Pelvic discontinuity is a separation through the acetabulum with the ilium displacing superiorly and the ischium/pubis displacing inferiorly. This is a biomechanically challenging environment with a high rate of failure for standard acetabular components. The cup-cage reconstruction involves the use of a highly porous metal cup to achieve biological bone ingrowth on both sides of the pelvic discontinuity and an ilioischial cage to provide secure fixation across the discontinuity and bring the articulating hip center to the correct level. The purpose of this study was to report long term follow up of the use of the cup-cage to treat pelvic discontinuity.

All hip revision procedures between January 2003 and January 2022 where a cup-cage was used for a hip with a pelvic discontinuity were included in this retrospective review. All patients received a Trabecular Metal Revision Shell with either a ZCA cage or TMARS cage (Zimmer-Biomet Inc.). Pelvic discontinuity was diagnosed on pre-operative radiographs and/or intraoperatively. Kaplan-Meier survival analysis was performed with failure defined as revision of the cup-cage reconstruction.

Fifty-seven cup-cages in 56 patients were included with an average follow-up of 6.25 years (0.10 to 19.98 years). The average age of patients was 72.09 years (43 to 92 years) and 70.2% of patients were female. The five year Kaplan-Meier survival was 92.0% (95% CI 84.55 to 99.45) and the ten year survival was 80.5% (95% CI 58.35 to 102.65). There were 5 major complications that required revision of the cup-cage reconstruction (3 infections and 2 mechanical failures). There were 9 complications that required re-operation without revision of the cup-cage reconstruction (5 dislocations, 3 washouts for infection and one femoral revision for aseptic loosening).

In our hands the cup-cage reconstruction has provided a reliable tool to address pelvic discontinuity with an acceptable complication rate.

The purpose of this study is to review the current treatment of Colles fractures by long term follow up and to compare these results with a similar paper published in 1965 by G.B. Smail. And secondly, to evaluate the degree of bone density in these patients and to see what, if any, treatment is being received in those with evidence of osteopenia.

The records and radiographs of 82 patients treated at Hutt Hospital between January 1997 and January 1998 were reviewed. Of these, thirty-two attended for re-examination. Subjective measures of pain, appearance and functional limitations were recorded, as were complications and whether the wrist had reached a stable state.

Anterior-posterior and lateral radiographs of both wrists were taken, from which measurements of residual dorsal tilt and shortening of radius were made.

Of the thirty two patients that presented for re-examination twenty went on to have bone density measurements.

When comparing results from two similar studies, spaced thirty seven years apart, subjective findings show that from a functional and appearance perspective there appears to be little difference between the two cohorts. With respect to pain, patients treated in 1997 complained of a lot less residual pain compared to those treated in 1960.

Objectively, the range of movement in the wrist joint was once again found to be similar in the two cohorts, as was the range of movement in shoulder, elbow appeared to be similar. Finger movement was difficult to compare.

Radiologically the degree of ventral dorsal tilt does not correlate with range of movement at the wrist.

Bone density scan results suggest that the majority of patients with evidence of osteoporosis are not been treated appropriately.

Overall conclusion is that the outcome for treatment of Colles’s fractures has not changed significantly in the past thirty seven years.

Aim

The gold standard treatment for late acute hematogenous (LAH) periprosthetic joint infection (PJI) is surgical debridement, antibiotics and implant retention (DAIR). However, this strategy is still controversial in the case of total knee arthroplasty (TKA) as some studies report a higher failure rate. The aim of the present study is to report the functional outcomes and cure rate of LAH PJI following TKA treated by means of DAIR at a long-term follow-up.

Introduction: The treatment of “congenital hip disease” by total hip arthroplasty is now well established, but the indications for this type of surgery, the preoperative planning, the selection of the stem and the technique to be followed are still open to debate. Aim of the study: The purpose of this study is to analyse the long-term follow up after use of the cementless-system (CLS) femoral component designed by Spotorno in dysplastic or congenitally dislocated hips. Material and Methods: Our study includes 70 hips in 59 patients, 49 females and 10 males, 36 left hips and 34 right hips that treated with total hip arthroplasty from 1987 to 2000. The mean age of the patients was 48.5 years (range 34–74 years). Forty-one hips were congenitally dislocated and twenty-nine were severe dysplastic. Preoperative planning with CT and CAD-CAE system were used for selection of the stem. 11 patients had bilateral total hip arthroplasties with Spotorno CLS stem. Many different cups were used. Results: The mean follow up was 8.1 years (range 2–14 years). No patients were lost during the follow-up period. Patients were evaluated clinically with Merle d’ Aubigne and Postel hip score. There was a significant postoperative clinical improvement of the mean pain score by 3.7 points, of walking ability by 2.2 points and of motion by 2, 6 points. Thigh pain was not reported. There were no deep infections or mechanical loosening that required revision of the femoral component. Conclusions: Although, the femoral component Spotorno CLS is used to every kind of hip diseases, had excellent long-term clinical results in adults, with dysplasia or congenital hip dislocation. Spotorno CLS uncemented femoral component represents an attractive option for adults with “congenital hip disease”

INTRODUCTION: The treatment of “congenital hip disease” by total hip arthroplasty is now well established, but the indications for this type of surgery, the preoperative planning, the selection of the stem and the technique to be followed are still open to debate. AIM OF THE STUDY: The purpose of this study is to analyse the long-term follow up after use of the cementless-system (CLS) femoral component designed by Spotorno in dysplastic or congenitally dislocated hips. MATERIAL AND METHODS: Our study includes 70 hips in 59 patients, 49 females and 10 males, 36 left hips and 34 right hips that treated with total hip arthroplasty from 1987 to 2000. The mean age of the patients was 48.5 years (range 34–74 years). Forty-one hips were congenitally dislocated and twenty-nine were severe dysplastic. Preoperative planning with CT and CAD-CAE system were used for selection of the stem. 11 patients had bilateral total hip arthroplasties with Spotorno CLS stem. RESULTS: The mean follow up was 8.1 years (range 2–14 years). No patients were lost during the follow-up period. Patients were evaluated clinically with Merle d’ Aubigne and Postel hip score. There was a significant postoperative clinical improvement of the mean pain score by 3.7 points, of walking ability by 2.2 points and of motion by 2,6 points. Thigh pain was not reported. There were no deep infections or mechanical loosenings that required revision of the femoral component. CONCLUSIONS: Although, the femoral component Spotorno CLS is used to every kind of hip diseases, had excellent long-term clinical results in adults, with dysplasia or congenital hip dislocation. Spotorno CLS uncemented femoral component represents an attractive option for adults with “congenital hip disease”

We assessed 224 patients treated with Autologous Chondrocyte Implantation performed 10–20 years ago (average 12.8 years). Average age at the time of the implantation was 33.3 years. Average size of lesion was 5.3 cm2 (range 0.6–16), while 55 patients sustained multiple lesions. The participants filled out five questionnaires. Lysholm score, Tegner-Walgren, modified Cincinnati (Noyes), Brittberg score, and KOOS were assessed. In addition, the patients were asked to grade their current situation compared to their previous follow up as better, worse of unchanged. Finally, they were asked if they would do the operation again, answering with yes or no.

The patients were divided into groups according to the location and characteristics of the cartilage lesions, or concomitant surgeries during the ACI. Assessment of the outcomes reveals a significant improvement in all groups, compared with the preoperative values.

There is no other study assessing a cartilage treatment with such a long follow up. According to the results of that study, autologous chondrocyte implantation seems to be an effective and durable solution for the treatment of large full thickness cartilage and osteochondral lesions of the knee joint

PURPOSE: Oldest elderly trochanteric fractures treatments are common but long term follow up studies are indistinct. Previous data about all outcomes are not reported for oldest one. The purpose was to update all the results for these oldest old patients.

METHODS: A prospective, longitudinal study was undertaken of 455 “31 A1, A2, A3” (OTA) peritrochanteric femur fractures through 2002. There were 84% female patients. The age was 88 (80–105) ±5 years. Associated hip arthritis rate was 10%. 31 A1 and 31 A2 really trochanteric fractures were 90% (31 A1: 52% and 31 A2: 38%), 31 A3 subtrochanteric were 10%. Surgical treatment was achieved for 97%: [extramedullary internal fixation (dynamic hip screw): 36%, intramedullary (trochanteric nail): 56%, hip arthroplasty: 5%]. Functional treatment (not displaced or contra-indicated) was achieved for 3%. Katz, mental, Parker, walking scores, live place before and at long term after fracture, radiological healing and complications were registered.

RESULTS: The radiological healing rate after 3 months was 85% and after 6 was 97%. Complications rate: the general complications rate during 1st month was 12% and between 1st and 3rd month was 8%. The local complications rate during the 1st month was 4% (local infection: 1%) and between 1st and 3rd month was < 1%. The new surgical procedures rate during the 1st month was < 0.5%, between 1st and 3rd month was 3%, between 3rd and 6th month was 3%. Clinical results: Post-operative weight bearing was uncertain. 6th month after fracture 72% of the patients were alive (dead: 28% and non-surgically treated: twice more). All scores and live place demonstrated dependence increase. > 6th month after fracture mortality was common.

CONCLUSION AND SIGNIFICANCE: Intra/extra capsular hip fractures ratio increases after 80. These are older, more dependant and help demanding. Hip arthritis inflates hip fracture risk. Success points technical procedures had been demonstrated by randomised studies: dynamic hip screws for stable fractures and trochanteric nails for unstable; hip prosthesis for arthritis or poor bone. Practice surgery for all trochanteric fractures. Don’t separate trochanteric/subtrochanteric. The prognostic is rather poor (mortality rate, functional outcomes), depending on initial functional score and dependence. Modern internal fixation is reliable. Arthroplasty should be considered.

Introduction

Acetabular bone deficiency presents one of the most challenging problems during revision hip arthroplasty. A variety of surgical options and techniques are available including impaction bone grafting. We present our medium to long-term experience of 68 consecutive hips in 64 patients who had acetabular revision using impacted cancellous bone grafting with bone cement with a mean follow up of 10.5 ±3.75) years (range 5.1 to 17.7 years).

Introduction: We compared the eight- to ten-year clinical and radiological results of the metal-on-metal Birmingham hip resurfacing (BHR) with a hybrid total hip arthroplasty (HYBRID) in two groups of 54 hips, previously matched for gender, age, body mass index and activity level.

Method: Patients were followed up in outpatients and function assessed by using the Oxford Hip Score, UCLA activity score and Euroqol score. Radiographs were assessed for osteolysis and wear. BHR were also assessed for the presence of a pedestal sign around the femoral component.

Results: The mean follow up of the BHR group was 9 years (8.17 to 10.33) and for hybrids 10 (7.53 to 14.5). Four patients had died in the hybrid group and one in the BHR. Four were lost to follow up in each group. The revision rate in the BHR group was 9.25% verses 18% in the Hybrid, a further eight patients in the hybrid group have evidence of wear and osteolysis and are intended for revision (p=0.008). One patient in the BHR group was explored for late onset sciatic nerve palsy. All patients in the hybrid group had evidence of polyethylene wear, mean 1.24mm (0.06–3.03). 90% of the BHR group had evidence of a pedestal sign.

Satisfactory function was shown in both groups. There was no significant difference between groups with respect to the OHS but the UCLA score was superior in the BHR group (p=0.008). There was no significant difference for Euroqol visual analogue score. 56% of hybrids were delighted with their hip replacement verses 65% of BHR patients.

Discussion: After ten years the hip resurfacing patients were still more active and had a lower revision burden than the hybrid hip replacements. Both groups showed worrying radiological evidence of change with long-term follow-up.

Aims

The aim of the present study was to analyze the oncological and neurological outcome of patients undergoing interdisciplinary treatment for primary malignant bone and soft-tissue tumours of the spine within the last seven decades, and changes over time.

To compare the long-term outcomes of fibular nailing and plate fixation for unstable ankle fractures in a cohort of patients under the age of 65 years. Patients from a previously conducted randomized control trial comparing fibular nailing and plate fixation were contacted at a minimum of 10 years post intervention at a single study centre. Short term data were collected prospectively and long-term data were collected retrospectively using an electronic patient record software. Ninety-nine patients from one trauma centre were included (48 fibular nails and 51 plate fixations). Groups were matched for gender (p = 0.579), age (p = 0.811), body mass index (BMI)(p = 0.925), smoking status (p = 0.209), alcohol status (p = 0.679) and injury type (p = 0.674). Radiographically at an average of 2 years post-injury, there was no statistically significant difference between groups for development of osteoarthritis (p = 0.851). Both groups had 1 tibio-talar fusion (2% of both groups) secondary to osteoarthritis with no statistically significant difference in overall re-operation rate between groups identified (p = 0.518,). Forty-five percent (n=42) of patients had so far returned patient reported outcome measures at a minimum of 10 years (Fibular nail n=19, plate fixation n=23). No significant difference was found between groups at 10 years for the Olerud and Molander Ankle Score (p = 0.990), the Manchester-Oxford Foot Questionnaire (p = 0.288), Euroqol-5D Index (p = 0.828) and Euroqol-5D Visual Analogue Score (p = 0.769). The current study illustrates no difference between fibular nail fixation and plate fixation at a long-term follow up of 10 years in patients under 65 years old, although the study is currently under powered

Introduction. It has been contentious whether an anatomic double-bundle technique for anterior cruciate ligament reconstruction (ACLR)is superior to that of a single-bundle technique. It has been hypothesized in the literature that the double-bundle technique could provide function closer to that of the anatomical knee joint. The purpose of this study was to compare the long-term clinical outcomes after single-bundle ACLR versus double-bundle ACLR. We hypothesized that the double-bundle technique would not be superior to the single-bundle technique. Methods. A retrospective, non-randomized, matched-paired comparative study was performed. Patients undergoing primary anterior cruciate ligament reconstruction, using either a double-bundle or single-bundle technique, between 2003 and 2008 were included and matched 1:1. Matching included age, sex, BMI, time from injury to surgery, side of injury and type of sport. Patients who underwent revision procedures, multiligament reconstruction or other ACLR techniques were excluded. Patients were subsequently followed up, noting occurrence of graft rupture and any other complications. Results. A total of 1377 ACLRs were performed during the study period. Seven hundred and fifty-six patients were excluded, leaving 396patients to be included in the matching (198 matched pairs). Mean follow-up time was 176.7 +/− 7.7 months (range, 166–211 months). Overall, 40 patients (10.1%) suffered from a graft rupture which consisted of 22 patients (11.1%) in the single-bundle group and 18patients (9.1%) in the double-bundle group. A multivariate analysis was performed using the Cox model and demonstrated that graft failure had no significant association with the surgical technique (hazard ratio (HR), 0.857(0.457;1.609), p=0.6313). (Figure 1) Five patients (2.5%) in the single-bundle group and 7 patients (3.5%) in the double-bundle group underwent secondary surgery for cyclops syndrome(p=0.5637). Three patients (1.5%) in the single-bundle group and 2 patients (1.0%) in the double-bundle group underwent arthrolysis(p=0.6547). Seven patients (3.5%) in the single-bundle group underwent secondary meniscectomy compared to 6 patients (3.0%) in the double-bundle group (p=0.7630). Conclusion. Double-bundle ACLR is not superior to single-bundle ACLR at long-term follow up. Therefore, orthopaedic surgeons do not need to use a double-bundle technique when performing ACL reconstruction. For any figures or tables, please contact authors directly

Abstract. Introduction. In revision knee arthroplasty, rotating hinge implants (RHK) have been considered to result in higher complication rates and lower survivorship when compared to constrained condylar implants (CCK). The aims of this study were to compare patient reported outcome measures (PROMs), complication rates and survivorship of RHK and CCK used in revision arthroplasty at a single, high volume elective orthopaedic centre with previously validated bespoke database. Methodology. One hundred and eight patients who underwent revision knee arthroplasty with either CCK or RHK and matched our inclusion criteria were identified. EQ5D, Health State and Oxford Knee Scores were collected pre-operatively and at 1 year post-operatively. Complication data was collected at 6 weeks, 6 months, 1 year and 2 years post-operatively. NJR data was interrogated, in addition to our own database, to investigate implant survival. Results. There was no statistically significant difference between RHK and CCK in implant survival at two to twelve years of follow up. In addition, we observed no statistically significant difference in the PROMs scores and complication rates of the two implants. Conclusion. This study shows that both the RHK and CCK remain viable options in revision arthroplasty, the implant survival and complication rate were comparable. We recommend prospective randomised control trials with long-term follow up to further investigate the use of CCK and RHK implants in revision knee arthroplasty

The aim of this study was to define the long-term outcome following adolescent clavicle fracture. We retrospectively reviewed all adolescent fractures presenting to our region (13–17years) over a 10-year period. Patient reported outcomes were undertaken at a minimum of 4 years post-injury (QuickDASH and EQ-5D) in completely displaced midshaft fractures (Edinburgh 2B, >2cm displacement, n=50) and angulated midshaft fractures (Edinburgh 2A2, >30 degrees angulation, n=32). 677 clavicle fractures were analysed. The median age was 14.8 (IQR 14.0–15.7) and 89% were male. The majority were midshaft (n=606, 89.5%) with either angulation (39.8%) or simple fully displaced (39.1%). Only 3% of midshaft fractures underwent acute fixation (n=18/606), all of which were fully displaced. The incidence of refracture following non-operative management of midshaft fractures was 3.2% (n=19/588), all united with non-operative management. Fracture type, severity of angulation or displacement was not associated with risk of refracture. There was one case of non-union encountered following non-operative management of all displaced midshaft fractures (0.4%, n=1/245). At a mean of 7.6 years following injury, non-operative management of both displaced and angulated fractures had a median QuickDASH was 0.0 (IQR 0.0–2.3), EQ-5D was 1.0 (IQR 1.0–1.0). 97% of angulated fractures and 94% of displaced fractures were satisfied with their final shoulder function. We conclude that Non-operative management of adolescent midshaft clavicle fractures result in excellent functional outcomes with a low rate of complications at long-term follow up. The relative indications for surgical intervention for clavicle fractures in adults do not appear to be applicable to adolescents

Purpose: Whiplash injury occurs due to motor vehicle accidents has its long term consequence, nevertheless very little is written about its long-term follow up. The aim of the study is to find out the long-term follow up of Whiplash injury and the factors affecting the long-term follow up. Method: It is a retrospective study which was done in Russells Hall Hospital in the west midland in UK. 64 patients were selected in this study. Only 54 patients were replied. An inclusion criterion was Whiplash injury due to RTA in years 1995, 1996 and 1997. Initial examination was performed 5.6 +/ – 4.5 days after trauma, and follow-up examinations 3, 6, 12, and 24 months. Exclusion criteria were any cervical spine bony injury, associate head injury and poly-trauma patients. The outcome measures used for assessment are SF36, Whiplash Disability Questionnaire score WDQS, and questions to cover their present symptoms, work circumstances before and after the injury, current and previous treatment. Results: In our study we found that the time it takes for the patient’s symptoms to resolve varies, it took less than 6 weeks in 4 patients, between 6 weeks to 3 months in 10 patients, between 6 months to 1 year in 15 patients and more than one year in 3 patients. The average follow up time was 10.3 years. Our results did show these figures: 22 patients were still symptomatic 10 years after injury, 18 still complaining of pins & needles, 13 still having frontal headache and 7 having occipital headache. Headache was one of the symptoms which annoyed Whiplash injury patients. Headaches following Whiplash injuries were occipital, frontal or generalised. Headache was usually of Muscular contraction type, often associated with greater occipital neuralgia. 16 patients still had treatment in the form of pain killers or physiotherapy. The mean WDQS was less than 20 in 38 patients. The mean WDQS in patients with low back pain was 29.23 and for those without back pain were 12.53. In the smokers the mean whiplash score was 32.2. In the non-smokers the Whiplash score was 17.93. The mean WDQS in those who do not drink alcohol was 26.73 and in those who drink alcohol were 16.58. Conclusion: Whiplash injury patients have long term residual symptoms mainly pins & needles as well as headache and dizziness. Claiming compensation is a bad prognostic factor on the long-term outcome of Whiplash injury patients. Drinking alcohol, Gender, BMI, treatment given after the initial injury and smoking have no effect on the long-term outcome of these injuries. Age & Low back pains are bad prognostic factors. Whiplash Disability Questionnaire score, SF 36 (for body pain) and time for symptoms to be relieved are sensitive outcome measures to assess those injuries

MOXIMED KineSpring® Knee Implant System is an Orthopaedic device designed for younger or highly active patients with osteoarthritis. The device is placed under the skin, is attached to the tibia and femur, and contains springs which help limit some of the forces that are transmitted through the knee during activities such as walking or running and thereby relieve pain that may be experienced by patients with early arthritis of the knee. The aim of this study is to determine the long term safety and efficacy of the KineSpring knee implant system. This is a prospective case series involving two centres in Glasgow. 29 patients (mean age of 45.1 years and range 18-65 years) were recruited into the study between 2011 and 2016. The Primary outcome measure was Oxford knee score (OKS) at 2, 5 and 10 years post-operatively. Secondary outcome measures include device related complications and survival, patient reported functional outcome measures, patient satisfaction, pain levels and change in radiographic classification of osteoarthritis. At 2-year follow-up, 7 implants were removed (74.1% survival). Complications include deep infection, requiring removal in 1 patient, 2 implant failures requiring removal and one spring breakage. In comparison to pre-operative measures there was an improvement in the pain (3.58 vs. 5.20, p=0.02), stiffness (4.16 vs. 4.47, p=0.6) and OKS (32.4 vs. 36.9, p=0.03). The KineSpring improves overall pain, stiffness and functional outcome at 2 years following surgery, however there was a high rate of removal and further long-term follow up analysis is required regarding its effectiveness

Background. Uncemented dual-tapered stems are a popular choice for primary total hip arthroplasty (THA). The purpose of this study was to examine long-term outcomes after primary THA utilizing a single dual-tapered stem. Patients and Methods. Utilizing our total joint registry, we retrospectively identified 1215 THAs (1055 patients) performed with an uncemented dual-tapered stem from 1998 to 2009. Mean age was 55 years, 70% were male, and mean BMI was 30 kg/m. 2. Mean follow-up was 10 years. Analysis included implant survivorship, clinical outcomes, and radiographic results. Results. Survivorship from stem revision for any reason was 99.0% at 5 years postoperatively and 98.4% at both 10 and 15 years. Survivorship from stem revision for aseptic loosening was 99.9% at 5-, 10-, and 15-years postoperatively. Survivorship from stem revision for periprosthetic fracture was 99.7%, 99.1%, and 98.9% at 5, 10, and 15 years postoperatively, respectively. In total, 18 (1.5%) stems underwent revision. Revisions were performed for periprosthetic fracture (10, 0.82%), infection (7, 0.58%), and aseptic loosening (1, 0.08%). Intraoperative fracture occurred in 58 (4.77%) THAs treated with cerclage wiring (52, 89.66%) or no treatment (6, 10.34%) and insertion of a standard prosthesis. At mean radiographic follow-up of 10 years, only 4 of 1084 (0.37%) stems with 1-year radiographic follow-up had any radiolucency around the proximal ongrowth coating, and only 1 (0.10%) of these had a circumferential radiolucent line (Gruen zones 1–14). Conclusions. This uncemented dual-tapered femoral stem is associated with excellent survivorship, reasonably low intraoperative fracture rate, and extremely low rates of revision for aseptic loosening, periprosthetic fracture, and infection when used for primary THA at long-term follow up. For any tables or figures, please contact the authors directly

Salter’s innominate osteotomy predisposes the hip to acetabular retroversion as it hinges upon the symphysis pubis. Retroversion is a recognised cause of osteoarthritis, hip pain and clinical signs of impingement, but there is uncertainty as to whether this over cover persists with growth and development. We reviewed the long-term follow up of twenty patients that had undergone a Salter’s osteotomy between 1985 to 1993 at The Royal Orthopaedic Hospital Birmingham or New Cross Hospital Wolverhampton. Sixteen skeletally mature patients were available for review that had previously had the pelvic osteotomy performed at a mean five years of age with a contralateral normal hip. Salter’s osteotomy had been performed for developmental dysplasia of the hip in 13 patients and for Perthes’ disease in three patients. Follow up was performed at an average age of 20 years. Outcome was assessed using the Harris Hip Score and a clinical examination for signs of impingement and by a measurement of acetabular version, on well centered pelvic radiograph. Acetabular version was evaluated by the relationship between anterior and posterior walls of both the normal and Salter acetabulum, using radiographic templates as described by Hefti. Mean acetabular version averaged 16.9 degrees (95% CI 7.6 to 26.1) of anteversion on the Salter side and 17.6 degrees (95% CI 10.4 to 24.8) anteversion on the contralateral normal hip. There was no statistical difference between the version on operated and normal hips, paired t test (p = 0.83). Harris Hip Score averaged 85, indicating a good outcome at long-term follow up. Two patients (12%) demonstrated retroversion, however neither of these had signs of impingement on clinical examination. After a Salter innominate osteotomy in childhood, we believe there is remodelling of acetabular version by skeletal maturity

Aims. Surface replacement arthroplasty (SRA), compared with traditional total hip arthroplasty (THA), is more expensive and carries unique concern related to metal ions production and hypersensitivity. Additionally, SRA is a more demanding procedure with a decreased margin for error compared with THA. To justify its use, SRA must demonstrate comparable component survival and some clinical advantages. We therefore performed a systematic literature review to investigate the differences in complication rates, patient-reported outcomes, stress shielding, and hip biomechanics between SRA and THA. Materials and Methods. A systematic review of the literature was completed using MEDLINE and EMBASE search engines. Inclusion criteria were level I to level III articles that reported clinical outcomes following primary SRA compared with THA. An initial search yielded 2503 potential articles for inclusion. Exclusion criteria included review articles, level IV or level V evidence, less than one year’s follow-up, and previously reported data. In total, 27 articles with 4182 patients were available to analyze. Results. Fracture and infection rates were similar between SRA and THA, while dislocation rates were lower in SRA compared with THA. SRA demonstrated equivalent patient-reported outcome scores with greater activity scores and a return to high-level activities compared with THA. SRA more reliably restored native hip joint biomechanics and decreased stress shielding of the proximal femur compared with THA. Conclusion. In young active men with osteoarthritis, there is evidence that SRA offers some potential advantages over THA, including: improved return to high level activities and sport, restoration of native hip biomechanics, and decreased proximal femoral stress shielding. Continued long-term follow up is required to assess ultimate survivorship of SRA

Background. Distal radius fractures are among the most common fractures encountered in the clinical setting, with a reported incidence of 17%. Of these common fractures, it has been said 60% are intra-articular in nature. Intra-articular or unstable and comminuted fractures represent severe, high energy injuries. There is a considerable amount of controversy as to which fixation method is superior. Even the OA concludes; “comparing external fixation (EF) with open reduction and internal fixation (ORIF) for the treatment of intra-articular distal radius fractures described no consistent benefit of one treatment over another”. There are only a few randomised control trials that go beyond one year to cover the long-term follow up (over two years). There has yet to be a meta-analysis of the long-term outcomes of open reduction internal fixation (ORIF) versus external fixation. We aim to show from this meta-analysis if there is any significant difference in the outcomes of either fixation method in the long-term. Method. We pooled the data of all available randomised control trials that compare the long-term outcomes of ORIF against external fixation of distal radius fractures. We completed a systematic review of PubMed, embase, MEDLINE and the Cochrane Library, from inception to December 2014. We then preformed our meta-analysis using RevMan 5.3 software. Results. We did not determine any significant difference in long-term outcomes when comparing ORIF with external fixation. However 6 of the 11 outcomes supported ORIF. Conclusion. There is no significant difference in the long-term outcomes between ORIF and external fixation. No meta analysis to date, short or long term, has been able to determine which is the superior, yet the future treatment of these fractures looks to be ORIF in the form of volar plating. We recommend before this becomes universal, further research must be carried out. Level of Evidence. Level 1. Disclosures. this was the first author's, Dr CJC Gouk, Masters dissertation at the University of Edinburgh. No financial support was received