that predict transfusion requirement may allow us to target cross-matching of individual patients.

153 patients underwent primary unilateral THA for osteoarthritis or rheumatoid arthritis during 2002 in our institution. 75 casenotes from these subjects were reviewed. Age, sex, diagnosis, weight, height, pre-operative haemoglobin (Hb) and haematocrit (Hct), anticoagulation type and timing were recorded, along with post-operative Hb and timing and quantity of any blood transfusion. Potential predictors of transfusion were examined using logistic regression analysis. ROC analysis was used to compare the relative predictive value of significant variables.

Mean (±SD) age at surgery was 67±11 years (53% females). Mean pre-operative Hb was 13.8±1.4g/dl, mean post-operative Hb was 10.2±1.0g/dl. 27 patients (36%) needed a transfusion; the most frequently given volume was 2 units and the mean number of units given was 0.85. The most common reason for transfusion was an asymptomatic low Hb (< 8.0g/dl). Pre-operative Hb and Hct were predictive of post-operative transfusion (logistic regression analysis P< 0.01). Age, gender, diagnosis and anticoagulation were not predictive. Using ROC analysis the optimal ‘cut-off’ value of pre-op Hb as a predictor was 12.7 g/dl, giving a sensitivity of 41% and a specificity of 88% for blood transfusion requirement. The optimal ‘cut-off’ for Hct was 0.41, sensitivity 74% and specificity 61%. There was no significant difference in the overall predictive value between these variables (comparison of area under ROC curves, P> 0.05).

In summary, subjects with a pre-operative Hb< 12.7 or Hct < 0.41 are more likely to require a blood transfusion after unilateral primary THA than those with an Hb or Hct above these values. In treatment centres where cross-matched blood is not available at short notice on demand, pre-operative cross-match of patients with blood counts below these values may be appropriate.

Introduction: The aim of this study was to assess the feasibility of telephone questionnaire interviews for assessing hip function after Total Hip Replacement (THR).

Methods: 100 patients attending the orthopaedic clinic for follow-up after undergoing THR were recruited to this study. A modified Harris Hip Score (HHS) was used as the questionnaire. This modified score assessed pain and function with 8 variables and had a maximum score of 91. The score thus obtained was multiplied by a factor of 1.1 to derive a score out of 100. Patients attending follow-up clinics were contacted by telephone between 1–2 weeks prior to their scheduled appointment and the questionnaire was completed. The questionnaires thus completed were compared to those completed in the clinic.

Results: The mean HHS obtained with the telephone interview was 85.22 as compared to 86.11 obtained at direct interview with a Pearson’s correlation coefficient of (0.906) and p-value for the difference of (0.111). Out of a total of 800 variables assessed 725 (90.37%) had the same scores by the two methods and only 75 (9.67%) showed a discrepancy. Only 3 patients had a difference of > 20 points between the two methods.

Conclusion: The study shows that there is no significant difference between scores obtained by telephone interview or direct interview using a modified HHS.

Telephone interview is an important tool for patient follow-up after THR and a useful adjunct to life-long review.