Introduction: Osteoarthritis of the first metatarsopha-langeal joint (MTPJ) is common. A range of surgical treatment options is described, including different designs of total arthroplasty. The MOJE is a ceramic-on-ceramic press fit arthroplasty. We present a maximum 8 year follow up of 32 procedures.

Methods: 32 MOJE arthroplasties were undertaken by the senior author (MF) in 30 patients (9 male, 21 female; mean age 61.9, range 37–76) over six years. Patients were followed up in special clinics where symptoms, levels of function and radiographs were subjectively and objectively scored using the SF-36, modified Kitaoka and AOFAS systems.

Results: 100% follow-up was achieved, with mean time since surgery 58 months (range 25–97). Mean scores were: Kitaoka 53.8 (15–75, maximum possible 75), AOFAS score was 61.3/100 (range 18–100, maximum 100), SF-36 physical score 48.6 (27.6–58.7) SF-36 mental score 52.2 (19.5–62.2). Eight implants had required revision; two for component fracture.

Radiologically, 15 showed component subsidence, 9 demonstrating radiolucency around one or both components. In one case where the patient had not undergone reoperation component fracture was seen on x-ray. Clinically, in patients who had not undergone subsequent fusion, 15 had less than 36 degrees of movement, 9 had between 36–45 degrees, 4 were in the 46–60 range and only one had more than 60 degrees. There were no cases of infection.

Discussion: Although several previous studies have suggested favourable initial outcomes with this implant, all focus only on early results. The longest follow-up we found was 29 months; these authors quote excellent early outcomes but acknowledge the need for longer-term follow-up. In our series, the reoperation rate of 25% up to 8 years is worryingly high. Whilst a cohort of patients clearly have satisfactory results with the MOJE, we would suggest that surgeons contemplating its use give due consideration to these outcomes before proceeding.

We report 114 of 117 (97% follow up) consecutive metal-on-metal hip resurfacings in 105 patients with a minimum of 5 years follow up implanted between October 1999 and May 2002. Revision of either the femoral or acetabular component during the study period is defined as failure. No other revisions have been performed or are impending. We had 4 failures giving us survivorship at 5 years of 97% (95% confidence interval (CI) 94 – 100). The mean follow up was 72 months and the mean age at implantation was 54.5 years old (Range 35 – 75). All patients were followed up clinically and radiographically.

The mean Harris hip score at follow up was 96.4. The mean Oxford Hip Score fell from 41.6 preoperatively (Range 16 – 57) to 15.3 postoperatively (Range 12 – 49) p< 0.0001. The UCLA Activity Scale rose from 3.93 preoperatively (Range 1 – 10) to 7.54 postoperatively (Range 4 – 10) p< 0.001.

Radiographic analysis revealed an average stem shaft angle of 130.6 degrees (Range 112 – 148) with average cup alignment of 36 degrees (Range 22 – 47). Neck thinning was present in 12 hips (10%) and we define a technique for measuring thinning. Heterotropic ossification was present in 17 hips and lucent lines around the femoral component in 10 hips.

This study confirms that metal-on-metal resurfacing produces an excellent clinical and functional outcome in the younger patient who requires surgical intervention for hip disease. The results compare favourably with those from the originating centre and confirm that resurfacing is well suited for younger higher demand patients. It is the first study with a minimum 5 year follow up from outside the originating centre.

Introduction: Preliminary results of the Birmingham Hip Resurfacing Arthroplasty were promising. The first series with minimum 5 year follow up was published in 2005 and came from the designing centre. Survivorship and functional results were good. This is the first series with a minimum 5 year follow up not from the designing centre.

Methods: All patients who underwent BHR between the dates of October 1999 and May 2002 were included in the study.

Results: We report 114 of 117 (97% follow up) consecutive metal-on-metal hip resurfacings in 105 patients with a minimum of 5 years follow up. Revision of either the femoral or acetabular component during the study period is defined as failure. We had 4 failures giving a survivorship at 5 years of 96.5% (95% confidence interval (CI) 93–100). The mean follow up was 72 months and the mean age at implantation was 54.5 years old (Range 35–75). All patients were followed up clinically and radiographically.

The mean Harris hip score at follow up was 96.4. The mean Oxford Hip Score fell from 41.6 preoperatively (Range 16–57) to 15.3 postoperatively (Range 12–49) p< 0.0001. The UCLA Activity Scale rose from 3.93 preoperatively (Range 1–10) to 7.54 postoperatively (Range 4–10) p< 0.001.

Radiographic analysis revealed an average stem shaft angle of 130.6 degrees (Range 112–148) with average cup alignment of 36 degrees (Range 22–47). Neck thinning was present in 16 hips (14%) and we define a technique for measuring thinning.

Discussion: This study confirms that metal-on-metal resurfacing produces an excellent clinical and functional outcome in the younger patient who requires surgical intervention for hip disease. The results compare favourably with those from the originating centre and confirm that resurfacing is well suited for younger higher demand patients.

Aims: To determine pre and post-op patient satisfaction and to document complications. Methods: A questionnaire based study of a consecutive series of 71 Birmingham Hip Resurfacings performed by a single surgeon over a two year period. Mean age 54 (range 29 to 70 years). Outcome measures used were the Oxford Hip Score and Short Form 36 Results: There was a signiþcant improvement in outcome scores following surgery. Oxford hip score improved from 41.1 to 16.6 (signiþcant p< 0.05) SF36 score improved from 24.8 to 48.2 (signiþcant p< 0.05) Complications were 2 femoral nerve palsies, 1 lateral popliteal nerve palsy, 1 re-operation for a retained guide pin, 1 post operative fracture, 1 DVT, 1 PE and 8 patients received oral antibiotics for wound erythema or discharge but there were no deep infections. 89% would recommend the operation to a friend, with males rating the operation more highly. Mean visual analogue score of 91% for overall satisfaction, again males rating higher. Conclusions: Birmingham Hip Resurfacing gave signiþcant improvements in patient function, comparable or better than other similar results looking at conventional hip replacement. Patient satisfaction is high despite the younger patient group with active life styles. The group includes one Jiu Jitsu instructor and a triple marathon runner. One patient had previously had a contralateral conventional uncemented total hip replacement which he was pleased with... until he had experienced Òthe ÒfeelÒ of my Birmingham HipÒ

Aims: Femoral offset is routinely measured prior to total hip arthroplasty in order to recreate the position of optimum abductor function. We aim to determine how radiologically measured offset changes with hip rotation and to evaluate the clinical relevance of any changes. Methods: We took standardised radiographs of a proximal femur at ten degree increments of rotation and measured the offset derived in each position. We then measured the apparent offset obtained in full internal and external rotation in a series of twenty consecutive patients attending for hip arthroplasty. Results: The model demonstrated that femoral offset is maximal between ten and twenty degrees of internal rotation and that small changes in rotation can cause large changes in apparent offset. From the clinical series of elderly, arthritic patients we show that there is a signiþcant change (mean of 11.4mm or 29%) in measured offset between internal and external rotation. In our series this discrepancy would have led to a change in selected femoral prosthesis in almost half the cases. Conclusion: Femoral offset measurements are only accurate, and therefore useful, if taken with the hip in or close to þfteen degrees of internal rotation.

Venous ulceration is a chronic disabling complication of deep vein thrombosis. The aim of this study is to estimate the incidence of venous leg ulcers five years or more after total hip replacement, and to investigate some of the clinical features associated with the development of the ulcers. A postal survey of all the patients who had received a total hip replacement 5–12 years previously was done.

Replies from 816 patients yielded 66 patients [8.1.%] with a history of leg ulcers. Prevalence of active ulceration was 2.6%. 43 patients [5.3%] reported ulceration since their hip replacement. A clinical review determined that 31 [3.8%] of these were true venous ulcers. The ulcers occurred with a higher frequency on the operated side, appearing at a mean of 5.8 years after the first lower limb arthroplasty [range 18 months to 12 years]. An average of 1.9 arthroplasties [primary and revision] were carried out prior to the ulcers appearing [max 5, min 1]. Our findings suggest that although the overall incidence rate of leg ulcers was similar to that reported in the general population, we found a tendency for the ulcers to occur on the operated rather than the unoperated leg.

We used MRI to examine the hips of 32 asymptomatic patients at 9 to 21 months after renal transplantation covered by high-dose corticosteroids. Five hips in three patients showed changes which indicate avascular necrosis, although radiographs, CT scans and isotope scans were normal. These patients had repeat MRI scans after another two years and three years. One patient with bilateral MRI changes developed symptoms and abnormal radiographs and CT and isotope scans in one hip nine months after the abnormal MRI. Intraosseous pressure was found to be raised in both hips, and core biopsies revealed necrotic bone on both sides. The other three hips have remained asymptomatic with unchanged MRI appearances three years after the initial MRI. It seems that idiopathic avascular necrosis does not always progress to bone collapse in the medium term.

In a prospective, randomised controlled trial, the efficacy of the A-V Impulse System in the prevention of deep-vein thrombosis was investigated in 84 patients who had undergone total hip replacement. The incidence of venographically proven, and clinically significant postoperative deep-vein thrombosis was 40% in the control group and 5% in the treatment group (p less than 0.001). No adverse reactions were recorded.

We have reviewed 107 patients of 80 years or over who underwent primary total hip replacement. They had many more complications than younger patients. Thus, acute dislocation occurred in 15%, and became chronic in 9%; there were femoral shaft fractures in 4.6% and these, with shaft perforation gave universally poor results. Nevertheless, 75% of patients had a satisfactory outcome, with worthwhile relief of pain. It would seem sensible to warn elderly patients and their relatives of the increased risks in this age group.