Background: Post-operative analgesia using parenteral opioids or epidural analgesia can be associated with troublesome side effects.

Locally administered pre-emptive analgesia is effective, reduces central hyper sensitisation and avoids systemic drug related side-effects and may be of benefit in total knee replacement.

Materials and Methods: 64 patients undergoing total knee replacement were randomised to receive a periarticular intra-operative injection containing ropivacaine, ketorolac, epimorphine and epinephrine or nothing.

All patients received patient controlled analgesia (PCA) for 24 hours post surgery, followed by standard analgesia. Visual Analogue Scale (VAS) pain scores during activity and at rest and patient satisfaction scores were recorded pre and post operatively and at 6 week follow up. PCA consumption and overall analgesic requirement were measured.

Results: PCA use at 6,12 and over 24 hours post surgery was significantly less in patients receiving the injection (P< 0.01, P=0.016, P< 0.01). Patient satisfaction in PACU and 4 hrs post operation was greater (P=0.016, P=0.013). VAS for pain during activity in PACU and at 4 hrs were significantly less (P= 0.04, P=0.007) in the injected group. The average ROM at 6 weeks was no different. Overall hospital stay and the incidence of wound complications was not different between the two groups.

Conclusion: Peri-articular intra-operative multimodal analgesia significantly reduces post-operative PCA requirement. Patient satisfaction was greater in the injection group.

Despite favourable wear characteristics of compression molded HMWPE in vitro preliminary data show no statistical difference in wear between RAM extruded HMWPE and compression moulded polyethylene. This study reviews AP and lateral radiographs for wear using the Martell technique at two, five years and maximum follow up (mean 88.2 months).

Reduced implant survivorship due to aseptic loosening has prompted research into alternative bearing materials. Simulator testing is useful but clinical studies are the gold standard to evaluate the wear characteristics of new bearing materials.

On hundred and twelve patients matched for sex, age, body mass index, primary pathology, Charnley grade, and follow up underwent uncemented total hip replacement using an identical implant. Group One (sixty-four patients) had a RAM extruded liner (GUR 4150 HP) and Group Two (forty-eight patients) had a compression molded liner (Montell H 1900). HMWPE sterilisation regimes were identical. AP and lateral radiographs were analysed for wear using the Martell technique at two, five years and maximum follow up (mean 88.2 months).

Preliminary data show a linear and volumetric wear rate in Group One of 0.067 mm/yr and 26 mm3/year respectively between two years to maximum follow up. Similarly, the wear rates for Group Two were 0.132 mm/yr and 45 mm3/year respectively. There was no statistical difference in acetabular osteolysis between Group One (16.3%) and Group Two (15%) patients at maximum follow up.

Despite favourable wear characteristics of compression molded HMWPE in vitro preliminary data show no statistical difference in wear between RAM extruded HMWPE and compression moulded polyethylene. Quality of the wear debris is more likely to be important in producing aseptic loosening than actual wear rate.

Background: Reduced implant survivorship due to aseptic loosening has prompted research into alternative bearing materials. Simulator testing is useful, but clinical studies are the gold standard to evaluate the wear characteristics of new bearing materials. Net compression molded polyethylene has clinically reported improved wear characteristics over traditionally used RAM extruded UHMWPE 1,4,17,22. Machining of the compression molded acetabular component however may be detrimental to its wear properties 29. We report a 23–29% increase in 2D and 3D linear and volumetric wear in a cohort of patients in which machined compression molded acetabular components were used.

Methods: Ninety-two patients matched for gender, body mass index, primary pathology, Charnley grade, and length of follow up underwent uncemented total hip replacement using an identical acetabular and femoral implant. Group 1 (52 patients) had a RAM extruded polyethylene liner (GUR 4150 HP) and Group 2 (40 patients) had a machined compression molded polyethylene liner (Montell H 1900). UHMWPE sterilisation regimes were identical. Antero-posterior and lateral radiographs were analysed for acetabular wear using the Martell technique at a minimum follow up of five years and a maximum mean follow up of 87.4 months for group 1 (SD=8.7) and 84.9 months for group 2 (SD 7.7).

Results: Both 2D and 3D linear and volumetric wear rates in patients with a RAM extruded polyethylene acetabular component were 23–29% less compared to patients that received a machined compression molded acetabular liner. There was a statistical difference in age between to the two groups (P=0.007). Looking at acetabular wear in patients over 55 years, machined compression poly was still 16–31 % worse then RAM extruded polyethylene although statistical difference could not be reached for 3D linear and volumetric wear. The incidence of acetabular osteolysis on review of radiographs at maximum follow up was similar in both groups (group 1 =16.3% versus group 2 =15%).

Conclusions: Despite favourable reports of improved wear characteristics of net compression molded UHMWPE, this study shows a 23– 29% increase in 2D and 3D linear and volumetric wear in machined compression molded acetabular components. It appears that machining of compression molded polyethylene bar stock, to obtain the final component, is detrimental to the wear properties of the acetabular liner.

We identified five (2.3%) fractures of the stem in a series of 219 revision procedures using a cementless, cylindrical, extensively porous-coated, distally-fixed femoral stem. Factors relating to the patients, the implant and the operations were compared with those with intact stems. Finite-element analysis was performed on two of the fractured implants.

Factors associated with fracture of the stem were poor proximal bone support (type III–type IV; p = 0.001), a body mass index > 30; (p = 0.014), a smaller diameter of stem (< 13.5 mm; p = 0.007) and the use of an extended trochanteric osteotomy (ETO 4/5: p = 0.028). Finite-element analysis showed that the highest stresses on the stem occurred adjacent to the site of the fracture. The use of a strut graft wired over an extended trochanteric osteotomy in patients lacking proximal femoral cortical support decreased the stresses on the stem by 48%.

We recommend the use of a strut allograft in conjunction with an extended trochanteric osteotomy in patients with poor proximal femoral bone stock.