With increasing numbers of total joint arthroplasties being performed, peri-prosthetic fracture incidence is rising, and operative management remains the gold standard. Short-term survivorship up to 12 months has been well-documented but medium to long-term is almost unknown. We present survivorship review from a district general hospital, undertaking 800 primary hip and knee arthroplasties per year. Patients with peri-prosthetic fractures and background total knee replacements were identified using our computer database between 2006–2011. All patients were operated on our site; methods used include open reduction, internal fixation (ORIF) using Axsos (Stryker Newbury) locking plates (28), intra-medullary nailing (1) or complex revision (6) depending on fracture and patient factors and surgeon's preference. Mortality was assessed at 30 days, 12 months and 5 years. Thirty-four patients were identified with a 7:1 female to male ratio and mean age of 76. 75% of patients had their primary arthrodesis at our hospital. There was only 1 plate failure noted requiring revision plating. Mortality at 30 days, 12 months and 5 years were 3.2, 12.5% and 50% respectively. When compared to the literature our time interval from index surgery to fracture is considerably longer (115 vs 42 months). Further multi-centre reviews are required to further asses this unexpected finding. Overall mortality is better than our hip fracture cohort, suggesting that good results can be achieved in District Hospital. The longer-term results are encouraging and can act as a guide for patients with this injury. We recommend that patients are managed in consultant-led, multi-disciplinary teams.

The aim of our study was to assess the accuracy of the theatreman system for data retrieval and to identify possible causes of the inaccuracies found.

A retrospective analysis was undertaken in our orthopaedic and trauma theatres at Morriston Hospital, Swan-sea. We reviewed 110 operations carried out in the department over a six-week period.

The following sources were assessed: case notes, theatre logbooks, theatre coding sheets and data from the-atreman.

Our study identifies inaccuracies and problems in data collection and its retrieval. This problem has been already highlighted by other sources.

As the codes are such a source of inaccuracy, with modern high processing capacity computers, we believe accuracy could be vastly improved by using plain language data entry. This avoids manual conversion to codes and eliminates inte-operator discrepancies and reluctance for some complex code entry. For only 25% of the cases to be retrievable from the theatreman system shows that the whole system and not only the input of data are at fault. As a unit, if we used this information to represent our workload, we would significantly be underestimating our workload.

There is a need for a computer system that recognises words, has ease of data input, generates operation notes and perhaps linked into the patient’s notes. We acknowledge that electronic case notes may help to correct some of these problems but worry that a system introduced with accuracy of data retrieval similar to the theatreman system, is worthless.

Objective: To develop and use a closed chamber to study the metabolism of isolated disc cells under controlled conditions such as reduced pH.

Design: Disc cells were incubated in the chamber for four hours, while embedded electrodes measured pH and pO2. A port allowed sampling.

Subjects: Nucleus pulposus cells were isolated from the coccygeal discs of 33 steers (18–24 months old), within three hours of slaughter.

Outcome measures: Metabolic rates were calculated from concentration changes. Cell viability was assesed on completion.

Results: At pH 7.4, metabolic rates were similar to those measured in tissue [1, 2] with lactic acid production and oxygen consumption rates of 157 and 12 nmol/million cells/hour respectively, and a 1: 2 ratio of glucose consumption: lactic acid production. Lactic acid production and oxygen consumption fell with extracellular pH, to 89 and 65 nmol/million cells/hour (lactate) and 8 and 5 nmol/million cells/hour (oxygen), at pH 6.7 and pH 6.2 respectively.

Conclusions: These results show a fall in lactic acid production and oxygen consumption with extracellular acid-ification. There is a complex interplay between different components of the nutritional environment. Investigating these in combination should give valuable information about disc cell metabolism, as changes can affect nutrient availability and hence cellular activity, viability, and matrix production rates.

Objective: To measure intradiscal pressures in scoliotic spines to further understand the role of mechanical forces in the development of scoliosis.

Design: Pressure readings were obtained in consented patients with ethical approval. A needle mounted pressure transducer was introduced into the disc during routine anterior scoliosis surgery.

Subjects: Ten human scoliotic discs from three patients.

Outcome measures: Intradiscal pressure profiles.

Results: Nuclear hydrostatic pressures varied from 0.2 to 0.6 MPa. The mean nuclear pressures for the three spines were 0.27+0.12, 0.35+0.06 and 0.47+0.12 MPa.

High stress, non- hydrostatic regions were consistently recorded in the concave annulus.

Conclusions: Nuclear pressures in these scoliotic patients were significantly higher than the 0.12 and 0.15 MPa recorded previously in non-scoliotic recumbent individuals^1;2 suggesting that spinal loading is abnormal in scoliosis.

Between January 1987 and December 1988 there were 7575 births in the Swansea maternity unit. Of these 823 (10.9%) were considered to be at ‘high risk’ for developmental dysplasia of the hip (DDH). Static ultrasound examination was performed in each case and the results classified on the basis of the method of Graf. A total of 117 type III–IV hips in 83 infants was splinted using the Aberdeen splint.

Radiographs of these hips were taken at six and 12 months. Hilgenreiner’s measurements of the acetabular angle were made in all cases and the development of the femoral capital epiphysis was assessed by measuring the epiphyseal area. The effect of splintage on the acetabular angle and the epiphyseal area between the normal and abnormal splinted hips was compared. Radiographs of 16 normal infants (32 normal unsplinted hips) were used as a control group.

This cohort has now been followed up for a minimum of nine years. There have been no complications as a result of splintage. The failure rate was 1.7% or 0.25 per 1000 live births. No statistical difference was found when comparing the effect of splintage on the acetabular angle and epiphyseal area between normal and abnormal splinted hips and normal unsplinted hips.

Our study has shown that while the Aberdeen splint had a definite but small failure rate, it was safe in that it did not produce avascular necrosis. The current conventional view that a low rate of splintage is always best is therefore brought into question if the Aberdeen splint is chosen for the management of neonatal DDH.

The significance of cobalt as a cause of symptoms after McKee hip arthroplasty is discussed. Seven patients are described in whom such arthroplasties became unsatisfactory after periods varying from nine months to four years. Six of these patients were cobalt-positive but nickel-and chrome-negative on patch testing. Macroscopic and histological necrosis of bone, muscle and joint capsule around the prostheses was found in five patients whose hips were explored. The symptoms were progressive pain, a feeling of instability, and in two cases spontaneous dislocation. Radiological features included acetabular fracture, bone resorption, loosening and dislocation of the prosthesis. Increased cobalt concentrations (determined by atomic absorption spectrophotometry) in the urine of four patients and in a variety of tissues in one patient are presented. Patch testing is recommended in the investigation of patients with troublesome McKee hip arthroplasties.