High failure rates have been associated with large diameter metal-on-metal total hip replacements (MoM THR). However there is limited literature describing the outcomes following the revision of MoM THR for adverse local tissue reaction (ALTR).

A total of 98 large diameter MoM THRs underwent revision for ALTR at our institution. The data was obtained from the clinical records and included the demographics, intra-operative findings of ALTR and post-operative complications. Any subsequent procedures and re-revision for any reason was analysed in detail. The clinical outcome was measured using functional outcome scores using the Oxford hip score (OHS), Western Ontario and McMaster Universities osteo-arthritis index (WOMAC) score and Short Form (SF12).

The mean age of the patients at the time of revision was 58.2 yrs. At a mean follow-up of 3.9 years (1.0 to 8.6) from revision for ALTR, there were 15 hips (15.3 %) with post-operative complications and 8 hips (8 %) requiring re-revision. The Kaplan–Meier five-year survival rate for ALTR revision was 91 % (95% confidence interval 78.9 to 98.0). There were no statistically significant predictors of re-revision. The rate of postoperative dislocation following revision was 9.2% (9 hips). The post-operative functional outcome depends on the intra-operative findings of tissue destruction secondary to ALTR.

The short term results following revision of large diameter MoM THR for ALTR are comparable with other reports in the literature. The use of constrained liners reduces the incidence of post-operative dislocation. There is an increased risk of postoperative instability following revision THR for ALTR. Early identification and intervention seems to be the logical approach in the management of patients with ALTR.

Purposes of study

Evaluation of the pre-operative documentation of neurovascular status in children presenting with Gartland Grades 2 and 3 supracondylar fractures and the development of an Emergency Department Proforma.

Background Various methods of analgesia have been described for shoulder surgery, and we routinely used inter-scalene analgesia. We hypothesised that inter-scalene analgesia provided better pain control than intra-bursal analgesia.

Methods We prospectively collected data over a consecutive two year period, with the first year patients (n=65) all having inter-scalene and the second year patients (n=79) having intra-bursal catheters. The interscalene 16F catheters were placed with the patient anaesthetised and an electrical Touhy needle. The intra-bursal 16F catheters were placed at the end of the arthroscopic shoulder operation, under direct vision, exiting from the posterior portal. Pain parameters collected were pain scores, visual analogue scales, analgesia useage, and whether or not the patients were comfortably able to go home the same day as surgery.

Results Pain and visual analogue scores showed no statistical differences between the two groups. Analgesia useage was greater in the inter-scalene group than the intra-bursal group, but was not statistically different. 32/65 (49%) of patients with inter-scalene catheters and 75/79 (95%) of patients with intra-bursal catheters were able to comfortably go home on the day of surgery, 28/33 (84%) of the inter-scalene patients were hospitalised due to post-operative pain, and 5/33 (15%) due to anaesthetic or medical problems. 2/4 (50%) of hospitalised intra-bursal patients had post-anaesthetic complications, and 2/4(50%) had pre-operative medical problems.

Discussion Inter-scalene analgesia is widely published as the most-effective route for post-shoulder surgery pain control. Our data does not support this view, and intra-bursal analgesia administration was found to be more effective at returning a comfortable patient home on the day of surgery. Our practice now routinely utilises intra-bursal catheters for either bolus analgesia or continuous pumps.

Aims: Intra-bursal versus inter-scalene post-operative effective pain control for Arthroscopic Shoulder Surgery

Methods: We prospectively collected data over a consecutive two year period, the first year patients (n=65) all having inter-scalene and the second year patients (n=79) having intra-bursal catheters. The interscalene 16F catheters were placed with the patient anaesthetised and an electrical Touhy needle. The intra-bursal 16F catheters were placed at the end of the arthroscopic shoulder operation, under direct vision, exiting from the posterior portal. Pain parameters collected were pain scores, visual analogue scales, analgesia usage, and whether or not the patients were comfortably able to go home the same day as surgery.

Results: Pain and visual analogue scores showed no statistical differences between the two groups. Analgesia usage was greater in the inter-scalene group than the intra-bursal group, but was not statistically different. 32/65 (49%) of patients with inter-scalene catheters and 75/79 (95%) of patients with intra-bursal catheters were able to comfortably go home on the day of surgery, 28/33 (84%) of the inter-scalene patients were hospitalised due to post-operative pain, and 5/33 (15%) due to anaesthetic or medical problems. 2/4 (50%) of hospitalised intra-bursal patients had post-anaesthetic complications, and 2/4(50%) had pre-operative medical problems.

Conclusions: Inter-scalene analgesia is widely published as the most effective for post-shoulder surgery pain control. Our data does not support this view, intra-bursal analgesia administration was found to be more effective at returning a comfortable patient home on the day of surgery. Our practice now routinely utilises intra-bursal catheters for either bolus analgesia or continuous pumps.