An international faculty of orthopaedic surgeons presented their work on the current challenges in hip surgery at the London Hip Meeting which was attended by over 400 delegates. The topics covered included femoroacetabular impingement, thromboembolic phenomena associated with hip surgery, bearing surfaces (including metal-on-metal articulations), outcomes of hip replacement surgery and revision hip replacement. We present a concise report of the current opinions on hip surgery from this meeting with appropriate references to the current literature.

Background: Both chemical and mechanical methods of prophylaxis have reduced the the incidence of thromboembolic complications following Total Knee Replacement (TKR). Only a few studies have shown that mobilisation on the first post operative day further reduces the incidence of thromboembolic phenomena. Aims: We conducted a prospective study to verify not only if early mobilisation but also whether the distance mobilised on the first post-operative day after TKR reduced the incidence of thromboembolic complications. Methodology: The incidence of deep venous thrombosis and pulmonary embolism were compared in 50 consecutive patients who underwent TKR from July 2006 following a change in the mobilisation protocol with 50 consecutive patients who underwent TKR before the protocol was instigated. The mobilisation protocol changed from strict bed rest the first post operative day to mobilisation on the first post operative day. Mobilisation was defined as sitting out of bed or walking for at least 15–30 minutes twice a day. The distance mobilised was accurately recorded by the physiotherapists. All patients underwent duplex scans of both lower limbs on the fourth post operative day. Results: There was a Significant reduction in the incidence of thromboembolic complications in the mobilisation group (7 in total) compared to the control group (16 in total) (p=0.03). Furthermore in the mobilisation group the odds of developing a thromboemobloic complication was Significantly reduced the greater the distance the patient mobilised, (Chi squared linear trend=8.009, p =0.0047). Early mobilisation in the first 24 hours post TKR is a cheap and effective way to reduce the incidence of post-operative DVT

Introduction. Since Smith-Peterson's glass mold arthroplasty in 1939, hip resurfacing arthroplasty was developed and introduced to orthopaedic surgery field but it had many problem like early loosening. Recently it is being popular for some indication as development of new implant design and manufacturing. There are still many suggested advantages of hip resurfacing arthroplasty. These include bone conservation, improved function as a consequence of retention of the femoral head and neck and more precise biomechanical restoration, decreased morbidity at the time of revision arthroplasty, reduced dislocation rates, normal femoral loading and reduced stress-shielding, simpler management of a degenerated hip with a deformity in the proximal femoral metaphysic, an improved outcome in the event of infection, and a reduced prevalence of thromboembolic phenomena as a consequence of not using instruments in the femur. But, there are limited or inconsistent data to support some of these claims regarding the benefits of hip resurfacing including the potential for a more natural feel because of the minimal disturbance of the proximal part of the femur resulting in a better and faster functional outcome. We evaluate the short term results of hip resurfacing arthroplasty using custom patient-specific tooling for prosthesis placement for better standardization. Materials and Methods. 40 cases, 36 patients(male:20, female:16) those of who were candidates of a Hip Resurfacing procedure, participated in the study. Mean follow up period was 2.5 years (8 months ∼3 years). A CT scan was performed on each patient and a 3D model was generated using the computer tomography dataset. From this model a bone-surface skin was extracted and this data set was used to create a personalized jig. Detailed analysis of the native bone structure was then used to preoperatively plan the appropriate size and position of the implant. A mean 7 degree corrective valgus angle was prescribed on all cases. Postoperative radiological datasets were superimposed onto preoperative plan position and offsets were measured. Operative times were recorded per step during the procedure. Surgeon comfort and ease of use was also noted. Results. Mean preop and postop implant position tolerance within 3 degrees. Mean postop implant stem-shaft angle was 136°(122°∼142°) and mean acetabular inclination angle was 41°(37°∼50°). Mean Harris hip scores was improved from 48.4 points preoperatively to 93.8 at final follw up. There were two cases (in one patient) of loosening of femoral metal head (See Figure 1.) with angulation and migration in avascular necsosis (postoperative 6 months) and one case of femoral neck fracture (postoperative 1.5 year) so we revised to primary total hip surgery. Mean surgical time was recorded to 55 minutes(35∼75). Personalized jig utility was positive with no intra-operative complications. Conclusion. “Femoral neck referencing personalized jigs” provides a surgeon an easy to use, accurate alignment tool to simplify a demanding hip resurfacing procedure with very predictable outcome but long term follow up and much cases are needed

Introduction: There is little dispute that flexion and extension spaces should be rectangular and equal in a knee replacement and that rotation of the femoral component has a bearing on function and outcome. However, there is dispute over what is the ‘correct’ rotation and how best to achieve it. Transepicondylar line, computer navigation, 3 degrees external rotation have all been tried with a similar lack of reliability (Siston et al, JBJS Am, 2005 Oct; 87(10):2276–80) Insall and Scuderi recommended placing a tensor in the knee in flexion and rotating the femoral cutting block so that its posterior edge is parallel to the top of the tibia (. Scuderi et al, . Orthop Clinc. North. America. , . 20. :. 70. –78, . 1989. ). We feel the Equiflex instrumentation designed by Mr Lennox will reliably achieve Insall and Scuderi’s recommendation and reduce the incidence of lateral retinacular release. Purpose of Study: To evaluate early clinical results and lateral retinacular release rates using Equiflex instrumentation to do TKR. Method: We evaluated 209 consecutive knees done with this technique at Basildon from 4 April 05 – 19 September 06. Pre and postop American Knee Society and Oxford scores, deformity, ROM were recorded for the 152 cases with 6 week follow-up. Lateral retinacular release rates and complications are presented for the entire cohort of 209 cases. Results: Average inpatient stay −4.9 days (20% discharged in −3 days) if we exclude complications. There were 31 Valgus knees, 178 varus knees with an average alignment of 5.95 (23 degree varus − 25 degree valgus). 38 uncemented knees. At 6 weeks, Knee score improved from 34.5 to 78.5, function score improved from 47.5 to 49.8, oxford score improved from 43.4 to 30.06. Average preop flexion was 105 degrees (65–130) and average postop flexion was 98 (40–130). We could correct alignment and achieve our technical goals in 99% of cases. A lateral retinacular release was required in only 5 out 31 valgus knees (16%) and 0 out of 178 varus knees (a total lateral release rate of 2.4%). Complications: Wound or ipsilateral skin problems – 10 (4.7%) all of which settled rapidly with antibiotics. Thromboembolic phenomena – 13 cases (6.2%) – 9DVTs, 5 PE. MUA – 3 (2.3%). Hairline crack of tibial cortex in soft porotic bone– 3 (1.4 %). MI – 2 (1 postop, 1 at 4 weeks). CVA – 4 (1 postop, 1 at 6 weeks). Confusion – 2. GI bleed -2 . Bleeding PR, Ca Rectum -1. Discussion: Perioperative complications probably under-reported in studies with> 1 year follow up. Callahan et al in their metaanalysis of literature from 1966–1992 did not include delayed wound healing, wound drainage, haematoma, urinary retention etc. They found a weighted mean complication rate of 18.1 % with a mortality per year of followup of 1.5%. Studies which have specifically looked at complications have reported an average of 3.9% superficial infections, 1.7% deep infections, 6.5% DVTs and 2.1% peripheral nerve damage (9). Our complication rates were well within published data and we could correct alignment and achieve our technical goals in 99% of cases. We required to do a lateral retinacular release only in 5 valgus knees with subluxed patellae and contracted lateral structures for an overall release rate of 2.4%. Conclusions:. This is a safe, effective and reproducible procedure with complications comparable to published data. The equiflex instrumentation does help in equalising the flexion-extension gaps, improves patellar tracking and reduces the incidence of lateral retinacular release. Design modification to include a calibrated quantifi-able tensioner may be helpful. Further follow up of the same cohort would be desirable to get medium and long term results

Aims

The timing of surgical fixation in spinal fractures is a contentious topic. Existing literature suggests that early stabilization leads to reduced morbidity, improved neurological outcomes, and shorter hospital stay. However, the quality of evidence is low and equivocal with regard to the safety of early fixation in the severely injured patient. This paper compares complication profiles between spinal fractures treated with early fixation and those treated with late fixation.

Comparison of the safety and efficacy of bilateral simultaneous total hip replacement (THR) and that of staged bilateral THR and unilateral THR was conducted using DerSimonian-Laird heterogeneity meta-analysis. A review of the English-language literature identified 23 citations eligible for inclusion. A total of 2063 bilateral simultaneous THR patients were identified. Meta-analysis of homogeneous data revealed no statistically significant differences in the rates of thromboembolic events (p = 0.268 and p = 0.365) and dislocation (p = 0.877) when comparing staged or unilateral with bilateral simultaneous THR procedures. A systematic analysis of heterogeneous data demonstrated that the mean length of hospital stay was shorter after bilateral simultaneous THR. Higher blood transfusion requirements were expected following bilateral simultaneous THR than staged or unilateral THR, and surgical time was not different between groups. This procedure was also found to be economically and functionally efficacious when performed by experienced surgeons in specialist centres.