Displaced fractures of the neck of femur are routinely treated in the elderly by either cemented hemiarthoplasty, in the fit, or uncemented hemiarthroplasty, in the less fit. In Scotland the Scottish Intercollegiate Guidelines Network (SIGN) guidelines are followed to identify which patients should have a cemented prosthesis. This is based on cardiovascular status, and the age and fragility of the patient. An uncemented prosthesis should be a final operation. A peri-prosthetic fracture is considered a failure of treatment as the patient then has to undergo an operation with a far greater surgical insult. We looked at all neck of femur fractures over a period of Jan 2007 to June 2010. The number of the peri-prosthetic fractures for uncemented hip hemiarthroplasties was established, and a case note review was carried out. There was 1397 neck of femur fractures. 546 hemiarthroplasties were carried out, of which 183 were cemented, and 363 uncemented. 15 patients (4% of uncemented hemiarthoplasties) had peri-prosthetic fractures. There were no peri-prosthetic fractures in the cemented group, p = 0.004 using Fisher's exact test. The case notes of these patients were analysed. We found there was a common link of significant cardiovascular risk, lack of falls assessment (only 14% of the patients had a completed falls assessment and 21% sustained their fracture during an admission to hospital) and confusion (50% had a degree of dementia that caused significant confusion). Cemented implants should be considered in all patients, especially those who are cognitively impaired or have failed falls assessments; even if the cardiovascular risk is significant. This decision should be made in conjunction with a senior anaesthetist. This is being implemented in our unit and a prospective audit is being carried out over the same time period (July 2010 to Dec 2013) to assess the benefit

Background. Thrust plate prosthesis (TPP) is a bone conserving prosthesis in use for over thirty years. TPP is a stemless and uncemented femoral prosthesis fixed at the lateral femoral cortex with a bolt, plate and screw. This has a metal-on-metal articulation with a 28mm Metasul head and Allofit press fit acetabular cup. Our study aimed to assess the functional outcome of this prosthesis. Methods. In our institution 234 TTPs were implanted between 1995 and 2005. All patients completed a self-assessed questionnaire of Harris Hip Score at 2 months, 1 year, and then yearly. Only those who had a follow up was within the last two years were included in the analysis. 76 patients who had failed to satisfy the criteria were excluded. Of the 158 hips in the study 75 hips were in male patients and 83 were in female patients. The median age of patients was 52 years (range 15 to 82). 75 hips were on the right side and 83 on the left. All patients were operated by the senior author or a senior trainee under his supervision (seven hips). Revision of the implant or decision to revise was taken as the end point of our study. Results. The median time to follow up was 7 years (range 1 to 15). The median pre-operative hip score was 43 (range 3 to 77) which rose to 83 points (range 11 to 100) at the latest follow up. Median hip score in females improved from 39 to 82 points and in males from 52 to 85 points. Twelve patients underwent revision surgery either for infection or aseptic loosening. Conclusion. The Thrust Plate Prosthesis had a good outcome with an increase in hip score of 40 points and a median survival of 7 years

Summary. The 80% porous structure of trabecular metal allows for bone ingrowth in more than 90% of the available surface. The Nexgen LPS Uncemented Knee using a trabecular metal tibial component has performed well at minimum of 5 years’ follow-up. Introduction. Total Knee Arthroplasty prostheses most frequently used in today's practice have cemented components. These have shown excellent clinical results. The fixation can however weaken with time, and cement debris within the articulation can lead to accelerated wear. Cementless implants are less commonly used, but some have also shown good long-term clinical results. The potential advantages of cementless implants are retention of bone stock, less chance of third-body wear due to the absence of cement, shorter operative time, and easier treatment of periprosthetic fractures. The posterior stabilised knee replacement has been said to increase tangential shear stresses on the tibial component and increases contact stresses on the cam and post mechanism hence the great debate of cruciate retaining or cruciate sacrificing implants. Objectives. We report the results of a prospective cohort of consecutive primary total knee arthroplasties using an uncemented posterior stabilised prosthesis using a trabecular metal (tantalum) tibial component at a minimum 5-year follow-up. Methods. Prospective 5 year follow-up of patients undergone an uncemented posterior stabilised total knee replacement using a trabecular metal tibial component (NexgenLPS). Clinical examination, Oxford knee score, Knee society score, SF12 and radiological evaluation undertaken at review. Results. 81 patients, 45 female, 36 male. Left 31, Right 50. Mean age 74.3 yrs range (51–90). SF12, mean: 31.8 range (25–37). Oxford Knee Score Pre-op Mean 20.1 range (9–36) Post op: Mean 32.1 range (9–48). Knee Society score. Pain Mean 91.8; range (60–100). Functional score mean 76.2; range (30–100). Mean Range of movement 110.5 degrees range (90–125). No evidence of loosening at 5 yrs. No deep infection. No Revisions. Conclusion. Although there are a variety of methods of achieving satisfactory initial fixation in cementless components, trabecular metal has an advantage owing to its cellular structure resembling bone. The 80% porous structure of trabecular metal allows for bone ingrowth in more than 90% of the available surface. The Nexgen LPS Uncemented Knee using a trabecular metal tibial component used in this series has shown no evidence of loosening at a minimum of 5 years’ follow-up and the prosthesis as a whole has performed very well clinically. Its early results are comparable to those prostheses most commonly used as reported by the arthroplasty registers. The longer term results from this prosthesis are awaited with interest