It costs the NHS £2billion/year to treat 70000 hip fractures. Following hemiarthroplasty a departmental x-ray is standard practice. During 2009 217 hemiarthroplasties were performed in our unit. 210 had postoperative radiographs (148 departmental, 62 in theatre). All patient demographics were considered and hospital costs accounted for. Mean patient age was 83 (55-100) years. Mean theatre times were 120 (51-213) minutes in the departmental x-ray group and 128 (74-187) minutes in the theatre imaging group. Hospital stay was decreased from 12.8 (3-41) days in the departmental x-ray group to 11.8 (3-32) days in the theatre imaging group. Orthopaedic beds cost £136/day. Departmental x-rays give a radiation dose of ∼12mGy and costs £48.30, theatre imaging gives ∼0.26mGy with no additional cost given the radiographers previous allocation to the list. Changing our practice to intra-theatre imaging has improved patient safety, reduced the average inpatient stay and saves our trust approximately £40,000 annually.
Most studies about hemi-arthroplasty of hip have focused on clinical aspects. Design features of various implants of hemi-arthroplasty have not been studied extensively. The aim was to investigate the relationships between radiological variables and possible mode of failure in various hemiarthroplasty implants in intracapsular neck of femur fractures. A retrospective review of 42 hemi hip arthroplasties, Austin Moore and Thompson prosthesis by Biomet, Medical Product Service (Tipsan) and Smit Medimed (SMPL) used in our hospital. Controversy exists between indication for a particular design in an unselected series of patients once excluding the choice of cementing or uncementing the prosthesis. In monoblock prosthesis not only the head-neck region affects the stability but also the stem fit in proximal femur. Surgeon preference to technique and approach excluded. Premorbidly all patients were mobilising independently. 5 criteria reviewed. 1) head size of prosthesis 2) neck length 3) prosthesis stem shaft angle 4) stem-cortical distance ratio and 5) shape of the femoral canal as classified by Dorr. Head size compared in AP views of involved hip and normal head size compared with that of prosthesis. A difference <2 mm or >3 mm indicative of incorrect size. Neck length measured by the vertical distance from center of head to superior aspect greater trochanter was zero. A range of +/− 5 mm was acceptable. Neck shaft angle with a difference of >5 degrees was indicative of varus position of the stem. Canals of the proximal femoral categorized as a) stove pipe b) champagne c) fluted varieties radiologically. X-ray magnification corrected. All measurements were done on immediate postoperative radiographs. Stability of various design features of straight stemmed and curved implants are dependant on the anterior bowing angle and canal ratio of femur to prosthesis. A prospective study with CT from selected shapes of the proximal femoral is being carried out. Inappropriate head size as reported by Thompson or neck length was related to incidence of dislocation resulting in failure. Our findings emphasise importance of careful selection of a particular implant design towards the morphology of the femoral canal.
Following the recommendation of NICE guidelines (CG124) we have recently started using cemented smooth tapered stem hemiarthroplasty as our standard management of intra-capsular neck of femur fractures. Prior to publication of the above guidelines the standard implant utilised was Thompson Hemiarthroplasty prosthesis. The cost implications of this change have not been fully appreciated and the benefit of these changes in ASA grade 3–4 patients has not previously been analysed. We identified a cohort of 89 patients admitted with displaced intra-capsular neck of femur fracture with an ASA grade 3–4. These underwent hip hemiarthroplaties at our centre over a period of 12 months (before and after guideline implementation). Data regarding in-hospital mortality, dislocation, reoperation and place of discharge were retrospectively collected and analysed. Our cohort included 46 patients who underwent a Thompsons Hemiarthroplasty, 30 patients who had a cemented smooth tapered stem hemiarthroplasty and 13 patients who had an Austin-moore Hemiarthroplasty. In-patient mortality rates were highest in the Austin-moore group, followed by the Thompsons group compared to none in the smooth tapered stem group. However, this was not statistically significant. One patient in the Thompsons group and one patient in the smooth tapered group had multiple dislocations and re-operations, compared with none in the Austin-moore group. In terms of percentage of patients who were discharged home from hospital the smooth tapered stem group had a percentage that was more than twice that of the Thompson's which was in turn higher than that found in the Austin-moore group. In conclusion, our data suggests that in patients with an ASA grade of 3–4 there is no significant benefit from using cemented smooth tapper stems when performing a Hip Hemiarthroplasty compared with a well performed Thompsons and that the cost savings of this is significant. We accept that our current numbers are relatively small and further work is needed.
Bone and joint infections of the lower limbs cause significant morbidity for patients. Infection is a devastating complication for prosthetic joint replacements. In this large case series from a single centre in the NE of England, we present our experience of using antibiotic impregnated dissolvable synthetic pure calcium sulphate beads [Stimulan R]1 for local elution of antibiotics at the site of infection. At our centre, from August 2012 to Jan 2015, antibiotic impregnated dissolvable synthetic pure calcium sulphate beads [Stimulan R]1 was used for local elution of antibiotics in 45 patients with lower limb bone or joint infections. Tailored plans were made by Orthopedic surgeon and Microbiologist MDTs based on bacteria and sensitivities. Cases included 20 THR, 13 TKR, 5
