Introduction: Infection post knee arthroplasty is a catastrophic surgical complication offering a major challenge to the orthopaedic surgeon. We present the outcome of a two-stage revision implantation technique utilizing a rotational hinge prosthesis with an antibiotic impregnated cement spacer in the interim period.

Materials & Method: Since 1995, 38 definitely infected knee replacements were revised. All were followed prospectively over a 10 year period. Initial treatment consisted of thorough debridement, removal of implants and a period of antibiotic administration. Vancomycin impregnated articulating cement spacer was inserted in the interim. C-reactive protein values were monitored periodically. At second stage all patients were clinically and biochemically free of infection.

Results: Second stage revision was performed at an average interval of 9 months (range 4 – 11 months). Average length of hospital stay post 2^nd stage was 19.8 ± 8.2 days. At follow-up (3.5 ± 2.5 years) outcome was poor in 33 % (amputations, arthrodesis, re-infections), good in 49 % (decreased ROM, PFJ pain) and excellent in 13 %. 3, 5% of patients had died with their prostheses in situ. The average pre and post operative Oxford Knee Score were 47.0 ± 7.5 and 21.6 ± 4.3 respectively.

Conclusion: Two-stage re-implantation using a hinge knee prosthesis is a safe and acceptable way of dealing with infected TKRs, conferring a stable reconstruction whilst allowing a through debridement. Thus potentially decreasing failure rates due to recurrence of primary infection. In this challenging group, complication rates were high, but at mid- and long-term review, no prostheses had failed from an aseptic cause. Moreover, this salvage procedure allows a quick rehabilitation and is tolerated well by patients.

1282 Primary total hip replacements were performed over the past 3 years at the Ravenscourt Park Hospital. Standardised post operative x-rays of the pelvis were archived on the Hammersmith Trust Picture Archiving and Communication System. 100 X-rays were randomly selected and reviewed by 3 independent observers (SHO, SPR, and a Consultant), and they were blinded as regards the Surgeon and their colleagues’ assessments. Surgeons who performed their procedure were excluded.

Digital radiographic analysis was performed using the OrthoView system (Meridian Technique Limited, Southamptom, UK). The acetabular component was studied with respect to cup version, the angle of inclination, the quality of cement technique, and the site of cup placement. The stems were studied for cementing technique and quality, stem alignment and limb length discrepancy. A hit was declared when excellence was achieved, whilst all others were declared as a miss. Inter observer rate in declaring a hit or miss was calculated (kappa). 58% of the radiographs studied were declared a hit, and 42% a miss.

All radiological reports were reviewed, and it was noted that no mention was made as regards the cup angles and the cementing quality. Each assessment took 3 minutes

(1.5). The aim of this post operative radiological assessment is to introduce a tool that could be used for appraisal of Surgeons, the surgical technique and for quality control.

The authors conclude that it is an easily reproducible technique, and can be performed by independent observers. These assessments will generate valuable data for research/auditing purposes, and act as an educational tool for trainees. They cautiously recommend this hit or miss approach, believing that it is a cost effective and efficient tool towards achieving better patient quality care and enhancing hip arthroplasty training skills.

Purpose: Periprosthetic fractures around hip prostheses are difficult problems because these fractures range from the very simple (requiring no surgical intervention) to the complex (requiring major surgery). This paper evaluates the primary stability and restoration of femoral bone stock following treatment of Vancouver type B-2 periprosthetic fracture of the femur using an extensively hydroxy-apatite coated revision stem implant.

Methods: We have prospectively reviewed 9 cases with B-2 periprosthetic fracture operated at our centre between 1996 to 2001. Of the nine patients, 4 were male and 5 female. The mean age was 76.7 years (50-92). All patients were treated by femoral revision using an extensively hydroxy-apatite coated titanium revision femoral stem (Restoration HA, Stryker, Rutherford, NJ). Fixation was augmented with a combination of cerclage cables and onlay cortical strut allografts.

Results: There has been no loss to follow-up. 1 patient died, but at most recent follow-up the fracture had united with radiological evidence of bone on-growth to the stem. Mean follow up in the rest of the cohort was 3.3 years. There was radiological evidence of fracture union in all patients. Mean subsidence of the stem was 0.22mm. At most recent follow-up the mean Harris Hip Score had improved to 77.2 (63-93). Favourable bone remodelling was observed in all patients with no evidence of stress shielding so far. At most recent follow-up there have been no cases of mechanical failure, deep infection or dislocations. No patient is awaiting further revision.

Conclusion and Significance: Te Restoration HA stem has produced excellent clinical results in our study. We have observed no intra operative fracture and low postoperative complication rate. We are extremely encouraged by the observed femoral remodelling. There has been no case of mechanical failure as yet and there is no reason to expect, once union and on-growth have occurred, that loosening will be a problem. In treating this challenging and increasingly common complication of total hip replacement, femoral revision using an extensively HA coated revision femoral component offers a reliable method of femoral fixation leading to successful fracture healing and early return to function.

We have prospectively compared the fixation of 100 intertrochanteric fractures of the proximal femur in elderly patients with random use of either a Dynamic Hip Screw (DHS) or a new intramedullary device, the Gamma nail. We found no difference in operating time, blood loss, wound complications, stay in hospital, place of eventual discharge, or the patients' mobility at final review. There was no difference in failure of proximal fixation: cut-out occurred in three cases with the DHS, and twice with the Gamma nail. However, in four cases fracture of the femur occurred close to the Gamma nail, requiring further major surgery. In the absence of these complications, union was seen by six months in both groups.