Introduction

Following National patient safety alert on cement use in hip fracture surgery, we investigated the incidence and pattern of 72 hours peri-operative mortality after hip fracture surgery in a District General Hospital.

Introduction

There is uncertainty about the relationship between improvement in range of motion (ROM) and functional outcome or patient satisfaction after total hip arthroplasty (THA). Using data from a prospective multi-centre study we investigated this relationship.

We examined data from a large prospectively collected dataset which followed up patients after Exeter total hip replacement (THR) - the Exeter Primary Outcome Study. We studied 78 patients who had total hip replacement for osteoarthritis on a morphologically normal hip, and in whom the other hip was also morphologically normal for comparison. All selected patients had complete patient outcome data at 1 and 5 years, and x-rays at 1 year were available.

We measured accuracy of reconstruction on AP Pelvis radiographs. The parameters measured were difference in height of lesser trochanter from horizontal pelvic line (LLD); length from ASIS to greater trochanter (indicating abductor length, AL); length from symphysis to centre of femoral head (SFH); length from centre of head to axis of femur (offset). We examined clinical outcomes including gain of Oxford Hip Score (DOHS) at 1 and 5 years, absolute OHS at 1 and 5 years, and absolute SF-36 Physical Functioning and Role Physical scores at 1 and 5 years.

Examining the ratios of AL, SFH, Offset, Offset to SFH ratio and LLD between side of THR and unaffected side all showed marked variation. Thus the ratio of SFH varied from 0.85 to 1.11. For further analysis we divided the patients into 3 groups on the basis of variability of the ratio from 1; we examined whether the clinical scores above varied between these 3 groups. 1 way ANOVA demonstrated no significant difference for any of the clinical outcomes for any of the 5 grouped x-ray variables.

Accuracy of reconstruction has been shown to affect the risk of dislocation after THR. Our results indicate that clinical outcomes of total hip replacement appear resilient to some degree of surgical inaccuracy. Future trials of navigation should be designed to demonstrate not only improved accuracy but also improved clinical outcome.

Introduction

Acetabular cup lucency predicts cup survival. The relationship of subchondral plate removal and cup survival is unclear. Using data from a prospective study conducted between January 1999 and January 2002 we investigated the role of subchondral plate removal in cemented acetabular cup survival at five years.