Introduction: The Durom hip acetabular component is a large diameter metal on metal (MoM) implant that has recently been the subject of much controversy. Dr. Lawrence Dorr, reported in a letter in April 2008 to the American Association of Hip and Knee Surgeons a worryingly high number of early revisions, as many as 8%, within the first 2 years as a result of a loose acetabular component. Following a Zimmer investigation an early revision rate of 5.7% in the US, but not in Europe, was revealed and this has resulted in the withdrawal of the implant from the market in the US and justifiable concern with regards to its usage resulting in decreased implantation within the UK. Surgical technique in the US has been sited as the main reason for failure as a result of low volume centres not performing crucial steps in the technique which include, but are not limited to, line-to-line reaming, use of trials in every case, proper cup position for this device, appropriate impaction techniques and no repositioning. We present the short term results and our experience of the Durom Acetabular component in our centre in the UK.

Method: We reviewed all patients that had a Durom Acetabular component implanted since its usage began in our unit in 2003. No patients were excluded and the end point being revision surgery of the Durom acetabular component. In addition we analysed the plain radiographs of a random selection of 50 patients to assess component integration.

Results: 260 patients had undergone primary hip surgery with the implantation of the Durom Acetabular component. 108 as part of a hip resurfacing and 152 as a large bearing MoM THR. Their follow up ranged from 1 to 7 years. 1 had undergone revision for thigh pain with aseptic failure of the acetabular component, 1 for ALVAL, 3 had undergone revison for infection and 1 for peri-prosthetic fracture. Analysis of the radiographs revealed a number of acetabulae with a lucent line visible around the implant. None of the implants had migrated from their original position at implantation.

Conclusions: At present their appears to be no evidence in our unit that the Durom Acetabular component has a higher than expected rate of early revision. However, a number of patients do appear to have lucency around the component on radiographs raising the possibility of questionable bony integration and on growth. Reports from the United States have suggested that the cup will “spin out” easily at revision showing no signs of bony integration. This may result in an increased revision rate in the future and we suggest that all patients that have a Durom acetabular component in situ be followed up with yearly clinical assesment and radiographs to assess the longevity of this component.

We report the outcome of 161 of 257 surgically fixed acetabular fractures. The operations were undertaken between 1989 and 1998 and the patients were followed for a minimum of ten years. Anthropometric data, fracture pattern, time to surgery, associated injuries, surgical approach, complications and outcome were recorded. Modified Merle D’Aubigné score and Matta radiological scoring systems were used as outcome measures. We observed simple fractures in 108 patients (42%) and associated fractures in 149 (58%).

The result was excellent in 75 patients (47%), good in 41 (25%), fair in 12 (7%) and poor in 33 (20%). Poor prognostic factors included increasing age, delay to surgery, quality of reduction and some fracture patterns. Complications were common in the medium- to long-term and functional outcome was variable. The gold-standard treatment for displaced acetabular fractures remains open reduction and internal fixation performed in dedicated units by specialist surgeons as soon as possible.

The incidence of acetabular fractures within the UK is about 3 in 100,000 of the population per year. Since Letournel and Judet first proposed that operative reduction and rigid internal fixation of displaced fractures will likely lead to better outcome, operative management of such fractures has become standard management in major trauma centres. Long term outcome results following acetabular surgery have been reported sparingly.

Two hundred and fifty-seven displaced acetabular fractures underwent an open reduction and internal fixation at St. George’s Pelvic Unit between 1992 and 1997. All surgery was performed by a single surgeon. 161 patients were followed up prospectively for a minimum of 10 years. Those lost to follow up were excluded. Anthropometric data, fracture pattern, time to surgery, associated injuries, approach, complication and outcome recorded on a database. Modified Merle D’ Auberge score was utilized as outcome measures.

The mean age was 36 years (15 to 85). Road traffic accident was the commonest mechanism of injury. We observed simple fractures in 34 % and associated fractures in 66%. 52% suffered polytrauma. Average time to surgery was 11 days and anatomic reduction was achieved in 73.9%. Results were excellent 46.8 %, good 25.5 %, fair 7.5 %, and poor 19.2 %. Poor prognostic factors were increasing age, delayed surgery, poor reduction, and posterior column, transverse posterior wall and T-shaped fracture patterns.

Acetabular surgery poses a major challenge to the trauma surgeon. Complications in the immediate, mid and long term are not rare. Our results compare to other series with shorter follow-up. We believe that the gold standard treatment for displaced acetabular fractures must be open reduction internal fixation performed by a dedicated pelvic surgeon at the earliest time possible. Moreover whether we are merely postponing the inevitable post-traumatic arthritis is still unknown.

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.

Introduction: A subjective observation suggests that a significant percentage of patients offered a TKR could benefit from a relatively more conservative, less invasive unicompartmental knee arthroplasty. We set out to challenge this hypothesis.

Materials & Methods: 1147 TKRs were performed between 2002 and 2005 at Ravenscourt Park Hospital. 50 consecutive knee x-rays of patients who underwent a TKR were reviewed by three independent observers. Medial and lateral articular cartilage height, varus angulation, and femero-tibial anteroposterior and mediolateral translation were measured on antero-posterior and lateral weight bearing radiographs. Skyline views were analysed for patellofemoral disease. The most appropriate procedure according to local radiological criteria was recorded for all three observers. Unicompartmental arthroplasty was considered when the following criteria was met 1) anteromedial disease with preservation of posterior slope, 2) preservation of the tibial spines, 3) no anteroposte-rior or mediolateral translation, 4) normal tibiofemoral alignment and 5) preservation of patellofemoral joint. Osteophytes were disregarded. Tricompartmental disease merited a TKR while isolated patellofemoral (PFJ) disease considered for PFJ replacement. Patients were not formally examined. Preoperative Knee Society Scores (KSS) and WOMAC scores were noted.

Results: The three observers indicated that 26 (52%), 21 (42%) and 22 (44%) patients respectively could potentially benefit from a unicompartmental arthroplasty given the right clinical setting. Consensus was reached for unicompartmental replacement in 16 (31.2%) and for TKR in 18 (36%) of cases. There was no correlation between the operation performed and operation proposed (42% ± 8) suggesting that the surgeon’s preference is a dominating factor. Interestingly within the proposed unicompartmental group Knee Society Scores were higher (100 ± 22 vs 71 ± 26) giving an indication to the disease severity.

Conclusion: The clinical benefit and economic value of opting for a unicondylar knee arthroplasty when indicated is considerable. None the less it was only considered by a minority of surgeons who undertake knee arthroplasty.

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.