Between December 2004 and June 2006, 136 patients (156 total hip replacements), were sent from the waiting list of the Cardiff Vale NHS Trust to the NHS Treatment Centre, Weston-super-Mare, in an attempt to reduce the waiting time for total hip replacement. Because of concerns about their outcome, each patient was contacted and invited to attend a review appointment with a consultant specialising in hip and revision hip replacement.

A total of 98 patients (113 hips) were reviewed after a mean of 23 months (11 to 30). There were 104 cemented hips, seven hybrid and two cementless. An acetabular inclination of > 55° was seen in 18 (16%). Radiolucent lines around the acetabular component were seen in 76 (67%). The femoral component was in more than 4° of varus in 47 (42%). The medial floor had been breached in 13 (12%) and there was a leg-length discrepancy of more than 1 cm in ten (9%). There were three dislocations, one femoral fracture, one pulmonary embolus, one deep infection and two superficial wound infections.

To date, 13% (15 hips) have been revised and a further 4% (five hips) await revision, mostly for a painful loose acetabular component. The revision rate far exceeds the 0.5% five-year failure rate reported in the Swedish Registry for the components used. This initiative and the consequent need for correction of the problems created, has significantly increased the workload of our unit.

144 total hip replacements were performed by Swedish Orthopaedic Surgeons at Weston NHS Treatment Centre between 2004–2006, in an attempt to reduce the waiting list in Cardiff. Following concerns regarding the outcome of knee arthroplasty patients, the Welsh Assembly funded a clinical and radiographic review of all hip arthroplasty patients from the same unit.

100 hips were reviewed at a mean follow-up of 24 months. The mean Oxford Hip Score was 30 (range 12–60).

Radiolucencies were seen in acetabular zone 1 in 34, and all 3 zones in 28 hips. Femoral component position was > 4 degrees varus in 41 cases. Medial floor breach with intrapelvic cement was seen in 12 cases. 10 cases had > 1cm leg length discrepancy. There were 3 early dislocations, 1 intraoperative distal femoral fracture, 1 Pulmonary Embolus and 2 superficial infections.

4 patients have received further treatment so far, and 12 have been listed for acetabular component revision for loosening. 1 has been listed for stem revision for symptomatic leg length discrepancy of 2.5cm.

There is an unacceptably high early failure rate in this group of patients. The cost of further investigation and revision surgery far outweighs cost-savings achieved by outsourcing treatment to a distant centre.