Introduction and Aims Back pain patients usually demand more time in clinic. A significant proportion of this time is spent in performing clinical examination. It has been recognised that detailed history of symptoms is the backbone in reaching the diagnosis and deciding the management plan for patients with lower back pain and/or radiculopathy. The aim of the study was to look at 1) Contributions from History and Examination. 2) Does Clinical Examination add any further information not identified from history?

Method A prospective, blinded study was carried out to determine the usefulness of history and clinical examination, individually to reach the diagnosis and plan the management. 75 consecutive lower back pain and/or radiculopathy patients were included in the study. Two orthopaedic registrars saw all the patients. One took detailed history and the other registrar performed clinical examination. Both registrars based on their information arrived at a provisional diagnosis. A consultant also took history and examined these patients. MRI scan was done as per clinical indication.

Results The data was analysed using standard statistics software. In all patients history suggested the possible diagnosis. Clinical examination did not add any further information to alter the course of management, which was planned for the patient. Clinical examination did not show any further information that was not identified in the MRI scan.

Conclusion Clinical examination does not add to the body of information available from history. Clinical examination does not add any further information not available on the scan. Clinical examination should be performed for patients considered for surgery to document the findings; here both subjective and objective assessment should be performed. Examination is not a useful screening tool.

Purpose: We report the clinical and radiological outcome of revision of cemented hip arthroplasties using Hydroxyapatite ceramic (HAC) coated femoral and acetabular components.

Methods: 86-revision hip arthroplasties were performed in 82 patients with JRI Furlong HAC coated femoral and acetabular components. 2 surgeon series. The patients were followed for a mean 12.6 years (7–15). The femoral component was revised in all hips and the ace-tabular cup was revised in 62 hips (72%). Threaded cup used in 37 (59%) patients and press fit cups with screws in the rest. Acetabular bone grafting was performed in 24 (38%) hips. The clinical outcome was measured using Harris, Charnley, Oxford hip scores. Anterior thigh pain was quantified on a visual analogue scale (VAS). The quality of life was assessed using EuroQol EQ-5D.

Results: The mean age was 78.2 yrs. The mean time to revision was 96 months. None lost to follow up. 11 patients died. Dislocation was seen in 2 patients (1 recurrent). 2 hips were infected (1 re revision, 1 excision arthroplasty). Cup liner revised in 1 patient. The mean Harris and Oxford scores were 82 (59 96) and 24.4 (12–52) respectively. The Charnley score was 5.0 (3–6) for pain, 4.9 (3–6) for movement and 4.4 (3–6) for mobility. Migration of acetabular component was seen in 2 (4%) hips. Acetabular radiolucencies were present in 26 hips (41%) The mean linear polythene wear was 0.05mm/year. Mean stem subsidence was 1.6mm (0.30– 2.4mm). Radiolucencies were present around 21 (33%) stems. Stress shielding was seen in 40 of 56 stems. Calcar resorption was seen in 11 stems (16%). Bony ingrowth was seen in 76(89%) of stems. Ectopic calcification was seen in 12 (19%) hips. Of the 3 hips re- revised, 2 were for deep sepsis and 1 for recurrent dislocation. Mean EQ- 5D description scores and health thermometer scores were 0.69 (0.51–0.89) and 79 (54–95). With an end point of definite or probable loosening, the probability of survival at 12 years was 95.1% (95% CI =2.7),96.3% (95% CI = 2.1) for acetabular and femoral components respectively. Overall survival at 12 years with removal or repeat revision of either component for any reason as the end point was 93% (95% CI= 2.3).

Conclusion: The results of this study support the continued use of this prosthesis and document the durability of the HAC coated components. Our study had fewer cases of loosening of the components and had a better survival than bipolar implants or cemented acetabular components

Introduction and Aims: Lower back and/or leg pain is a symptom of a number of pathological conditions involving lumbosacral nerve roots. Disc herniation is one of the most common causes of LBP (after mechanical back pain). There is controversy regarding the progression of disc degeneration and/or lower back pain to symptomatic disc prolapse over time.

Method: The aim of the study was to determine the natural progression of patients with lower back pain/disc degeneration established clinically and on MRI to symptomatic disc herniation over three to six years. Total of 970 patients who had an MRI scan between January 1998 and September 2000 were included in the study. Information about disc pathology, level and number of discs involved were recorded from MRI scan reports. A short questionnaire was sent to all patients. It contained 10 questions regarding current status of pain and neurology, any treatment in form of back injection and operation, current occupation and smoking status.

Results: The collected data was analysed using standard statistics software (SPSS). The results will be discussed.

Conclusion: The information provided by this study will be useful in judging the natural progression of lower back pain and/or disc degeneration to a symptomatic prolapse intervertebral disc. It will also be useful in medico-legal cases where patients had pre-existing disc degeneration and subsequently developed disc herniation over time.

Introduction and Aims: Back pain patients usually demand more time in clinic. A significant proportion of this time is spent in performing clinical examination. It has been recognised that a detailed history of symptoms is the backbone in reaching the diagnosis and deciding the management plan for patients with lower back pain and/or radiculopathy.

Method: A prospective, blinded study was carried out to determine the usefulness of history and clinical examination, individually, to reach the diagnosis and plan the management. Sixty consecutive lower back pain and/or radiculopathy patients were included in the study. All the patients were seen by two orthopaedic registrars. Detailed history was taken by one and clinical examination was performed by the other registrar. A provisional diagnosis was made by both registrars based on their information. A consultant also took history and examined these patients. MRI scan was done as per clinical indication.

Results: The gathered information was analysed using standard statistics software. The data indicates that clinical examination on its own was non-contributory in reaching diagnosis and plan the management. All information obtained by history alone correlated well with MRI results. The full results and cost implications will be discussed.

Conclusion: Routine clinical examination of spine can be omitted without compromising the patient care, where clear history is available to reach diagnosis and plan the management. Clinical examination should be performed on those patients who need surgery to document the pre-operative neurology.

Introduction and Aims: We report the clinical/radiological outcome of revision of cemented hip arthroplasties using Hydroxyapatite ceramic (HAC) coated femoral and acetabular components

Method: Sixty revision hip arthroplasties were performed in 64 patients with JRI Furlong HAC coated femoral and acetabular components. Mean follow-up was 10 years. Clinical outcome was measured using Harris, Charnley and Oxford hip scores. Anterior thigh pain was quantified on a visual analogue scale (VAS) and quality of life using EuroQol EQ-5D.

Results: The mean age was 78 years. The mean time to revision was 96 months. Eleven died to causes unrelated to index revision. Mean Harris and Oxford scores were 82 and 24.4. The Charnley score was 5.0 for pain, 4.9 for movement and 4.4 for mobility. Migration > 4mm of the acetabular component was seen in two hips. Acetabular radiolucencies were present in 26 hips. Mean linear polythene wear was 0.05mm/year. The mean subsidence was 1.6mm. Radiolucencies were present around 21 stems. Stress shielding was seen in 40; calcar resorption in 11; and endosteal cavitation around two stems. Ectopic calcification was seen in 12 hips. Three hips were re-revised – two for deep sepsis, one for recurrent dislocation. Mean EQ- 5D description and health scores were 0.69 and 79 (p> 0.05). With failure defined as repeat revision because of aseptic loosening, the rate of survival at 12 years was 100% for acetabular and femoral components. Overall survival at 12 years with removal or repeat revision of either component for any reason as the end point was 93% (95% CI ± 2.3).

Conclusion: The results of this study support the continued use of this prosthesis and document the durability of the HAC coated components, with fewer cases of loosening of the components, and a better survival than bipolar implants or cemented acetabular components. As loosening can occur as a late phenomenon, a longer follow-up is needed to determine the longevity of the HAC coated prosthesis.

Purpose: We report the clinical and radiological outcome of revision of cemented hip arthroplasties using Hydroxyapatite ceramic (HAC) coated femoral and acetabular components.

Patients and Methods: 66-revision hip arthroplasties were performed in 64 patients with JRI Furlong HAC coated femoral and acetabular components. The patients were followed for a mean 10.6 years (7–15). The femoral component was revised in all hips and the acetabular cup was revised in 52 hips (79%). The clinical outcome was measured using Harris, Charnley and Oxford hip scores. Anterior thigh pain was quantified on a visual analogue scale (VAS). The quality of life was assessed using EuroQol EQ-5D. All pre op, immediate post op and last follow up radiographs were analysed for ace-tabular and femoral component loosening.

Results:The mean age was 78.2yrs (58–89yrs). The mean time to revision of the primary hip replacement was 96 months (24 to 161). 11 patients died due to causes unrelated to the index revision. At last follow up, the mean Harris and Oxford hip scores were 82 (59 – 100) and 24.4 (12-52) respectively. The Charnley score was 5.0 (3-6) for pain, 4.9 (3-6) for movement and 4.4 (3-6) for mobility. Acetabular bone grafting was performed in 26 (50%) hips. Migration > 4mm of the acetabular component was seen in 2 (4%) hips. Acetabular radiolucen-cies were present in 26 hips (55%). The mean linear polythene wear was 0.05mm/year. The mean stem subsidence was 1.6mm (0.30- 2.4mm). Radiolucencies were present around 21 (33%) stems. Stress shielding was seen in 40 of the 56 stems. Calcar resorption was seen in 11 stems (16%). Endosteal cavitation was seen around 2 stems. Ectopic calcification was seen in 12 (19%) hips. Of the 3 hips re- revised, 2 were for deep sepsis and 1 for recurrent dislocation. The mean EQ- 5D description scores and health thermometer scores were 0.69 (0.51-0.89) and 79 (54-95) respectively (p> 0.05 for both scores compared to average UK population scores). With failure defined as repeat revision because of aseptic loosening, the rate of survival at 12 years was 100% for the acetabular and femoral components. Overall survival at 12 years with removal or repeat revision of either component for any reason as the end point was 93% (95% CI ± 2.3).

Conclusion:The results of this study support the continued use of this prosthesis and document the durability of the HAC coated components. Our study had fewer cases of loosening of the components and had a better survival than bipolar implants or cemented acetabular components. As loosening can occur as a late phenomenon, a longer follow up is needed to determine the longevity and durability of the HAC coated prosthesis.