INTRODUCTION

Historically, the clinical performance of novel implants was usually reported by designer surgeons who were the first to acquire clinical data. Regional and national registries now provide rapid access to survival data on new implants and drive ODEP ratings. To assess implant performance, clinical and radiological data is required in addition to implant survival. Prospective, multi-surgeon, multi-centre assessments have been advocated as the most meaningful. We report the preliminary results of such a study for the MiniHip™femoral component and Trinity™ acetabular component (Corin Ltd, UK).

Introduction: It is well established that prompt medical management and early surgery for patients with fractured neck of femur has been shown to reduce mortality and reduce hospital length of stay. A Trauma Pathway Group (TPG) was established at Mayday Hospital, in August 2007 to assess local practises and to implement improvements, led by senior clinicians in Orthopaedics, Anaesthetics and Orthogeriatrics, and liaising with senior hospital managers within the trust. Here we present results after one year of the TPG.

Means and methods: We reviewed all patients admitted to Mayday with a fractured neck of femur over 60 years of age at admission between 1st October 2006 and 31st September 2007 (prior to the TPG) and between 1st October 2007 and 31st September 2008 (after the TPG).

We compared these two groups, focussing on pre-operative delays, length of stay in hospital and in-hospital mortality.

Results: There were 185 patients admitted to Mayday University Hospital between 1st October 2006 and 31st September 2007, and 212 between 1st October 07 and 31st September 2008. The average age of patients admitted was 83. 75% were female. There was no significant difference in mean age or sex between the two groups. The mean wait for surgery was reduced from 4.3 days to 1.3 days (p< 0.001). The mean length of stay was reduced from 33.5 days to 26.2 (p< 0.005). The in-hospital mortality was not significantly altered - 14.6% in the first year, and 16.0% in the second.

Discussion: The TPG has had a significant impact on the management of patients with fractured neck of femur. Our figures and feedback from staff and patients has been positive, and the work has increased the prominence of the care of these patients, so has enabled us to significantly improve the care of this extremely vulnerable group.

Introduction: Cementless acetabular components have been associated with a higher rate of pelvic osteolysis compared to cemented components. Modular locking mechanisms and wear against screw heads and holes have been implicated in the production of polyethylene particles. Pressure waves and particle access to the pelvis are facilitated by screw holes. The patients in this study had a cementless, modular cup with screw fixation but not in all holes. Therefore factors thought to contribute to osteolysis were present.

Methods: 178 consecutive patients (198 hips) underwent primary THA using the EPF cementless cup (Plus Orthopaedics AG, Switzerland). 30 patients (31 hips) had died, 5 hips were revised, 8 were lost to follow up and 9 were unable to attend for radiographs. 126 patients (145 hips) were followed up clinically (Harris Hip Score) and radiographically. Mean follow up was 8.0 years (6.3–9.4). AP, lateral and Judet view radiographs were analysed for osteolysis. Polyethylene wear rates were determined using a validated 2D method (Martell).

Results: The mean HHS was 89.0 (44.4–99.9). Osteolysis was seen in 19 hips (13.1%). In only 6 hips (4.1%) osteolysis was evident on the AP radiograph. In 13 hips (9.0%) osteolysis was only seen on lateral or Judet view radiographs. No cups were considered to be loose. Mean linear polyethylene wear rate was 0.10 +/− 0.06 mm/yr. Mean volumetric polyethylene wear rate was 43.2 +/− 28.2 mm³/yr. There was no significant difference between wear rates in hips with osteolysis compared to no osteolysis. Only 1 revision was for aseptic loosening.

Discussion: The EPF cup produced good clinical results, and appeared radiologically stable at 8 years. Wear rates are similar to other studies of cementless cups. The osteolysis rate is low given this “worst case scenario” especially considering the increased likelihood of detecting osteolysis with multiple radiographic views.

Introduction and aim: In order to harness existing surgical skill and expertise of the operator trained in conventional total hip arthroplasty (THA) it would be advantageous to adopt a mini-incision surgery (MIS) THA technique that is similar. It would also make economic sense for MIS THA to be performed using existing conventional instrumentation available in every elective orthopaedic unit. The aim of this retrospective comparative study was to verify safety, efficacy and durability of this MIS THA technique via a modified anterolateral approach developed in our hospital by the senior author. This technique utilises standard instrumentation and does not require the use of an image intensifier.

Materials and Methods: The implants used in the study were the SL-Plus (Plus Endoprothetik AG, CH-Rotkreuz) and the EPF cup (Plus Endoprothetik AG, CH-Rotkreuz). We report on our experience of a consecutive series of 111 patients operated for osteoarthritis of the hip joint.

Results: Fifty-nine patients (53.2%) were implanted using MIS technique; the remainder (52 cases, 46.8%) were operated using conventional THA via traditional anterolateral approach. In patients undergoing MIS technique a skin incision averaging 8 cm (range 7.5 to 9 cm) was made over the greater trochanter with two thirds lying superior to its tip. The surgical procedure lasted forty minutes on average, and no excessive retraction was needed. The small incision can be extended with ease if access proves difficult, but this proved unnecessary in any of our cases.

The mean follow-up for the MIS THA group was 22.9 months compared to 33.1 months for the conventional THA group. All our MIS patients had less postoperative blood loss, needed less post operative painkillers, and mobilised earlier. There was however no significant difference in the duration of postoperative hospital stay between the two patient groups. We have had no incidence of dislocation and continue to use this technique during routine THA.

Discussion and conclusion: A review of the MIS THA literature is provided to compare this technique with those described by other authors. The authors believe this to be a safe, cost effective alternative to MIS THA techniques that require special instrumentation and the use of the image intensifier.

Aim: To audit blood transfusion practice in primary total hip arthroplasty (THA) and primary total knee arthroplasty (TKA) after introduction of more stringent blood transfusion criteria.

Methods: A retrospective survey was carried out for all THR and TKR. Data was collected over a period of four months with a blood transfusion criteria of haemoglobin (Hb) concentration of 8.0 g/dl and below. This was compared against a three month period after the reduction in the blood transfusion criteria to a Hb concentration of 7.0 g/dl and below. An analysis of all pre-operative and post-operative (day-2 post-op) Hb concentrations was performed. The post-transfusion Hb concentration was recorded 1-day post transfusion.

Results: A total 539 TKA and 521 THA were performed. Following the new blood transfusion protocol the rate of blood transfusion was significantly reduced from 9.4% to 3.6% for TKA, and from 28% to 12.8% for THA.

Conclusion: A significant reduction in transfusion rates is achieved in TKA and THA by introduction of a Hb concentration 7.0 g/dl as a trigger for blood transfusion. This new trigger is based on the current body of evidence available and is integrated in to well defined care pathway. A 50% reduction in donated blood is predicted in the UK in 2007 if vCJD testing is enforced. We feel early redressing of blood transfusion practice in the UK is advised if we are to avoid a catastrophic reduction in our TKA and THA capacity.