Aim. There is a lack of both epidemiological data and of high-quality evidence to guide the management of Prosthetic joint infection (PJI). We hypothesised that there is substantial heterogeneity in the clinical presentation and management of PJI in Australia and New Zealand, and that the proportion with clinical cure at 24 months is independently associated with modifiable variables in surgical and antibiotic management. Method. Prospective binational multicentre observational study aiming to enrol 400–600 patients with large joint PJI, defined as per IDSA criteria. Following screening and written informed consent, data are collected at baseline and after 3, 12 and 24 months. The main outcome measures are clinical cure, functional status (based on Oxford joint and SF12 scores) and direct health care costs at 24 months. Results. As of April 2016, 15 sites in Australia and 5 in New Zealand have full ethics approval and have begun recruitment and over 275 patients have been recruited, of whom 59% were male and the average (SD) age was 69 (11.3) years. Obesity was common, with a mean body mass index of 32, and 23% of the cohort were diabetic. The most common joints involved were knees (55%) and hips (39%). Most infections were late postoperative acute haematogenous infections (41%), with early post-operative (<30 days) and chronic infections less common. Staphylococcus aureus was the most common causative organism (38%) and debridement and implant retention (DAIR) was the main initial management strategy (61%), with a two-stage revision the next most common (25%). The median duration of IV antibiotics was 42 days, regardless of management strategy. Rifampicin was used in only 38% overall, and in only 60% in the subgroup with Gram positive infections treated with DAIR. Conclusions. There are no generally agreed upon guidelines for the management of PJI in Australia and New Zealand, and this is reflected in heterogeneity of management strategies. Acute haematogenous infections are more common, and rifampicin use less common than expected. The PIANO study has been successfully established with minimal funding and will serve as a platform for much needed interventional studies to answer important questions about PJI management including the role of rifampicin and the timing and duration of antibiotic treatment. Acknowledgements. *PIANO Study Group – Craig Aboltins, Eugene Athan, Thi Aung, Tim Blackmore, Steve Chambers, Roy Chean, Peter Choong, Benjamin Clark, Josh Davis, Nick Graves, Steven Graves, Kate Grimwade, Garry Hooper, Paul Huggan, Justin Jackson, Chris Lemoh, Peter Leung, Mark Loewenthal, David Looke, Penny Lorenc, Christopher Luey, Laurens Manning, Stephen McBride, Sarah Metcalf, Nora Mutalima, Vana Nagendra, David Paterson, Kerry Read, Alistair Reid, Owen Robinson, Marjoree Sehu, Yuen Su, Archana Sud, Adrienne Torda, Ashley Watson and Piers Yates. The PIANO study is supported by a research grant from Hereus Medical; they played no role in study design, data analysis or the decision to publish

To determine the risk of total knee replacement (TKR) for primary osteoarthritis (OA) associated with overweight/obesity in the Australian population. This population-based study analyzed 191,723 cases of TKR collected by the Australian Orthopaedic Association National Joint Registry and population data from the Australian Bureau of Statistics. The time-trend change in incidence of TKR relating to BMI was assessed between 2015-2018. The influence of obesity on the incidence of TKR in different age and gender groups was determined. The population attributable fraction (PAF) was then calculated to estimate the effect of obesity reduction on TKR incidence. The greatest increase in incidence of TKR was seen in patients from obese class III. The incidence rate ratio for having a TKR for obesity class III was 28.683 at those aged 18-54 years but was 2.029 at those aged >75 years. Females in obesity class III were 1.7 times more likely to undergo TKR compared to similarly classified males. The PAFs of TKR associated with overweight or obesity was 35%, estimating 12,156 cases of TKR attributable to obesity in 2018. The proportion of TKRs could be reduced by 20% if overweight and obese population move down one category. Obesity has resulted in a significant increase in the incidence of TKR in the youngest population in Australia. The impact of obesity is greatest in the young and the female population. Effective strategies to reduce the national obese population could potentially reduce 35% of the TKR, with over 10,000 cases being avoided

Slipped Capital Femoral Epiphysis (SCFE) is a common paediatric disorder with documented racial predilection. No data exists regarding the Australian indigenous and Australian non-indigenous populations. This study provides a comprehensive demographic and epidemiologic analysis of SCFE in South Australia, with emphasis on establishing associations between increasing obesity and incidence. A demographic review of all cases of SCFE managed in South Australian public hospitals between 1988 and 2007 was performed. Clinical presentation, surgical management and complication profile information was collected. Given that obesity is implicated in the biomechanical causation of SCFE due to increased shearing forces, particular emphasis was placed on gathering weight, race, gender and age data. A profile of the incidence and nature of SCFE was generated. Comparisons were then drawn between this profile and existing epidemiologic percentile data of weight, age and gender in South Australia. A rising prevalence of obesity in South Australia corresponded with a rising incidence of SCFE. However, this relationship was not linear as the incidence of SCFE has doubled in the last 20 years and the average weight of SCFE patients has increased markedly. The indigenous population was found to have higher rates of obesity than the non- indigenous population in South Australia. The indigenous population also has a relative risk of developing a SCFE of over three times the non-indigenous population. The overall rate of complications in South Australian public hospitals was low, with avascular necrosis being recognised in our profile. The rise in incidence of SCFE in South Australia; especially noticeable in the indigenous population is associated with an increasing prevalence of obesity. The considerable morbidity associated with SCFE was confirmed in our analysis and further highlights the importance of public health initiatives to tackle obesity in our community

Australia is a foundation member of the Asia Pacific Orthopaedic Association—thus, recognising our geographical position in the most rapidly advancing region in the world. It is a serious mistake to think of Asia as ‘third world’. Research, education and surgical techniques are at the forefront of modern technology. Australia has to be a part of this ‘learn and teach’ movement. We have much to gain through exchange and travelling fellowships; paediatric, spinal, trauma and arthroplasty fellowships are available. The Orthopaedic Sports Medicine Travelling Fellowship is co-ordinated with corresponding organisations in Europe, North America and South America and previous travelling fellows become part of the influential Magellan Society. APOA has many sections (knee, hip, hand, spine, trauma, infection, sports medicine and paediatrics), with each having regular Congresses. Join APOA and attend the Triennial Congress in Taipei November 2010 and be impressed at the level of research

Initially, all surgeons in Australia were generalists and those with an interest in the anatomy of the hand performed hand surgery. Early hand surgeons, such as Benjamin Rank, excelled and Rank and Wakefield's Textbook of Hand Surgery was widely used throughout the world. Eventually, groups of like-minded surgeons formed the Australian Hand Club in 1972, which subsequently became formalised as The Australian Hand Surgery Society (AHSS), in 2001. A very high standard of hand surgery has been achieved in Australia, with most hand surgeons having trained in either plastic surgery or orthopaedic surgery, and then further trained in Fellowships in Europe or North America. Bernard O'Brien and John Hueston achieved international recognition in the field of microsurgery and Dupuytren's surgery. Wayne Morrison has been responsible for pioneering work in toe–to–hand transfer and basic research. Tim Herbert changed the way fractures of the scaphoid are managed throughout the world. In 2007 the AHSS commenced a Travelling Fellowship Programme to facilitate an increased involvement in Australia in academic hand surgery and to foster contacts between hand surgeons of the future. At the present time, the AHSS is concentrating on education and training in order to raise the overall standard of management of hand surgery, particularly in relation to after hours' trauma. This is particularly necessary in rural and regional areas where hand surgery has traditionally been treated by occasional practitioners. There is a risk that hand surgery falls between the two stools of plastic surgery and orthopaedic surgery and the AHSS wishes to further formalise training and education within the Royal Australasian College of Surgeons (RACS) as a single training stream in the future. There are potential threats both within and without, with safe working hours a particular threat in relation to reducing both the quantity and quality of training. The future will almost certainly involve greater emphasis on biomaterials and prosthetic compounds, but trying to ensure a uniformly high standard of hand surgery management throughout the country will remain as a primary focus

Aim. Culture negative (CN) prosthetic joint infections (PJI) account for approximately 10% of all PJIs and present significant challenges for clinicians. We aimed to explore the significance of CN PJI within a large prospective cohort study, and to compare their characteristics and outcomes with culture positive cases. Methods. The Prosthetic joint Infection in Australia and New Zealand Observational (PIANO) study is a prospective, binational, multicentre observational cohort study conducted at 27 hospitals between July 2014 and December 2017. We compared baseline characteristics and outcomes of all patients with culture negative (CN) prosthetic joint infection (PJI) from the PIANO cohort with culture positive (CP) cases. “Treatment success” was defined as absence of clinical or microbiological signs of infection, no need for ongoing antibiotics, and no need for revision or resection arthroplasty since the end of the initial treatment. We also describe PJI diagnostic criteria in the CN cohort and apply internationally recognised PJI diagnostic guidelines. Results. Of the 650 patients eligible for inclusion, 55 (8.5%) were CN and 595 were CP. Compared with the CP cohort, CN patients were more likely to be female [32 (58.2%) vs 245 (41.2%); p=0.02], involve the shoulder joint [5 (9.1%) vs. 16 (2.7%); p=0.03] and have a lower mean C-reactive protein (142 mg/L vs. 187 mg/L; p=0.02). Overall, outcomes were superior in CN patients, with culture negativity an independent predictor of treatment success at 24 months (aOR 3.78; 95%CI 1.65 – 8.67). Of the 55 CN cases meeting Infectious Diseases Society of America (IDSA) diagnostic criteria, 45 (82%) met European Bone and Joint Infection Society (EBJIS) criteria (probable or definite) and 39 (71%) met the 2013 Musculoskeletal Infection Society (MSIS) criteria. Conclusions. Culture negativity is an independent predictor of treatment success in PJI. It is unclear whether this is because some of them are not actually infections, or for other reasons such as lower bacterial load or earlier effective antibiotic treatment. Diagnostic criteria for PJI vary substantially in their sensitivity, with MSIS criteria being the least sensitive. Acknowledgements. This work is being presented on behalf of the broader PIANO investigators and the Australasian Society for Infectious Diseases Clinical Research Network. The PIANO study received seed funding from Heraeus Medical and the John Hunter Hospital Charitable Trust Fund

Introduction There are no reports on the epidemiology of revision hip arthroplasty in Australia. The aim of this study was to characterise the epidemiology of revision hip arthroplasty in relation to primary hip replacements in Australia. Methods This study covered the seven year period 1993/1994 to 1999/2000. Data on all primary hip replacements and revisions done were obtained from the Australian Institute of Health and Welfare using the ICD-9 (81.53) and ICD-10 (Block No. 1492) cartegorisation. The data was stratified by age (five year age groups), sex, year and state or territory. Log linear modelling was used to examine the rate of revision procedures out of the total number of procedures (primary and revision). The effects of gender, age and year were examined in a series of hierarchical log-rate models (Poisson Loglinear Regression). Results For the period of the study there were 18,027 revision cases and 122,595 cases of primary hip replacement, representing a revision rate of 14%. The rate of increase of primary hip replacements was significantly higher than the rate of increase of revisions (t= −12.1, p< 0.0005). The number of primary hip replacements performed nationally increased by 810 (95% confidence intervals 658,964) a year. The number of revisions increased by only 62 (95% confidence intervals 21,104) a year. The proportion of revisions decreased by 0.3% per year as determined by regression analysis. The hierarchical log-rate models indicate significant interactions between age and gender and beween age and year. Conclusions The number of primary and revision hip replacements has been increasing with time. The rate of increase of revision hip replacements has been lower. The proportion of hip replacements that are revisions has been gradually dropping, probably due to a greater increase in the number of primary hip replacements

Introduction: THR and TKR have been shown to be successful treatments for moderate to severe osteoarthritis of the hip and knee. The requirement for total joint replacement will increase as the population ages. This study reports on the incidence of THR and TKR in an Australian population. Method: Age and gender specific numbers of THR and TKR for the Australian population, 1994–1998 were obtained from the Australian Institute of Health and Welfare. The same data for South Australia, 1988–1998 were obtained from the Department of Human Services Epidemiology Branch. The incidences were calculated and tested for changes over time. Results: For the Australian population in 1994 there were 9,120 THR and by 1998 this had increased by 25.9% to 11,488 THR. There were 10,132 TKR in 1994 and by 1998 this had increased by 42.8% to 14,472 TKR. Stratified by age group changes in incidence rate with respect to time was statistically tested using regression analysis. For the eleven year data from South Australia there was a significant increase in the overall incidence of THR (p=0.012). There were significant increases in TKR incidence, although this increase was not uniform across all age groups (p< 0.001). The increase in TKR incidence was greater than that for THR. For both THR and TKR there were no significant differences on the basis of gender. Conclusion: The incidence of THR is increasing in Australia and TKR incidence is increasing at a greater rate. Future projections must take into account these changing incidences as well as changes in population demographics

There has been significant advancement in the principles and practices of Tissue Banking in Australia over the last two years. Those advances relate to scientific development, regulatory modulation and inter-relationships between both Federal and State governments. Licencing issues. The Therapeutic Goods Administration of the Federal Department of Health and Aged Care. Prior to 1997, Code of Ethics. Formal government regulations. Code for Good Manufacturing Practice Freeze dried materials. First national licence. Synthetic osteogenic proteins Centralisation of processing. Number of Tissue Banks in Australia. Considerable variation amongst Tissue Banks. Financial statistics. Difficulty in attaining and maintaining TGA licence. Inherent inefficiencies. Core activities. Nonstandardisation of processing regimen. International precedence. Further potential benefits. Consideration by Federal Government through Health Minister’s Advisory Council. Probable end point

Aims. This study describes the Osseointegration Group of Australia’s Accelerated Protocol two-stage strategy (OGAAP-1) for the osseointegrated reconstruction of amputated limbs. Patients and Methods. We report clinical outcomes in 50 unilateral trans-femoral amputees with a mean age of 49.4 years (24 to 73), with a minimum one-year follow-up. Outcome measures included the Questionnaire for persons with a Trans-Femoral Amputation, the health assessment questionnaire Short-Form-36 Health Survey, the Amputation Mobility Predictor scores presented as K-levels, 6 Minute Walk Test and timed up and go tests. Adverse events included soft-tissue problems, infection, fractures and failure of the implant. Results. Our results demonstrated statistically significant improvements in all five outcome measures. A total of 27 patients experienced adverse events but at the conclusion of the study, all 50 were walking on osseointegrated prostheses. Conclusion. These results demonstrate that osseointegrated prostheses are a suitable alternative to socket-fit devices for amputees experiencing socket-related discomfort and that our strategy offers more rapid progress to walking than other similar protocols. Cite this article: Bone Joint J 2016;98-B:952–60

This study aims to explore the trend in spine fusion surgery in Australia over the past 10 years and to explore the possible influence of health insurance status (private versus public) on the rate of surgery. Data pertaining to the rate of lumbar spine fusion from 1997 to 2006 were collected. Data on publicly performed procedures in NSW were obtained from Inpatient Statistics Collection of NSW Health, and data on privately performed procedures were obtained from Medicare Australia Statistics. Population data was obtained from the Australian Bureau of Statistics. Data on total hip and total knee arthroplasties performed were collected to provide a comparator. Health insurance coverage was also investigated to control for insurance status, this data was obtained from the Private Health Insurance Administration Council. There has been a slowly declining trend in the number of publicly performed spinal fusion procedures over the past 10 years, falling by 63% from 1997 to 2006 in NSW. In comparison, privately performed spinal fusion procedures have increased by 166% over the same 10 year period. Compared to spine fusion, the rates of total hip and total knee replacement procedures in the public sector of NSW have fallen by smaller proportions (58.9%% and 42.1%, respectively) over the same 10 year period. The increase in privately performed joint replacements has been less than that seen for spine fusion, with increases of 120% and 74%% for knee arthroplasties and hip arthroplasties, respectively. In 2006, spine fusion surgery was 10.8 times more likely to be done in the private sector than in the public sector, compared to corresponding figures of 4.2 times and 3.0 times for knee replacement and hip replacement, respectively. Our study has demonstrated that there is a disproportionately high rate of spine fusion procedures performed in the private sector. Possible explanations for this difference include: over servicing in the private sector, under servicing in the public sector, differences in medical referral patterns, surgeon and patient preferences, and financial incentives

Introduction: Slipped Capital Femoral Epiphysis (SCFE) is the most common hip problem of adolescence. Obesity and African and Pacific Islander races have been associated with increased susceptibility. In the setting of increasing rates of obesity in Australian adolescents over the last twenty years, it is unknown whether the incidence of this condition is increasing. There are no studies to date on the Australian population and it is unknown whether there is an increased incidence in the local Aboriginal population. Aims: The demographics of SCFE patients presenting to the Women’s and Children’s Hospital (W& CH) in Adelaide were studied, from 1988 to the present, with particular emphasis on weight and race. This was then compared to weight for age percentiles data in the Australian population. The issues of prophylactic pinning of the contralateral side and the efficacy of the department protocol of “pinning in situ” were also studied. Method: Systematic chart review, statistical analysis, and comparison with data from the Australian Bureau of Statistics and the Centre for Applied Anthropometry, University of South Australia, pertaining to weight and racial mix in South Australia. Results: SCFE was associated with obesity. Over 45% of the cohort was above the 95th percentile for weight. The mean weight was in the 85th percentile and the median weight was in the 94th percentile. As an example, the average weight of children aged 12 to 14 years was 13kgs more than the median value of children in this age group. There was a clear increase in incidence of this condition over the last twenty years which corresponds with increasing obesity rates in the community. There was a higher incidence in the indigenous population as compared with the non-indigenous population. Out of the 236 patients enrolled, 5 cases were complicated by avascular necrosis. The overall complication rate was low. Rate of progression to contralateral slip was low as was the rate of prophylactic pinning. Conclusions: Our complication rate when compared to other centres is relatively low and would seem to support our consistent protocol of “pinning in situ”. The low rate of progression to contralateral slip also supports our protocol of watchful surveillance rather than mandatory prophylactic pinning of the contralateral side. We have shown that SCFE is associated with obesity in Australia when compared with general population data. Obesity is also more common in the Aboriginal population and we postulate that this explains the higher incidence of SCFE in this group. In keeping with increasing rates of obesity amongst Australian adolescents, the increasing incidence of this condition further highlights the importance of public health initiatives to tackle obesity in the community

Aims

Tenosynovial giant cell tumour (TGCT) is a rare benign tumour of the musculoskeletal system. Surgical management is fraught with challenges due to high recurrence rates. The aim of this study was to describe surgical treatment and evaluate surgical outcomes of TGCT at an Australian tertiary referral centre for musculoskeletal tumours and to identify factors affecting recurrence rates.

To examine surgeon supervision in orthopaedic trauma in Australia. An Australia-wide cross-sectional survey was performed using a mass electronic mail-out distributed to members of the Australian Orthopaedic Association. Rates of supervision for six common operations (tibial nailing, femoral nailing, hip hemiarthroplasty, hip fracture fixation, ankle fracture fixation, paediatric supracondylar fracture). Other factors recorded included; payment type, hospital type, state, seniority, theatre availability, and trauma load. Responses were tabulated and analysed using SAS software. 21.9% of surgeons completed the survey, out of 739 surgeons who were sent the e-mail invitation. Univariate analysis showed increased supervision to be associated with; more junior consultants, regional and rural hospitals, state (NSW and Victoria), and method of payment (fee for service). However, multivariate analysis showed that fee for service payment (compared to sessional payment) was the only factor significantly associated with increased supervision for all operations surveyed. Higher remuneration for surgeons may increase supervision rates of trainees

Current evidence suggests that in Australia more than 80% of individuals are not receiving treatment for osteoporosis following an initial osteoporotic fracture. The earliest opportunity to identify many individuals with osteoporosis is following their first osteoporotic fracture, which is usually less severe than subsequent fractures. As these fractures are usually treated by orthopaedic surgeons it was decided to survey Australian orthopaedic surgeons to determine their understanding, attitudes and involvement in the management of osteoporosis. Methods: The AOA in conjunction with the BJD distributed a questionnaire to 945 members. The results of 449 (48%) returned questionnaires were collated and sent to the Swedish National Competence Centre for Musculo-skeletal Disorders for analysis. Results: Responding surgeons claimed to treat at least 24,000 osteoporotic fractures per year. Sixty per cent felt they had ‘none’ or ‘insufficient’ training in osteoporosis and considered they had ‘no’ or only ‘slight knowledge’ in managing the condition. Approximately 65% of surgeons either ‘never’ or only ‘sometimes’ initiated investigation or treatment of patients with osteoporotic fractures; only 11% ‘always’ or ‘very often’ initiated investigation or treatment. If an osteoporotic fracture is suspected most (70%) refer to a GP or osteoporosis specialist, with only 22% evaluating the condition themselves. Although 46% claimed that they referred patients for a BMD study always or most of the time, only 14% did so routinely. Fifty percent felt it was the GP’s responsibility to identify and initiate the evaluation of the underlying osteoporosis of patients with fragility fractures, compared with 29% who considered that this was the orthopaedic surgeon’s responsibility. Eighty five per cent of the respondents do not prescribe any pharmacological treatment for osteoporosis management. Most commonly (36%) there was a preference for surgery rather than drug prescription. Twenty four percent had access to a specific osteoporosis team for treating osteoporosis. No experience with treating osteoporosis (23%) and no formal education in osteoporosis (16%) were other common reasons. Very few orthopaedic surgeons felt it was their responsibility to treat osteoporosis, however 52% were interested in attending a course on osteoporosis. The findings are contrasted with those of an international study conducted by the Bone and Joint Decade and the International Osteoporosis Foundation, using the same questionnaire. Conclusions: The evidence of under- treatment of osteoporosis after first fragility fractures, suggests that it may be necessary for orthopaedic surgeons to re-evaluate their approach to the management of osteoporosis, either by themselves or others. Further educational opportunities in this area should be considered

Hip resurfacing arthroplasty (HRA) is a bone conserving alternative to total hip arthroplasty. We present the early 1 and 2-year clinical and radiographical follow-up of a novel ceramic-on-ceramic (CoC) HRA in a multi-centric Australian cohort.

Patient undergoing HRA between September 2018 and April 2021 were prospectively included. Patient-reported outcome measures (PROMS) in the form of the Forgotten Joint Score (FJS), HOOS Jr, WOMAC, Oxford Hip Score (OHS) and UCLA Activity Score were collected preoperatively and at 1- and 2-years post-operation. Serial radiographs were assessed for migration, component alignment, evidence of osteolysis/loosening and heterotopic ossification formation.

209 patients were identified of which 106 reached 2-year follow-up. Of these, 187 completed PROMS at 1 year and 90 at 2 years. There was significant improvement in HOOS (p< 0.001) and OHS (p< 0.001) between the pre-operative, 1-year and 2-years outcomes. Patients also reported improved pain (p<0.001), function (p<0.001) and reduced stiffness (p<0.001) as measured by the WOMAC score. Patients had improved activity scores on the UCLA Active Score (p<0.001) with 53% reporting return to impact activity at 2 years. FJS at 1 and 2-years were not significantly different (p=0.38). There was no migration, osteolysis or loosening of any of the implants. The mean acetabular cup inclination angle was 41.3° and the femoral component shaft angle was 137°. No fractures were reported over the 2-year follow-up with only 1 patient reporting a sciatic nerve palsy.

There was early return to impact activities in more than half our patients at 2 years with no early clinical or radiological complications related to the implant. Longer term follow-up with increased patient numbers are required to restore surgeon confidence in HRA and expand the use of this novel product.

In conclusion, CoC resurfacing at 2-years post-operation demonstrate promising results with satisfactory outcomes in all recorded PROMS.

Arthrogryposis multiplex congenita is believed to be a specific clinical entity which is aetiologically unrelated to the "arthrogryposis-like" deformities of known neurological diseases such as myelomeningocele and myelodysplasia. The observation that the condition appeared to be three times as common in Melbourne, Australia, as in four centres in the United Kingdom (Wynne-Davies and Lloyd-Roberts 1976), prompted this survey of 132 patients: 73 from the United Kingdom, 34 from Australia and 25 from Wilmington, Delaware, USA. The survey aimed to established the same criteria for diagnosis in the three countries and to search for prenatal and genetic aetiological factors. It was shown that all centers treated more newborn children with this disorder during the 1960s than either before or after that period. All cases were sporadic and there was no family association with talipes equinovarus, congenital dislocation of the hip or hereditary neuromuscular disease. "Environmental" findings from all three centers were similar and it was concluded that arthrogryposis multiplex cogenita is a non-genetic disease of early pregnancy, associated with a variety of unfavourable intra-uterine factors. In addition, an unknown but possibly viral environmental agent may have been present to a significant extent only during recent decades and is now declining

Introduction and Aims: The use of resurfacing hip replacements has increased dramatically in recent years. The aim of this study was to compare the early results of this treatment with conventional cemented, cementless and hybrid primary total hip replacement in Australia. Method: The data used for this report included all conventional primary total hip and resurfacing procedures, as well as any subsequent revisions of those procedures which had been undertaken and reported to the Australian Orthopaedic Association National Joint Replacement Registry (AOA NJRR) before 31 December 2002. Analysis included the determination of demographics, components used and method of fixation. Early revision rates and reasons for failure were also assessed. The AOA NJRR commenced data collection in September 1999 and has had national coverage since 2002, therefore any results reported at this stage are early outcomes. Results: Almost 33,000 primary total hip replacements were recorded, of these 2130 were resurfacing procedures (6.5%). This proportion of resurfacing was consistent across states with the exceptions of Victoria (11%) and Tasmania (0.6%). Cementless hip replacement was the most common form of primary total hip replacement (41%) with hybrid (34%) and cemented (18.2 %) less common. There was marked state variation in the proportion of cemented and cementless fixation with NSW having a low proportion of cement fixation (4.5%). Early revision rates for cemented conventional primary total hip replacement are significantly less compared to cementless and hybrid hips (cemented v cementless) hazard ratio (adjusted for age and sex) 2.13; 95% CI (1.49, 3.05) p< 0.0001) (cemented v hybrid) hazard ratio (adjusted for age and sex) 1.94; 95% CI (1.37, 2.77) p=0.0002). There was no difference between cementless and hybrid hips. The most common reason for early revision was dislocation and the risk of this was related to head size with larger sizes showing a reduced risk. Although revisions per 100 observed component years were higher for resurfacing hip replacements than for conventional hips (1.73 v 1.18), this difference was not statistically significant. The principal reason for early failure of resurfacing hips was fracture. Conclusion: The AOA NJRR has identified prosthesis specific differences in early outcomes and failure mechanisms following primary total hip replacement. Continued monitoring of existing and new prostheses will provide surgeons with independent quality information to assist in the selection of the most appropriate prostheses for particular clinical situations

The aim was to investigate the outcomes of patients admitted with orthopaedic injuries to adult Level 1 trauma centres. All patients admitted to the two Level 1 adult trauma centres in Victoria, Australia were registered by the Victorian Orthopaedic Trauma Outcome Registry (VOTOR). Baseline data collected included age, gender and injury cause, diagnosis and management. Patients were contacted 6 months after their trauma. Pain, disability, health related quality of life and work status were determined using visual analogues scales, global disability scales, SF12 and the work subscale of the Sickness Impact Profile. Patients were categorized into 3 groups: isolated orthopaedic injury alone, multiple orthopaedic injuries alone and orthopaedic injuries and other injuries. Non-parametric tests were used to compare outcomes across these groups. Six month outcomes were determined in 75.6% of 1181 eligible patients. The patients lost to follow-up were more likely to be male, younger and have isolated injuries than those who were available for follow-up. Patients reported ongoing pain (moderate-severe pain 37.2%), disability (79.5%) and inability to return to work (35.2%). Poorer outcomes were evident in those who had other injuries than those with isolated or multiple orthopaedic injuries alone. A large proportion of patients presenting to adult Level 1 trauma centres have ongoing pain and disability and a reduced capacity to work 6 months after orthopaedic injuries. Further research into the long-term outcomes of these patients is required to identify patient sub-groups and specific injuries and treatments that result in high morbidity

Introduction: There are no current estimates of the risk of transmission of HIV, HBV, HCV, or HTLV by musculoskeletal tissue transplantation. Such accurate data would be helpful to determine the effectiveness of current and proposed screening and processing procedures, and contribute to increased confidence in the use of musculoskeletal tissue products. Methods: The prevalence rates of HIV, HBV, HCV, and HTLV were determined from 12.245 musculoskeletal tissue donors from three bone tissue banks across Australia from the period 1993 to 2004. The incidence rates among tissue donors were estimated by comparing the data with age-specific incidence rates of first-time blood donors. We estimated the probability of a tissue donor was within the window period when infection was undetected by serological screening procedures by the modified incidence-window period model. Further we calculated the projected probability of viremia with the addition of nucleic-acid amplification testing (NAT). Results: The prevalence (per 100,000 persons) of confirmed positive tests among musculoskeletal tissue donors was 169.15 for HIV, 427.68 for HBV, 534.63 for HCV, and 121.66 for HTLV. This is greater than the prevalence among first-time blood donors during the same period (6.47 for HIV, 136.00 for HBV, 215.29 for HCV, and 3.46 for HTLV). The incidence rate among musculoskeletal donors were estimated to be 15.81, 0.68, 3.53, and 4.85 per 100,000 person-years, respectively. The estimated probability of viremia (per 100,000 persons) at the time of donation was 1.38 for HIV, 0.46 for HBV, 1.82 for HCV, and 0.85 for HTLV. These estimations would be even lower with the addition of NAT – 0.57, 0.23, and 0.20 respectively. Conclusions: The prevalence and incidence of HIV, HBV, HCV, and HTLV among musculoskeletal tissue donors, although low are significantly higher than those of first-time blood donors. Current screening and processing measures are effective, though the probability of viremia can be reduced further by nucleic-acid amplification testing