Aims: Minimum ten year clinical, radiological and postmortem results of the flexible Cambridge Cup. This acetabular prosthesis was designed to replace the horseshoe shaped articular cartilage and provide physiological loading with minimal resection of healthy bone. Method: Fifty female patients aged over 70 years with a displaced intra-capsular fracture of the femoral neck were recruited to the ethically-approved prospective study. They underwent implantation of the Cambridge Cup, which has an outer polybutyleneterephthalate shell and an inner UHMWPE bearing, with a Thompson-type hemiarthroplasty. The cups were manufactured with a 60μm plasma-sprayed coating of hydroxyapatite. This was removed from half the cups to simulate the effects of long-term HA resorption. Implants were sterilised by gamma irradiation in air. Independent clinical and radiological assessments were undertaken before discharge, at 6 weeks, one year, 18 months, two -, five-, seven- and ten years. Patients were scored using the Barthel Index, the Charnley-modified Merle d’Aubigne scores and latterly the Oxford hip score. The date and cause of death were obtained from hospital records and death certificates. Fifteen Cambridge Cups were retrieved post-mortem for histological and wear analysis. Results: The mean functional scores recovered to levels before fracture. These scores decreased with advancing age at five years. The mortality rates were 16%, 28%, 46% and 92% at 1, 2, 5 and 10 years. The Oxford hip scores in patients surviving between five and ten years were maintained. The HA coated implants remained asymptomatic. Three uncoated components required revision for migration. No evidence of accelerated UHMWPE wear was seen on retrievals or radiographs. Histological analysis of the retrieved HA coated specimens showed excellent bony fixation, uncoated cups showed predominantly fibrous tissue. Conclusion: The uncemented Cambridge Cup was implanted in a challenging environment of osteoporotic bone. Clinical, radiographic and post-mortem results up to ten years are excellent

The Self Aligning (SAL I) total knee prosthesis (Sulzer, Winterthur) is a first generation cruciate retaining mobile bearing implant allowing unrestricted rotation and up to 5 mm. of translation. A consecutive series of two hundred and three SAL I components in one hundred and sixty- seven patients were implanted between 1990 and 1994 and were reviewed clinically and radiographically. Quality of life outcomes (SF-12 and WOMAC) were also reviewed pre-operatively and regular intervals. This first generation mobile bearing knee implant in this series, continues to function well at a minimum ten years follow-up, with a mechanical failure rate (8%) comparable to fixed bearing designs. A consecutive series of SAL I total knee arthroplasties were performed between 1990 and 1994 and were reviewed clinically, radiographically and with standardized quality of life outcome tools, including the SF-12 and the Western Ontario MacMaster Osteoarthritis Index (WOMAC). Patient demographics, radiographs, and multiple validated outcome measures (WOMAC, SF12, Knee Society Clinical Rating System) were evaluated pre-operatively, at three, twelve, and twenty-four months and every two years thereafter. The series included two hundred and three SAL I implants in one hundred and sixy-sevenpatients. There have been sixty-nine patient deaths (eighty-five procedures), nine patients (eleven procedures) now reside in nursing homes and are unable to return due to medical complications, two patients (three procedures) could not be located. Nine-teen patients/procedures have had revision surgery. Therefore, seventy-six patients (ninety-three procedures) were evaluated with over ten year follow-up (average 10.89 years, range 10.03–13.72). Indications for revision included, sepsis (three), aseptic loosening (eight), instability (two) and poly-wear (six). The KSCRS was assessed for all remaining patients at greater than ten years including pain (45.83), function(65.60), range of motion extension(0.13) and flexion(113.82) as well as the results of the WOMAC (pain-4.36, joint stiffness-2.29, function-18.66, total- 15.92) and SF-12 (Mental-55.37 Physical- 34.99). The SAL I mobile bearing implant continues to perform comparably to fixed bearing cruciate retaining designs. This first generation mobile bearing knee implant continues to function well at a minimum ten years follow-up, with a mechanical failure rate (8%) comparable to fixed bearing designs

Introduction. Since the introduction of 3rd generation Metal-on-Metal-Hip-Resurfacing-Arthroplasty (MoMHRA), thousands of such prostheses have been implanted worldwide in younger patients with end-stage hip osteoarthritis. However, no independent centre has reported their medium-to-long term outcome. The aim of this study is to report the ten year survival and outcome of the Birmingham Hip Resurfacing (BHR), the most commonly used MoMHRA worldwide. Methods. Since 1999, 648 BHRs were implanted in 555 patients, the majority of which were male (326). The mean age at surgery was 52.1years (range: 17–82), with primary OA as most common indication (85%). Mean follow up was 7.1years (range: 1–11). The Oxford Hip Score (OHS) and UCLA questionnaires were sent to all patients. Implant survival was established, with revision as the end point. Sub-analysis was performed by gender, femoral component size (small: <45mm, standard: 46–52, large: >53mm) and age at surgery (young:<50yrs, old:>50yrs). Results. Preliminary results show that survival and clinical outcome were better in men than women (p=0.013) and in patients with large and standard components compared to small (p=0.005). In women the survival and clinical outcome were worse in the young than the old (p=0.049). In men there was no difference in survival or clinical outcome between the young and old (p=0.106). In young men the 10-year survival was 95%, the mean OHS was 45 and the mean UCLA score was 8.1. Conclusion. The results of resurfacing are good in men. They perform particularly well in the young and highly active men who tend to have problems with conventional hip replacements

Introduction. Despite being from different manufacturers, Exeter stem and Ogee cup are commonly used together as cemented ‘cross breed’ combination in United Kingdom. The purpose of this study was to evaluate the long-term outcome of this combination. Materials and methods. The ten years outcome of 131 primary hip replacements using an Exeter stem and an Ogee cup combination were studied retrospectively from clinical audit data and radiographs. Results. The Harris Hip score (HHS) improved significantly from 46 pre-surgery to 88 post-surgery. This had a gradual decrease to 81 over ten years. This effect was associated with a decrease in function score but a sustained pain score. Radiologically, five cups were loose and two stems had failed. One stem had migrated and another had progressive endosteolysis. There were two recurrent dislocations, of which one was revised to a bipolar socket. The ten year survival of the combination implant was 99% (CI 97 to 100) with revision as an end point. The same with impending failure as end point was 93% (CI 87 to 99). Conclusion. It might be preferable to have a multi-centric prospective study to demonstrate the performance of this commonly done combination implant at various settings. In the meantime it is concluded that the Exeter stem-Ogee cup combination arthroplasty has acceptable outcomes at ten years

Total knee replacement (TKA) surgery is an excellent and well-proven procedure for the treatment of end stage arthritis of the knee. Many refinements have taken place over time in an attempt to improve the components, wear qualities of the polyethylene, and the surgical technique to improve accuracy of component positioning, reduce patient pain, improve postoperative range of motion, ultimately improve results and to prolong the time until revision surgery may occur. This study examines the results of a gap balancing surgical technique in which components were implanted that had a posterior cruciate substituting design. This technique is performed with exacting alignment and balancing of the flexion and extension gaps prior to implantation of the knee components. The follow up is at a minimum of ten years. 515 consecutive knee replacements were followed prospectively for a minimum of ten years. The average age at surgery was 70 years, 73% of patients were female, with an average BMI of 31. All patients carried a diagnosis of osteoarthritis and a cemented, posterior stabilized design TKA (Balanced Knee System, Ortho Development) was implanted. All cases were performed by one of two experienced joint replacement surgeons. The surgical technique demanded flexion and extension gap balancing as well as soft tissue balancing prior to finishing cuts being performed on the femoral side (See figures 1 and 2). Polyethylene spacers come in 1 millimeter increments. 28% of patients died postoperatively at an average of 7.4 years. These patients were older on average at the time of index surgery (76.6 years). None had undergone revision surgery. Of the remaining patients Knee Society scores (39 preop to 91 post op at ten years), function scores and range of motion all improved significantly. What's more, these results were not diminished at ten years. There were no component failures and less than 1% radiographic progressive lucent lines. Eleven revision surgeries (2.1 %) were performed with 2 acute superficial wound revisions, 3 late infections, one patellar tendon disruption from a fall at 7 years (BMI 45.7), 2 complete revisions performed elsewhere for unsatisfactory results, and 3 spacer exchanges for perception of postoperative laxity. For the current study we also examined subgroups of the morbidly obese, octogenarians, and those with a preoperative valgus deformity of greater than 15%. At follow-up these subgroups fared very well with the exception of the heaviest BMI's being limited in range of motion because of soft tissue impingement. Results suggest that this balancing technique gives excellent results with few complications at ten year evaluation. We believe that careful attention to bony and soft tissue balancing and equalization of gaps in flexion and in extension will prove beneficial for TKA longevity in even longer-term evaluation. Figures 1 and 2 demonstrate gap balancing blocks and alignment rods in extension and in flexion

Aim: In this study we present our ten year experience of primary spinal infection. Method: Retrospective case note review of 42 patients who presented to our institution with primary spinal infection between 1995–2005 was carried out. Demographic data and information with regard to timing and modes of presentation, results of radiological and laboratory investigations, and methods of treatment were collected. The financial impact of Home Intravenous Antibiotics Service (HIAS) was also investigated. Results: Axial pain was the most consistent symptom seen in 100% of the patients. Only 62% had pyrexia at presentation. Major neurological deficit was seen in 10.2%. Mean duration of symptoms was 25 days (range 1–202). Mean time from presentation to diagnosis was 19 days (range 0–172). Staphylococcus Aureus was the most common organism. Mean duration of Intravenous antibiotics was 60 days (range 13–240) followed by oral antibiotics for mean duration of 65 days (range 0–161). CRP was more reliable in monitoring the disease over time. At mean follow up of 5.4 years (0.6–10.5) there has been no mortality directly related to the infection. With our management there has been 14% recurrence rate. All re- presenting within the first year after initial presentation (Mean 5.5 Months, range 1–11). HIAS saved a total of 940 in-patient days with a total cost saving of approximately £350,000.00. Conclusion: In the majority of patients spinal infection can be successfully treated. Disease severity dictates the duration of antibiotic treatment and whether surgery is required. Recurrent infection occurred in a number of patients with more significant past medical history and pre-existing risk factors. Finally, HIAS is extremely cost effective in this group of patients

Aim. To assess the ten year subjective knee function and activity level following four-strand semitendinosis and gracilis (STG) anterior cruciate ligament reconstruction. Methods. 86 patients underwent anterior cruciate reconstruction by two knee surgeons in the year 1999. 80 patients meet the inclusion criteria of STG reconstruction by a standard operative technique. Patient evaluation was by completion of a Lysholm Knee Score and Tegner Activity Level Scale at a minimum of ten years from reconstructive surgery. This was by initial postal questionnaire and subsequent telephone follow-up. Results. 80 patients underwent anterior cruciate reconstruction with average age 30.9 years +/− 8.8 (15 to 58 years). There was a 77.5% (62 patients) response at ten years to the questionnaire. The mean Lysholm Knee Score at ten years was 78.4 +/− 12.8 (39 to 90). The mean activity level had decreased from 8.3 to 5.3 at ten years according to the Tegner Activity Scale. 11 patients required medial and lateral partial menisectomies at the time of original reconstruction. This group of patients had a Lysholm Knee Score of 67.6 +/− 19.1 and Tegner Activity Scale of 3.9 at ten years following reconstruction. 17 of the 80 patients (21.25%) required re-operation because of further knee symptoms, with 4 patients requiring revision of the anterior cruciate following re-rupture. Conclusion. Anterior Cruciate Ligament Reconstruction with four-strand STG hamstring graft provides a reliable method of restoring knee function with a 5% revision rate for re-rupture at ten years. Combined partial medial and lateral menisectomy at the time of the initial reconstruction is a poor prognostic indicator for function at ten years

Background. Anterior Cruciate Ligament Reconstruction is a commonly performed orthopaedic operation. The use of a four-strand semitendinosus and gracilis hamstring graft (STG) is a well established method of reconstruction to restore knee stability. Aim. To assess the ten year subjective knee function and activity level following STG anterior cruciate ligament reconstruction. Methods. 86 patients underwent anterior cruciate reconstruction by two knee surgeons in the year 1999. 80 patients meet the inclusion criteria of STG reconstruction by a standard operative technique. Patient evaluation was by completion of a Lysholm Knee Score and Tegner Activity Level Scale at a minimum of ten years from reconstructive surgery. This was by initial postal questionnaire and subsequent telephone follow-up. Results. 80 patients underwent anterior cruciate reconstruction with average age 30.9 years +/− 8.8 (15 to 58 years). There was a 77.5% (62 patients) response at ten years to the questionnaire. The mean Lysholm Knee Score at ten years was 78.4 +/− 12.8 (39 to 90). The mean activity level had decreased from 8.3 to 5.3 at ten years according to the Tegner Activity Scale. 11 patients required medial and lateral partial menisectomies at the time of original reconstruction. This group of patients had a Lysholm Knee Score of 67.6 +/− 19.1 and Tegner Activity Scale of 3.9 at ten years following reconstruction. 17 of the 80 patients (21.25%) required re-operation because of further knee symptoms, with 4 patients requiring revision of the anterior cruciate following re-rupture. Conclusion. Anterior Cruciate Ligament Reconstruction with four-strand STG hamstring graft provides a reliable method of restoring knee function with a 5% revision rate for re-rupture at ten years. Combined partial medial and lateral menisectomy at the time of the initial reconstruction is a poor prognostic indicator for function at ten years

The results of a functional, clinical and radiological study of 30 children (60 hips) with whole body cerebral palsy are presented with a mean follow-up of ten years. Bilateral simultaneous combined soft-tissue and bony surgery was performed at a mean age of 7.7 years (3.1–12.2). Evaluation involved interviews with patient/carers and clinical examination. Plain radiographs of the pelvis assessed migration percentage and centre-edge angle. Twenty two patients were recalled. Five had died of unrelated causes and three were lost to follow-up. Pain was uncommon, present in 1 patient (4.5%). Improved handling was reported in 18 of 22 patients (82%). Carer handling problems were attributed to growth of the patients. All patients/carers considered the procedure worthwhile. The range of hip movements improved, with a mean windsweep index of 36 (50 pre-operatively). Radiological containment improved, with mean migration percentage of 20 degrees (50 preoperatively) and mean centre-edge angle of 29 degrees (−5 preoperatively) No statistical difference was noted between the three year and ten year follow-up results demonstrating maintained clinical and radiological outcome improvement. In conclusion, we consider that bilateral simultaneous combined hip reconstruction in whole body cerebral palsy provides painless, mobile and anatomically competent hips in the long term

Anterior cruciate ligament (ACL) reconstruction is a commonly performed operation. A variety of graft options are used with the most popular being bone-patellar-tendon-bone and hamstring autograft. There has been an increase in the popularity of hamstring autograft over the past decade. The aim of the study was to assess the ten year subjective knee function and activity level following four-strand semitendinosis and gracilis (STG) anterior cruciate ligament reconstruction. 86 patients underwent anterior cruciate reconstruction by two knee surgeons over a 12 month period (January 1999 to December 1999). 80 patients meet the inclusion criteria of arthroscopic ACL reconstruction. The same surgical technique was used by both surgeons involving four-strand STG autograft, single femoral and tibial tunnels and aperture graft fixation with the Round headed Cannulated Interference (RCI) screw. Patient evaluation was by completion of a Lysholm Knee Score and Tegner Activity Level Scale at a minimum of ten years from reconstructive surgery. This was by initial postal questionnaire and subsequent telephone follow-up. 80 patients underwent anterior cruciate reconstruction with average age 30.9 years (15 to 58 years). There was a 77.5% (62 patients) response at ten years to the questionnaire. The median Lysholm Knee Score at ten years was 94 (52 to 100). The median activity level had decreased from 9 to 5 at ten years according to the Tegner Activity Scale. 73% of patients reported a good or excellent outcome on the Lysholm score. The group of patients was further divided into those that required meniscal surgery and those that did not. The patients that did not require meniscal surgery had a median Lysholm score of 94 and those that required meniscal surgery had a similar median Lysholm score of 92.5. However it was noted that 8 patients required medial and lateral partial menisectomies at the time of original reconstruction. This group of patients had a median Lysholm Knee Score of 83.5 and Tegner Activity Scale of 4 at ten years following reconstruction. 17 of the 62 patients (27.4%) required re-operation because of further knee symptoms, with 4 patients requiring revision of the anterior cruciate following re-rupture. In conclusion anterior cruciate ligament reconstruction with four-strand STG hamstring autograft provides a reliable method of restoring knee function, with a 6% revision rate for re-rupture at ten years. Combined partial medial and lateral menisectomy at the time of the initial reconstruction is a poor prognostic indicator of function at ten years

Introduction. In an ageing population the incidence of patients sustaining a neck of femur fracture is likely to rise. Whilst the neck of femur fracture is thought to be a pre-terminal event in many patients, there is little literature following this common fracture beyond 1 year. With improving healthcare and increasing survival rate, it is likely that a proportion of patients live to have subsequent fractures. However little is known about if these occur and what the epidemiology of these fractures are. Aim. To describe the epidemiology of fractures sustained over a ten year period in patients who had an “index” neck of femur fracture. Method. All patients from the Lothian region, who sustained a neck of femur fracture and were admitted to the Royal Infirmary of Edinburgh in Scotland between 01/01/2000 and 31/12/2000 were prospectively identified and had their orthopaedic notes and where appropriate death records retrospectively reviewed in Aug 2010, to identify further fractures and orthopaedic treatments. Patients admitted from without the Lothian region were excluded from the study. Other information regarding their pre-injury medical history, what surgery was performed, age, social status, co-morbidities and where relevant cause and date of death were recorded. Results. In the year 2000 there were 628 patients identified as having sustained a neck of femur fracture giving an incidence of 12/10,000/year. 534 (85%) of the 628 fractures were sustained by falls, with the remainder being direct trauma, pathological or an unknown cause. The mean age of patient at the time of sustaining the neck of femur fracture was 87.5 years old, with a range of 17 to 101 years old. 136 (21.7%) patients went on to sustain further fractures. The top five most frequent fractures involved the contralateral neck of femur (55; 31%), radius (34; 19%), humerus (24; 13.4%), ipsilateral femur (19; 10.6%) and tibia (10; 5.6%). 32 (23.5%) people sustained multiple fractures after the initial hip index fracture. 24% of patients had previously sustained some form of fracture prior to their index neck of femur fracture. Conclusion. Our results demonstrate that over a fifth of patients who sustain a neck of femur fracture will sustain a further fracture in the next ten years. Rather than regarding a neck of femur fracture as a terminal event, resources and support should be directed at preventing further fractures in this high risk population. As patients live longer and health care and the treatment of neck of femur fractures improves it is likely that the incidence of further fractures will rise. We believe our results will be useful for all departments treating neck of femur fractures

The goal of treatment of an intra-articular fracture is anatomic restoration of normal anatomy and rigid internal fixation to allow for early motion. Weber Type ‘B’ ankle fractures (AO Type B and Lauge-Hansen supination-external rotation) are the most common ankle fractures that require internal fixation. Brunner and Weber first described the use of antiglide plate for treatment of these fractures in 1982. The aim of our study was to assess the functional and radiological outcomes of patients who underwent this procedure. This was a retrospective analysis of a consecutive series, reviewing patients over a ten year period, from 1990 to 1999, in a regional orthopaedic and trauma unit. There were 122 antiglide plate fixations performed in total over the period under review. Our group consisted of 64 patients who had an isolated closed lateral malleolor fracture, thereby excluding patients with open injuries and bimalleolar fractures. 6 patients were lost to follow-up. There were 25 males (age 19–64 years) and 31 females (age 13–62 years) with a mean age of 42 years. The patients were assessed by the American Orthopaedic Foot and Ankle Society (AOFAS) Score and the average follow-up was 5.8 years. The implant used was a 3.5mm AO DCP applied along the posterior surface of the lateral malleolus. This was followed by early commencement of postoperative ankle and foot exercises, allowing toe touch weight bearing out of cast until union. Our results (AOFAS Score out of 100) show that 92% (52 patients) had good to excellent result (Score> 80) with only 8% (4 patients) had a satisfactory outcome. We recommend the use of an antiglide plate because of its biomechanical stability especially in osteoporotic bones which allows for early motion and the nearly nil incidence of implant removal

This study was undertaken between May 1992 and April 2002 in a hospital where there was a targeted screening programme for Developmental Dysplasia of the Hip. All data was collected prospectively. 2,578 infants with clinically unstable or at risk hips underwent bilateral hip ultrasound examination. This was performed by the senior author. At risk hips were considered to be those where there was a history of breech presentation, foot deformity, oligohydramnios on prenatal maternal ultrasound scans or a strong family history of Developmental Dysplasia of the Hip. There were significant changes in the reasons for referral for targeted screening over the ten year period. In the first year of the study 1.5% of referrals were because of oligohydramnios. In the last year of the survey 16.5% of referrals were because of oligohydramnios. The number of referrals for screening because of oligohydramnios increased sixty fold between the first year and last year of the study period. The overall number of infants referred for targeted screening more than doubled between the first and the last year of the study period. Of the infants that were found to have unstable or dislocated hips, no infants had oligohydramnios as a risk factor. The number of referrals for targeted ultrasound screening is increasing. In a targeted screening programme for Developmental Dysplasia of the Hip we suggest that oligohydramnios should not be used as a possible risk factor

Introduction: We present our results after 10 years use of the Kent hip.

Methods: Between 1994 and 2004, 58 patients (m19, f39) aged 52 to 90 (mean 76) had a Kent hip. Indications were for a loose implant (22), recurrent dislocation (6), femoral or stem fracture (9), and other causes (13). An antero-lateral approach with an antero-lateral longitudinal femoral window was used to remove the previous stem and cement. The window was re-attached by cross screws. An average of 7 (4–10) cross screws were used. An uncemented Biomex cup and polythene liner was used in 48 cases and 10 cups were cemented. A modular 28 mm head and variable length neck was used. Recorded anaesthetic grade was ASA Grade II for 33 patients and ASA Grade III in 13 patients.

Results: Operative time was 130 +/− 37.5 min. Mean recorded blood loss was 1300ml (300–4000ml). Patients were up partial weight bearing at a mean of 5 days (2–80). Hospital stay was 19 days (7–212). There were 3 hospital deaths, one from MRSA sepsis, one chest infection and one MI.

Complications included dislocation (13 out of 53 patients or 24.5%), heterotopic ossification (47%), screw fracture (8%), superficial infection (11%) and deep infection (5.7%). Survival tables show an implant survival rate of 85% at 5 years.

Discussion: Most dislocations settled without further surgery. Heterotopic ossification was minor. The Kent hip system is a flexible and robust solution for a wide range of difficult revision cases. It allows early full weight bearing. We prefer the Kent implant to massive re-cementing, bone grafting or Girdlestone excision. We recommend this device for wider use.

BACKGROUND

Despite many years of clinical experience the optimal bearing choice in total hip arthroplasty (THA) remains controversial. This study aims to directly compare the three widely used bearing surfaces: metal-on-highly crosslinked polyethylene (MoHXLPE), ceramic-on-ceramic (CoC) and metal-on-metal (MoM), regarding clinical and radiologic outcome parameters.

About ten years ago we introduced sophisticated instrumentation and an increased range of component sizes for the Oxford unicompartmental knee replacement (UKR) to facilitate a minimally invasive surgical (MIS) approach. The device is now routinely implanted through an incision from the medial pole of the patella to the tibial tuberosity. This has resulted in a more rapid recovery and an improved functional result. As the access to the knee is limited there is a concern that the long term results may be compromised. The aim of this study was to determine the 10 year survival.

A prospective follow up of all Phase 3 minimally invasive Oxford UKR implanted by two senior authors (DWM & CAFD) has been undertaken. So far 1015 UKRs have been implanted for anteromedial osteoarthritis. All patients received a cemented implant through a MIS approach and were followed up prospectively by an independent observer. The data was collected prospectively regarding pre-operative status, complications and clinical as well as functional outcome at predetermined intervals.

The average age of patients was 66.4 years (range: 33 – 88) with mean Oxford Knee Score 41 (SD: 7.9) at the time of last follow up, Knee Society Score (objective) of 84 (SD: 13) and Knee Society Score (functional) of 83 (SD: 21). At ten years the survival of this cohort is 96%. There were 22 revisions including 7 for progression of arthritis, 5 for infection, 5 for bearing dislocation, 4 for unexplained pain and one for rupture of ACL secondary to trauma.

We conclude that the Oxford Knee can be implanted reliably through a minimally invasive approach, giving excellent long term results.

We have determined the 10 year life expectancy of 5,831 patients who had undergone 6,653 elective primary total hip replacements (THR) at a regional orthopaedic centre between April 1993 and October 2004.

Methods: We ascertained dates of deaths for all those who had undergone surgery during this period and constructed Kaplan Meier survivorship curves for these patients. Standardized mortality ratios were calculated by comparing this data with available UK mortality rates for the same age groups over the same time period.

Results: The mean age at operation was 73 with a male to female ratio of 2:3. Of those with 10 year follow up 29.5% had died a mean of 5.6 years after surgery. 10-year survivorship was 89% in patients under 65 years at surgery, 75% in patients aged between 65 – 74 years and 51% in patients over 75.

The standard mortality rates were significantly higher than expected for patients under 45 years, 20% higher for those between 45 and 64 years and progressively less than expected for patients aged 65 and over.

Discussion: By comparing our mortality curves with prosthesis survivorship curves from the most recent Swedish Arthroplasty Register results we were able to demonstrate that the survivorship of cemented hip arthroplasties exceeds that of the patients over the age of 60 in our area. As these prostheses are less expensive than their uncemented equivalents this suggests these are the prosthesis of choice in this age group.

We determined the 10 year life expectancy of 5,831 patients who had undergone 6,653 elective primary total hip replacements (THR) at a regional orthopaedic centre between April 1993 and October 2004. Using Hospital, General Practitioner (GP) and the local health authority’s records, we determined dates of deaths for all those who had undergone surgery during this period.

The mean age at operation was 73 (13–96) with a male to female ratio of 2:3. Of those with 10 year follow up 29.5% had died a mean of 5.6 (0–11.1) years after surgery. Using Kaplan Meier curves, 10-year survivorship was 89% in patients under 65 years at surgery, 75% in patients aged between 65 – 74 years and 51% in patients over 75.

The standardised mortality rates (SMR) were significantly higher than expected for patients under 45 years, 20% higher for those between 45 and 64 years and progressively less than expected for patients aged 65 and over.

The survivorship of cemented hip arthroplasties (derived from the Swedish Arthroplasty Register 2004) exceeds patients’ life expectancy in those over the age of 60 in our area suggesting that this is the procedure of choice in this population.

Introduction: Excellent early and medium term results have been reported for hip resurfacing. This is a minimum 5 year clinical outcome review of the resurfacings performed by a single surgeon in an independent series.

Methods: There were 329 resurfacings (302 patients). The mean follow-up is 6.6 years (5 to 9.2). 2 patients were lost to follow-up and 6 have died due to unrelated causes. The mean age at the time of surgery was 56.0 years (28.2 to 75.5). Mann-Whitney U-test was used to analyse change in hip scores, and survival analysis was performed using the Kaplan-Meier analysis using SPSS statistical software package.

Results: The mean Harris Hip Score was 51.3 (7 to 91) pre-operatively and 94.3 (24 to 100) postoperatively (p< 0.001). The mean Oxford hip scores was 38.3 (16 to 60) pre-operatively and 15.9 (12 to 46) postoperatively (p< 0.001). The mean Western Ontario and McMaster Universities Osteoarthritis Index score was 47.9 (5 to 96) pre-operatively and 6.9 (0 to 58) postoperatively (p< 0.001). The University of California Los Angeles activity scale was 4.7 (1 to 9) pre-operatively and 7.5 (3 to 10) post-operatively (p< 0.001). Mean satisfaction at the latest follow up was 9.3 (3–10) out of 10.

There were ten revisions. Kaplan-Meier analysis showed survival of 96.5% (95% confidence interval 94.7 to 98.4) at 7 years taking revision for any cause as the end-point. There was a 3.9 times higher failure rate in women compared to men.

Discussion: Medium term results of hip resurfacing in this independent series are excellent and are comparable to those from the pioneering centre. Failure rates are significantly higher in women compared to men. Long term follow up results are still awaited, however careful consideration should be made when selecting patients for hip resurfacing particularly in women.

The volume of spinal procedures have increased over the last two decades (220% in lumbar region). A simultaneous increase in re-operation rates (up to 20%) has been reported. Our aim was to compare with literature the reoperation rates and complications for various spinal procedures from a peripheral unit and to provide this information to the patients

This was a retrospective study of all patients who underwent spinal surgery during the period 1995 to 2005 by one surgeon. Using ICDM-9 codes and private notes patients were identified and medical records were used to gather relevant data. The following information was extracted-demographics, diagnosis, ASA criteria, primary procedure, any complication/s, secondary procedures, duration of follow up and to secondary procedure. The index procedures were grouped into regional and according to indication. Both complications and reoperations were grouped into early (within three months) or delayed (after three months) from the index operation. Reoperation rates and complications were calculated and compared with literature.

Four hundred and thirty-nine patients formed the study population. Five patients had inadequate data and were excluded. 23 patients have since died. Demographics showed 22% were smokers and 9% were either unemployed or sickness beneficiary. The commonest diagnosis in the lumbar spine was disc herniation (194). Stenosis and disc degeneration were the next most common surgical indications. In the cervical spine 27 patients had disc herniation and 15 patients were operated for trauma. Lumbar discectomy was the commonest procedure-191 patients with one third having microdiscectomy. Instrumented fusion was performed in 97 while 37 patients underwent decompression only. The majority of cervical spine patients (46) had discectomy and fusion.

Stabilisation for trauma formed a reasonable workload in both cervical and lumbar regions. Early complications included dural tears (seven), neurological symptoms (eight), wound infections (12) and pulmonary embolism (one) and repeat disc herniation. Delayed problems included repeat disc herniation, pseudoarthrosis and implant related symptoms. Overall re-operation rate was 14.52% with 5.02% early and 9.4%delayed repeat surgery. Repeat discectomy (eight) and decompression and exploration (seven) were the common early reoperation whereas fusion post discectomy (19) and recurrent disc herniation (12) were indications for delayed intervention. Removal of metalware (8) was another large late re-operation group.

Our re-operation rates fall within the quoted figures in literature. However our early re-operation rates are somewhat higher. These figures help us to inform patients better at the time of consent for the primary procedure especially lumbar disc surgery as most of the re-operation were required after discectomy.