The recruitment drive, investment and collaboration within Betsi Cadwaladr University Health Board (BCUHB) sites providing specialist lower limb arthroplasty and trauma service has evolved over last few years with aims to improve patient care and reduce reliance on tertiary referral centres. Through our service-evaluation project, we reviewed the results of treatment provided for periprosthetic femur fractures (PPFFs) presenting to BCUHB sites over last 4 years. We retrospectively reviewed consecutive PPFFs admitted at three BCUHB sites from January’20 to June’23 with mean follow-up of 20.8 ± 13.2 (8–49) months [n=161; Mean age: 82.2 ± 8.5 (59–101) years, Females:107]. Over the review period we noted a 23% increase in service demand for care of PPFFs. Majority were managed surgically [132/161] [38 revision arthroplasties; 94 ORIFs] at BCUHB sites and two patients were referred to tertiary centre. Average time to surgery was 3.5 days. 90% of the PPFFs were managed successfully with 10% (16/159) having orthopaedic complications needing further intervention. 6.3 (10/159) had medical complications and did not need orthopaedic re-intervention. In our series, 12-month re-operation rate was 6.1% (8/132) and 1-month, 3-month and 1-year mortality rate was 6.3%, 11.3% and 21.4% respectively. These results are comparable to the published results of PPFF management at tertiary centres. Potential cost savings compared to transfer to tertiary centre for PPFF management was £2.31 million. Thus, it is possible to successfully provide adequate care for PPFFs at DGHs and efforts should be made to appropriately equip and adequately staff DGHs, to provide service for local PPFF care.
Uncemented total hip replacement is on the rise worldwide. Latest studies from various European and other developed country joint registers are clearly showing that it is taking preference over the cemented joint replacements. These figures were discussed most recently at the London hip meeting. Our study is related to one single make of implant the Exceed hip (Biomet) at two hospitals in Northamptonshire, Kettering UK. Our series includes 256 cases of Exceed uncemented total hip replacement done in 236 patients with a minimum follow up of 6 months and maximum of 5 years. The study included 126 female and 110 male patients. Out of this number 121 cases were done at Kettering General Hospital and 135 cases were performed at Woodlands Hospital private limited in Kettering. The cases were performed by 2 senior consultants and one junior consultant. The total number of cases was 317 but 73 cases were lost to follow up and 2 patients had expired at the time of the study. In all cases pre operative and post operative Harris hip scores were measured. Patients were asked to fill up the scores in retrospect through post. The range of motion parameter and range of motion scale were measured and added from clinical notes. The average age of patients in our study was 71.2 years with the oldest patient being 90 years old and the youngest being 34 years old. Most common cause for replacement was primary osteoarthritis in 202 cases. In 52 cases it was done for secondary osteoarthritis due to rheumatoid arthritis or post traumatic osteoarthritis following dislocation and acetabular fractures. In 2 cases it was done for fracture neck of femur. All the cases were done through posterior approach. One senior surgeon used bone grafts in the acetabular floor harvested from the femoral head at time of surgery in all of his cases. The ABT ringloc shell, polyethylene liner was used in all cases. The average pre operative Harris hip score was 43.15 and average post operative Harris hip score was 78.32. In 4 cases peri prosthetic fractures occurred per operatively and needed fixation. In 3 cases dislocation occurred but only one case needed revision due to recurrent dislocation.INTRODUCTION
MATERIAL & METHODS
A 68 year old female patient underwent a left total hip replacement for primary osteoarthritis in March 2004. She was referred back by her GP 5 years as she was struggling with mobility and felt there were mice in her hip. It was squeking so loudly that it could be hear at a distance of 25 metres. There was no history of any falls or dislocation in the last 5 years. The implant used was an Exeter/ABG ceramic total hip prosthesis with Palacos cement. This ladies discomfort in her hip had been always there. She never described herself as being satisfied with the THR. However, her discomfort had worsened terribly over the last year. The slightest movement around her hip caused her severe pain. Tremendous squeaking could be heard when she was made to walk. She had significantly limb length discrepancy of 2.5cms. The radiographs revealed that she had probably broken the ceramic head as pieces could be seen around the neck area.Introduction
On examination
Revision surgery is generally recommended for recurrent dislocation following Total hip arthroplasty (THA). However, dislocation following revision THA continues to remain a problem with further dislocation rates upto 28% quoted in literature. We present early results of one of the largest series in U.K. using dual mobility cemented acetabular cup for recurrent hip dislocation. We retrospectively evaluated 40 patients where revision of hip replacement was performed using cemented dual mobility acetabular prosthesis for recurrent dislocations from March 2006 till August 2009 at our district general hospital by a single surgeon (senior author). The series comprised of 13 men and 27 females with average age of 73.4 years (49-92). The mean follow-up period was 23 months. (36 months –6 months). All the hips that were revised had 3 or more dislocations, some them more than 10 times. The cause of dislocation was multifactorial in majority of cases including acetabular component malpositioning mainly due to loosening and wear. A cemented dual mobility cup was used in all cases. In six cases the femoral stem was also revised.Introduction
Methods
We propose that Total Hip Replacement with correction of fixed flexion deformity of the hip and exaggerated lumbar lordosis will result in relief of symptoms from spinal stenosis, possibly avoiding a spinal surgery. A sequence of patients with this dual pathology has been assessed to examine this and suggest a possible management algorithm. A retrospective study of 19 patients who presented with dual pathology was performed and the patients were assessed with regards to pre and post-operative symptoms, walking distance, and neurological status.Introduction
Materials and methods
There is a difference of opinion regarding the usefulness of MR Imaging as a diagnostic tool for triangular fibrocartilage complex (TFCC) tears in the wrist. Our aim was to determine the accuracy of direct magnetic resonance arthrography (MRA) in the diagnosis of triangular fibrocartilage complex (TFCC) tears of the wrist in a district general hospital setting. In a retrospective review of 21 patients who presented with complains of wrist pain and following a clinical examination, all had direct MR arthrography of the wrist in our hospital in a 1.5Tesla scanner. All had a diagnostic arthroscopy within 2-4 months of the MR scan. All patients had chronic ulnar sided wrist pain, although only two had a definite history of trauma. The findings of each diagnostic method were compared, with arthroscopy considered the gold standard. Twenty-one patients were studied (10 male: 11 female), mean age 42 years (range 27-71) years). Seventeen TFCC tears were diagnosed on arthroscopy. For the diagnosis of TFCC tears MRA had a sensitivity, specificity and accuracy of 67%. Our results echoed the opinion of some of the previous investigators with an unacceptable sensitivity or specificity for a diagnostic tool. MR arthrography needs to be further refined as a technique before it can be considered to be accurate enough to replace wrist arthroscopy for the diagnosis of TFCC tears. Other centres have reported better accuracy, using more advanced MRI technology. Until this iswidely available at all levels of healthcare the results of MRI for the diagnosis of TFCC tears should be interpreted with caution.
Elective Orthopaedics has been targeted by the UK Department of Health as a maximum six-month waiting time for operations could not be met. The National Orthopaedic Project was initiated as a consequence and Independent Sector Treatment Centres (ISTCs) and well established private hospitals were utilised to treat NHS long wait patients. We audited the primary total hip replacements performed in our hospital in 1998 and 2003 to compare the differences in the patient characteristics in particular age, length of stay and ASA grade.Introduction
Materials and methods
