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Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_I | Pages 64 - 64
1 Jan 2011
Schmied M Kelly M Ballantyne J Brenkel I
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Hip and knee arthroplasty account for over 95 000 hospital days annually in Scotland. The gross cost of over £81 million can be reduced by £10 million by decreasing length of stay by just one day per patient.

We performed a retrospective analysis of the data from the Scottish Arthroplasty Project (SAP). We specifically looked at length of stay in patients undergoing total hip and knee replacements between 1996 and 2007. We analysed the data on over

91000 total hip and knee replacements. In addition we looked at the influence of age, volume and day of admission on the 2007 data

Over the 11 year period there were significant variations in improved length of stay across the health boards. For the 2007 data, we found that patients treated in boards with high patient volume had shorter hospital stays. Admission policy and age of the patients affected the length of stay it did not account for the large differences between health boards.

The data from the Scottish Arthroplasty Project shows that higher surgical volume correlates with reduced length of stay in arthroplasty patients. The reasons for this are likely to be multifactorial but generalisable and need to be examined more closely with another study.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_II | Pages 306 - 306
1 May 2010
Naal F Schmied M Maffiuletti N Leunig M Hersche O
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There is only a paucity of information on the outcome of resurfacing arthroplasty in patients suffering from hip osteoarthritis secondary to developmental dysplasia (DDH). When performing arthroplasty in dysplastic hips, the anatomic abnormalities offer reconstructive challenges, in particular in resurfacing. The present study was therefore conducted to address the following questions: Can hip resurfacing arthroplasty provide satisfactory clinical results in patients with DDH? Can the patients return to sports and recreational activities? Can the hip biomechanics be restored? And finally, can surface arthroplasty reestablish a normal, symmetric gait pattern? The study comprised 24 consecutive patients (32 hips) with a mean age of 44.2 years who underwent surface replacement due to hip osteoarthritis secondary to DDH. Surgery was performed by two senior surgeons using either the Durom implant or the Birmingham Hip Resurfacing prosthesis, dependent on the surgeon’s preference. At a mean follow-up of 43 months, all patients were evaluated cross-sectionally. We assessed clinical and radiographical data and investigated spatiotemporal gait parameters using an electronic mat. The Harris Hip Score improved from 54.7 +/−13.3 to 97.3 +/−5.2 (p< 0.001) and University of California at Los Angeles (UCLA) activity levels increased from 5.3 +/−2.0 to 8.6 +/−1.6 (p< 0.001), respectively. Hip flexion improved from 95.7° +/−16.5° to 106.7° +/−10.6° (p< 0.001). At a mean of 11.2 +/−4.8 weeks after surgery, all patients returned to sports activity. They participated in a mean of 6.0 +/−2.6 different disciplines, 2.8 +/−1.3 times and 4.1 +/−3.6 hours per week. The most common disciplines were cycling, swimming, exercise walking and downhill-skiing. Spatiotemporal parameters of gait demonstrated a symmetrical gait pattern without major differences to normative data. Both, the hip lever arm ratio and the femoral offset increased significantly (p< 0.001) from 0.48 +/−0.07 to 0.57 +/−0.08 and from 39.3 +/−8.2 mm to 45.6 +/−6.2 mm, respectively. Grade I heterotopic ossifications were seen in two hips, there were no Grade II or III ossifications. Two surface replacements failed, both failures could be attributed to surgical errors. The surface arthroplasty risk index was 3.2 +/−1.4 for the entire cohort and 4.5 for the revision cases. Femoral radiolucencies were detected in ten of the remaining 30 hips. The present study demonstrated that hip resurfacing achieved satisfactory clinical results in patients with hip osteoarthritis secondary to DDH. The failure rate of 6.3% did not reach our expectations, however, both failures could be attributed to surgical errors. Further follow-up is nevertheless of utmost importance to assess the significance of femoral stem radiolucencies in this young and active group of patients.


Orthopaedic Proceedings
Vol. 88-B, Issue SUPP_I | Pages 74 - 74
1 Mar 2006
Schmied M Hersche O Munzinger U
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Introduction: The standard implant for patients with rheumatoid arthritis is a cemented system. Early aseptic loosening is a major concern in patients with bad bone quality, usually seen in inflammatory arthritis

Aim of the study: The aim of this retrospective study is to find out, whether the cementless CLS-stem is an appropriate implant for patients with rheumatoid or juvenile arthritis.

Material and methods: Between 1984 and 2002 63 patients with rheumatoid or juvenile arthritis were treated with a cementless Stem (CLS) in our clinic. The mean age was 53 years (range from 25 to 71 years). We evaluated the x-rays (aseptic loosening and other complications) as well as the clinical outcome (Harris Hip Score). Patients with a minimum follow-up of 24 months (mean fu 5 years) were included in the study.

Results: There was no stem revision due to aseptic loosening. No patient had radiological signs of aseptic loosening. 8 patients suffered a fracture of the greater trochanter or the proximal femur during surgery. Two patients had to be revised for trochanteric problems.

Conclusion: The cementless CLS stem is an appropriate implant for patients with rheumatoid or juvenile arthritis. Careful implantation is necessary to avoid trochanteric or femoral fractures.