Press-fit fixation of uncemented acetabular components is increasingly being used for total hip replacement (THR) surgery. This study was aimed to analyse the survival of an established, un-cemented flexible metal backed cup with non-highly cross-linked polyethylene in primary and simple revision THR.

We assessed the outcome of 1703 consecutive cementless elastic acetabular cups (Atlas, FH France) with non-highly cross-linked polyethylene (GUR1030) in total hip replacement surgery. There were 1582 patients (513 males and 1079 females) with mean age of 74 years (36–97 years). Seventeen senior operating surgeons accounted for 88.5% of cases from a single arthroplasty unit. Survival analysis was calculated using the Kaplan Meier Estimator. At 184 months post surgery the survivorship was 92.4% (95% CI 88.3–94.7) with cup revision for any cause as an endpoint. Three patients died within first month of surgery and 268 patients (17.13%) died due to unrelated causes.

Overall, 59 patients had revisions (3.5%), Thirty eight patients (2.3%) were due to acetabular causes such as: aseptic loosening in 6 patients (0.35%); hip instability in 13 patients (0.76%); and deep infection in 11 patients (0.64%).

We believe the cementless elastic acetabular cup on in total hip replacement is tolerant of technique and patient variation and continues to give excellent long-term results and its continued widespread use can be recommended.

National Institute of Clinical Excellence (NICE) recommended total hip replacement (THR) surgery for fit patients with fracture neck of femur (NOF) in 2011. Our hospital implemented hip fracture program to follow these recommendations the same year. However, the increased incidence of further procedures compared with those undergoing the THR for osteoarthritis alone has led to concern regarding dislocation and other complications when using THR treatment for fracture NOF particularly with the posterior approach.

We introduced dual mobility implant for THR for hip fracture program patients to minimize risk of hip instability but allowing the use of the posterior approach which is recognised as giving a faster recovery than the Hardinge type approaches in this patient group. The Arthroplasty database for hip fracture program was reviewed from September 2011 to September 2015 for appropriateness of this treatment. During this period, 120 Dual Mobility THRs were carried out in 119 patients (36 males, 84 females) with mean age at 78 years (42–94) and average follow-up of 24 months (2–56 months). All patients were either operated by a fellowship trained arthoplasty surgeons or the senior surgeons using posterior approach. All patients undergoing THR for NOF were found to meet the NICE guidelines criteria for THR. No post-operative dislocation, infection, hetotropic ossification or lysis was recorded. Mean Harris Hip Score (HHS) at 19 months was 82 (54–98). In this cohort 112 patients (94.3%) were able to ambulate in non-trendlenburg gait pattern. One patient developed deep vein thrombosis in early post-operative period.

This study emphasises beneficial use the dual mobility implant combined with the posterior approach in THR for fracture NOF patients and highlights the areas of improvements in hip fracture management.

Introduction

Primary Total Elbow Replacement (TER) is gaining popularity as a primary treatment option for osteoporotic fractures of the elbow, particularly in patients with low demand. The aim of this study was to assess the clinical and functional efficacy of TER as a primary treatment for comminuted distal humerus fractures in the elderly.

Introduction

The use of the dynamic hip screw is common practice for the fixation of intertrochanteric fractures of the femur. The success of this procedure requires accurate guide wire placement. This can prove difficult at times and can result in repeated attempts leading to longer operating time, multiple tracks and more importantly greater radiation exposure to both patient and operating staff. We hypothesised that rather than using the standard anterior-posterior projected image (Figure 1) of a proximal femur, rotating the intensifier image (Figure 2) so that the guide wire appears to pass vertically makes it easier to visualise the projected direction of the guide wire.

The ability to drive represents autonomy and independence of individuals. For many patients not being able to drive severely restricts their social, personal and professional activities leading to adverse effects on their well being. This study assessed the current evidence on driving advice after total hip replacement (THR) and compared it with the real time ability of patients to drive their own cars after primary THR. We present a prospective review of car driving ability of 130 patients (80 males and 50 females) who were treated with THR.

The results show that 105 patients (81%) were able to drive within 6–8 weeks after surgery. It took more than 12 weeks for 22 patients (17%) to start driving again. There was no reported deterioration in the driving ability after primary total hip replacement surgery. Conversely, 49 patients (38%) felt a subjective improvement in their driving capability after THR. Three patients (2%) were still not confident to drive even at 12 weeks post THR. In spite of the clear advice, only 69% practiced on a stationary car before driving on the road. In our study sample 67 patients (63.8%) had a right THR and 65 patients (61.9%) were manual car drivers and all were able to drive between 6–8 weeks.

This study demonstrates that patients should not resume driving motor vehicles for a minimum period of six weeks following total hip replacement surgery. This is inclusive of automatic and manually operated automobiles, and irrespective of laterality of surgical interventions. Return to driving after a six week period should be based on the individual’s capability and confidence to control the vehicle safely. Patients should be given clear advice to practice on the stationary vehicles before starting to drive on the road.

Clinical management of ankle injuries often involves use of braces to provide pain relief and stability. Individuals with braced ankles may be at more risk of injury while turning. The aim of this study was to evaluate the biomechanical effects of one of the commonly prescribed pneumatic ankle braces on gait parameters while turning.

Three-dimensional gait data was collected using a 7 camera, VICON 612 (Oxford Metric, UK) motion analysis system (120 HZ) synchronised with a single Kistler force plate embedded in the floor and set at a sampling frequency of 600HZ. Sixteen retro-reflective markers were attached to anatomical landmarks on both lower limbs and pelvis using wig tape. In the case of the braced ankle, markers were attached on the brace over the respective body landmarks.

Out of ten trials, five were performed with and the other five without brace. Comparative results were produced between braced and un-braced ankle during turning at 90 degrees with the right foot landing on the force plate and turning right. Results show that use of brace is effective in reducing gross moments about the ankle joint even at the time of turning but it does not totally eliminate motion.

Both conditions showed different rotation moments at knee but hip rotation moments were not affected by the brace. Knee rotation moment without brace was mainly in internal rotation (0.301Nm/kg) towards the terminal stance phase and it reduced to 0.128Nm/kg by bracing the ankle.

A new type of turning strategy was identified where the subject pre-planned the turn in late swing phase before landing on the ground probably to avoid a fall. It is important that patients with ankle injuries receive supervised gait training to improve their turning confidence during their rehabilitation therapy.

This study was aimed to develop a non-invasive technique to analyse motion of the patella during the gait cycle. Ten subjects with no history of patello-femoral pain syndrome or evidence of patella mal-tracking on clinical examination were individually assessed on 160 dynamic walking trials. Retro-reflective markers were attached to the proximal, distal, medial and lateral poles of the patella and the position of the patella relative to the centre of the knee joint was tracked and recorded during their gait cycle using a nine camera (120Hz) ViconTM infra-red motion analysis system.

We found that there was more medial-lateral motion (shift) of the patella than proximal-distal (tilt) motion during the gait cycle. It was noted that the patellar shift motion occurred in the swing phase or the early stance phase of the gait cycle of all subjects with the maximum patellar shift occurring when the knee was flexed between 30–56 degrees in the majority of subjects. Similarly the patellar tilt motion occurred in the swing phase or the early stance phase of the gait cycle with the maximum patellar tilt occurring between 20–36 degrees of knee flexion in the majority of subjects.

These results indicate that normally the maximum amount of patellar shift and tilt occurs in the swing and early stance phases of the gait cycle and that abnormal patellar motion can be detected if excessive shift or tilt occurs outside of these phases. From the findings of the current study, it is proposed that future studies are needed to quantify patellar motion during walking. The future work should be directed to assess patellar motion during swing phase and early stance phase of the gait cycle using more sophisticated techniques like dynamic magnetic resonance imaging to exactly quantify patellar motion.

Ankle injuries in cricket fast bowlers are of topical interest with a number of elite pace bowlers recently sustaining injuries. Previous biomechanical research has concentrated on the injury risk to the fast bowler’s lumbar spine with no research focused on the leading leg and specifically the ankle biomechanics of the fast bowler and its predisposition to injury.

We investigate the leading leg biomechanics in maximal and submaximal fast bowling. Ten fast-medium paced bowlers of elite level had their leading leg biomechanics assessed during their bowling action. Using a nine camera infra-red ViconTM 612 motion analysis system linked to a KistlerTM 9281CA force platform the moments of the subjects leading leg during their delivery stride was analysed. Each subject performed ten trials at a maximal ball release speed (> 97km/hr) and ten trials at a submaximal ball release speed (< 97km/hr) with the speed of the ball tracked by a SR3600 radar gun.

All three large joints of the leg were observed and joint moments examined in both directions of all three orthogonal planes giving a total of eighteen joint moments investigated. Of these results only the difference in the ankle plantar flexion was found to be significant. The average ankle plantar flexion peak moment in the maximal and submaximal ball release speed groups were found to be 2.008Nm/kg and 1.790Nm/kg respectively. This difference was statistically significant (p< 0.02)

The increased ankle plantar moment reflects the important role the ankle plays in the generation of extra ball release speed in the fast bowler. However this role does place increased stress on the ankle which may predispose it to injury. This study suggests that the ankle plays a significant role in the fast bowler’s delivery action and post injury rehabilitation needs to take this into consideration.

This study assessed factors responsible for exclusion of patients from bone donation at primary hip arthroplasty in order to improve bone banking.

Fifty-five patients underwent screening in preoperative clinics assessing their suitability for femoral head donation. Records at the bone bank were then reviewed post operatively to check whether bone had been harvested from these individuals during surgery.

Overall, 95% of the patients screened did not proceed to bone banking. After the initial screening stage 60% of patients were excluded. The majority of exclusions (70%) were unacceptable as donors because of their potential risk of transmission of disease to recipients. Although 40% were consented for donation, femoral heads from only 5% were harvested and sent for storage in the bone bank during hip arthroplasty.

Orthopaedic surgeons must take an active part in bone banking and alternative sources of bone grafts require exploration in the future to meet the increasing demand.

Purpose of Study: To develop a non-invasive technique to assess and analyse patella kinematics during the gait cycle.

Methodology and Results: Ten subjects with no history of patellofemoral syndrome or patella maltracking on clinical examination were individually assessed on eight dynamic walking trials each. Retroreflective markers were attached to the proximal, distal, medial and lateral poles of the patella and the position of the patella relative to the centre of the knee joint was tracked and recorded during their gait cycle using a nine camera (120Hz) ViconTM infra-red motion analysis system.

It was found that there was more medial-lateral motion (shift) of the patella than proximal-distal (tilt) motion during the gait cycle.

It was noted that the patella shift motion occurred in the swing phase or the early stance phase of the gait cycle of all subjects with the maximum patella shift occurring when the knee was flexed between 30–56 degrees in the majority of subjects.

Similarly the patellar tilt motion occurred in the swing phase or the early stance phase of the gait cycle with the maximum patella tilt occurring between 20–36 degrees of knee flexion in the majority of subjects.

Conclusion: The results of this study show that patella motion can be identified non-invasively using the ViconTM motion analysis system. These results indicate that normally the maximum amount of patella shift and tilt occurs in the swing and early stance phases of the gait cycle and that abnormal patella motion can be detected if excessive shift or tilt occurs outside of these phases.

Introduction The need for bone graft has increased in recent years partly due to the greater numbers of revision hip arthroplasties being performed secondary to the increasing life expectancy in the UK.

Method Our study prospectively reviewed the practice of bone banking at Portsmouth Hospital NHS Trust to look into the various factors responsible for exclusion of patients from donation of bone. All 55 patients under-went screening in a preoperative assessment clinic using a standard proforma to assess their suitability for femoral head donation during the course of their primary hip arthroplasty and records at the bone bank were then reviewed post operatively to check whether bone had been harvested from these individuals during surgery. Results 95% of the patients screened did not proceed to bone banking. After the initial screening stage 33 patients (60%) were excluded due to a variety of reasons. The majority of those excluded (23 patients) were not accepted as donors because of the potential risk of transmission of disease to their recipients.

Although 22 patients (40%) were consented for allograft donation, femoral heads from only 3 patients (5%) were harvested and sent for storage in the bone bank during hip arthroplasty.

Discussion The harvesting of viable bone stock was shown to be poorly utilised in our study. Orthopaedic surgeons must take an active part in bone banking and alternative sources of bone grafts need to be explored in the future to meet the increasing demand.

Bone grafting is used extensively in orthopaedic reconstructive surgery. Revision hip arthroplasty often presents surgeons with difficult bone loss problems, which can sometimes be addressed using donated bone. This need for bone graft has increased in recent years with greater numbers of joint replacements and increasing life expectancy after replacement, particularly as prostheses are being implanted into younger patients. Current practice of bone banking involves careful donor selection, stringent screening tests and internal safety systems in bone banks to prevent the ever present threat of communicable diseases. Introduction of strict monitoring systems to prevent allograft-related diseases has rendered a significant number of primary hip replacement patients unsuitable for bone donation. This study audited the practice of bone banking at Portsmouth Hospitals NHS Trust to look into various factors responsible for exclusion of patients from bone banking. All 55 patients underwent screening in pre-operative assessment clinics using standard Proforma to assess their suitability for femoral head donation during the course of their primary hip replacement surgery. After the initial screening stage 33 patients (60%) were excluded due to variety of reasons. The majority of those excluded (23 patients) were not accepted as donors because of their potential risk of transmission of disease to the recipients. The situation is likely to become worse in future as the incidence of communicable diseases is rising in the UK. Alternative sources of bone grafts should be explored in future to meet the demands for, example auto-banking.