The aim of this study was to compare the efficacy of a hyaluronic acid (HA) supplement and a local anaesthetic (Bupivacaine) at providing early and short-term post-operative anagesic control following knee arthroscopy.

Patients were randomised to receive either 10mls of 0.5% Bupivacaine or 10mls of HA into the joint immediately after completion of surgery. WOMAC and Tegner-Lysholm scores were obtained at baseline then at 1, 2, and 6-weeks post surgery. VAS pain scores were obtained at baseline; 1 and 24-hours; and 1, 2 and 6 weeks following surgery.

49 patients received intra-articular Bupivacaine and 49 HA. There was no statistical difference in any of the outcome measures (WOMAC, Tegner-Lysholm, VAS pain scores) at any time point between the groups overall. Patients with grade III-IV chondral defects that received HA reported significantly lower VAS pain scores at rest and movement at all time points.

Use of Bupivacaine and HA intra-articular injection results in equivalent analgesic control in the immediate post-operative period and first six-weeks following surgery when administered immediately at the end of knee arthroscopy. Utilizing HA following knee arthroscopy does not sacrifice analgesic control and minimises exposure to chondrotoxic agents. Selective use of HA may improve pain-control in those with advanced chondral defects.

Abstract: Many former high level Gaelic Athletic Association (GAA) players present later in life with disabling hip arthritis requiring surgery. Many of these have evidence of the recently recognised condition of femoro-acetabular impingement (FAI). This condition results from abnormal abutment of the femoral head-neck junction with the acetabulum resulting in pain and progressive hip dysfunction. The prevalence is estimated at 10–15% in the general population, however it appears to be more common in young athletic males, and patients in their 20’s and 30’s with increased sporting activity. There has been an increase in the number of current players presenting with often poorly understood hip symptoms. We aimed to determine its prevalence in current top flight GAA players and in a cohort of past players.

92 current players and 8 retired players from the 1970’s were recruited. Questionnaires were distributed at training sessions and via e-mail. These consisted of a general questionnaire aimed at symptoms of interest, the Oxford Hip Scale and the Tegner Activity Level Scale.

Over half of current players experience hip symptoms with the majority being groin and hip pain but also a significant number complained of stiffness. Up to half of those with symptoms trained at reduced intensity and a further 20% missing training on a regular basis. 5 players in particular ceased playing for a period of between 3 and 36 months. Only 59 of 92 current players scored zero on the Oxford Hip Scale indicating a significant proportion have problems on a daily basis. The mean oxford hip score was 5.43 with a range of 0–29. The average Tegner Activity score was 10 despite having a number of players with significant symptoms indicating their desire to continue to play. 12 of the 92 underwent surgical procedures varying from Gilmore’s groin repairs and adductor tenotomies to hip arthroscopy.

It is evident that there is a link between hip symptoms in current players and FAI. Many hip conditions were previously unrecognized and thus left untreated, resulting in premature retirement of players. We therefore propose that it is vital that players are assessed for FAI at a young age and that training regimes should be altered and closely monitored in order to prevent the exacerbation of such a serious condition.

Neurological conditions affecting the hip pose a considerable challenge in replacement surgery since poor and imbalanced muscle tone predisposes to dislocation and loosening. Consequently, total hip replacement (THR) is rarely performed in such patients. In a systematic review of the literature concerning THR in neurological conditions, we found only 13 studies which described the outcome. We have reviewed the evidence and discussed the technical challenges of this procedure in patients with cerebral palsy, Parkinson’s disease, poliomyelitis and following a cerebrovascular accident, spinal injury or development of a Charcot joint. Contrary to traditional perceptions, THR can give a good outcome in these often severly disabled patients.

Introduction: Proximal femur fractures are an important cause of morbidity in the elderly and comprise a significant proportion of acute orthopaedic admissions.

Aim: To study the demographics of and factors responsible for prolonged hospital stay following admission with a fractured neck of femur.

Methods: We reviewed of a consecutive series of hip fractures presenting to our unit over a five-year period between 2000 and 2004. A complete patient cohort was obtained from the casualty register, the OT register and from a Hospital In-Patient Enquiry (HIPE) database. Pathological, high energy and peri-prosthetic fractures were excluded. We reviewed records to obtain demographic and clinical data including age, sex, length of stay, time to operation and co-morbidities. Those who remained in-patients for greater than 14 days were analysed for reasons responsible for prolonged stay.

Results: 717 low-energy hip fractures treated in the period 2000–2004. The M:F ratio was 1:3.3. The average age for males and females was 73.6 yrs (SD 11.23) and 79.6 yrs (SD 9.74) respectively. The overall average length of stay was 28 days. 351 patients (49%) stayed in hospital > 14 days. For these, the mean length of stay was 48 days (range 15–443). Reasons for prolonged stay included acute medical and surgical issues (32%), social and placement issues (22%), active chronic disease (17%) and post-operative complications (4%).

Conclusion: Hip fractures in the elderly constitute a significant burden on an acute trauma service. Further strategies are needed to address both medical and social reasons for prolonged stay in and delayed discharge from hospital. A national hip fracture audit is required.