The ideal method of fixation for femoral components in total hip arthroplasty (THA) is unknown. While good results have been reported for cemented and uncemented components, there is relatively little published prospective data with twenty years or more of follow up. Results of the Furlong femoral component have been presented at an average of 17 years follow up. We have extended this follow up period to an average of 22.5 years with a minimum of 22 years and a maximum of 25 years. This study included all patients treated using the Furlong femoral component between 1986 and 1991. Patients were reviewed preoperatively and then at 6, 12, 26 and 52 weeks post operatively and annually thereafter. They were assessed clinically and radiographically and the Merle d'Aubigne Postel hip score was calculated at each visit. A Visual Analog Score (VAS) was also recorded to assess patient satisfaction with their procedure. A Kaplan Meier survival analysis was performed.Introduction
Methods
Deep vein thrombosis(DVT) and pulmonary embolism(PE) are well-recognised complications following lower limb arthroplasty (Cohen et al, 2001). The National Institute for Clinical Excellence and British Orthopaedic Association recommend the use of both mechanical and chemical prophylaxis. At our institute regimens have changed reflecting new developments in the use of thombo-prophylaxis. Our aim was to assess the efficacy of these methods in preventing complications. Since moving from Aspirin and compression stockings (TEDS) only, three different treatment methods were prospectively audited. Regimen 1 consisted of Aspirin (150 mg OD) and TEDS for 6 weeks (n=660). Regimen 2 used Clexane 40mg OD (n=448). Regimen 3 used Rivaroxaban (n=100) as licensed and Regimen 4 Dabigatran (n=185) as licensed. We looked at rates of venous thromboembolism (VTE), rates of post op bleeding/haematoma and wound complications. Patients were reviewed prior to discharge, and at a six-week follow-up. Any casualty attendances were also recorded up to 12 weeks post-operatively.Introduction
Methods
A reduced range of movement post total knee replacement (TKR) surgery is a well recognised problem. Manipulation under anaesthesia (MUA) is a commonly performed procedure in the stiff post operative TKR. Long term results have been variable in the literature. We prospectively followed up 48 patients since 1996 from one centre, over an average of 7.5 years, (range 1 to 10 years) and report on the long term results. The mean time to MUA post TKR was 12.3 weeks (range 3 to 48). Pre MUA, the mean flexion was 53°. The mean immediate passive flexion post MUA was 97°, an improvement of 44° (Range 10° to 90°, CI < 0.05). By one year, the mean flexion was 87°, improvement of 34°, (range −15° to 70°, CI< 0.05). At ten years the mean flexion was 86°. We found no difference between those knees manipulated before or after 12 weeks. In addition there was no difference found in those knees which had a pre TKR flexion of greater or less than 90°. There were no complications as a result of MUA. However, one patient was eventually revised at two years secondary to low grade infection. Our findings show that MUA is safe and effective method at improving the range of motion in a stiff post operative TKR. The improvement is maintained in the long term irrespective of time to MUA and range of motion pre TKR
To compare a randomised group of patients undergoing UKA to investigate the advantages of the minimal invasive approach in the early post-operative stage. 100 patients on the waiting list for UKA were recruited into the trial. Patients were prospectively randomised into 2 groups: Group 1 – longitudinal skin incision with dislocation of the patella, Group 2 – the minimally invasive approach. Standard milestones were recorded post-operatively: time to achieve IRQ, independent stair climbing and to discharge. Additionally, patients were scored with the AKSS and Oxford knee questionnaire pre-operatively, at 6 weeks, 6 months and 1 year. No significant differences were found between the 2 groups in the measured parameters.Aims
Results
Hydroxyapatite (HA) coated femoral stems require a press fit for initial stability prior to osteointegration occurring. However this technique can lead to perioperative femoral fracture. 506 consecutive patients under 72 years who underwent primary total hip replacements (THR) under 72 years were investigated for perioperative femoral fractures. All patients were independently assessed pre- and post-operatively in a research clinic. Assessment was made by Merle d'Aubigné and Postel (MDP) hip scores and radiographs. Between 1995 and 2001 patients were randomised to a partially HA coated, Osteonics Omnifit or fully HA coated Joint Replacement Instrumentation Furlong stem. Between 2001 and 2004 all patients received an Anatomique Benoist Girard (ABG II) stem partially coated. Fractures were identified from check radiographs and operative notes. The type of fracture was classified according to the modified Vancouver classification. The incidence of revision was also recorded.Introduction
Materials and Methods
