Resurfacing arthroplasty of the hip is being performed more frequently in the United Kingdom. The majority of these patients are younger than 55 years of age, and in this group the key benefits include conservation of femoral bone stock and the potential reduction in the rate of dislocation afforded by the larger resurfacing head. Early aseptic loosening is well recognised in patients younger than 55 years of age, and proponents of resurfacing believe that the improved wear characteristics of the metal-on-metal bearing may improve the long-term survival of this implant. There has been some concern, however, that resurfacing may not be conservative of acetabular bone.

We compared a series of 33 consecutive patients who had a hybrid total hip arthroplasty with an uncemented acetabular component and a cemented femoral implant, with 35 patients undergoing a Birmingham hip resurfacing arthroplasty. We compared the diameter of the implanted acetabulum in both groups and, because they were not directly comparable, we corrected for patient size by measuring the diameter of the contralateral femoral head. The data were analysed using unpaired t-tests and analysis of covariance.

There was a significantly larger acetabulum in the Birmingham arthroplasty group (mean diameter 56.6 mm vs 52.0 mm; p < 0.001). However, this group had a significantly larger femoral head diameter on the contralateral side (p = 0.03). Analysis of covariance revealed a significant difference between the mean size of the acetabular component implanted in the two operations. The greatest difference in the size of acetabulum was in those patients with a larger diameter of the femoral head. This study shows that more bone is removed from the acetabulum in hip resurfacing than during hybrid total hip arthroplasty, a difference which is most marked in larger patients.

Statement of purpose: To evaluate survivorship and knee function in patients who have undergone Kinematic Condylar Total Knee Replacement at a minimum of 15 years.

Methods: We evaluated all patients undergoing primary cemented TKR with the Kinematic Condylar implant (Howmedica), between January 1981 and December 1988. All operations were performed by a single surgeon through a medial parapatellar approach, with sparing of the PCL, all cemented and no patellae resurfaced.

Operation notes were analysed to confirm the type of procedure, underlying diagnosis, and thickness of tibial insert. Information was derived from patient records and postal questionnaire to all surviving patients, which included: WOMAC, SF-36, satisfaction scale and history of revision surgery.

Results: We have identified a total of 804 consecutive cases, 185 of these were bilateral giving a total of 619 patients. Mean age at implantation was 66 (range 17 to 83), with female:male ratio of 3:1. The underlying diagnosis was Osteoarthritis in 49%, and Rheumatoid Arthritis in 51% of patients.

As at September 2003 there were 153 patients (25%) still alive, using revision as an endpoint survivorship was 59.3% at a mean time since implantation of 17 years 8 months. Pain and function portions of the WOMAC questionnaire revealed mean scores of 37 and 47 out of 100.

Conclusion: This cohort has been shown to have 92% implant survivorship at ten years. We have shown that the survivorship deteriorates significantly between 10 and 17 years. Functional and pain scores after 17 years for patients with surviving implants were poor.

Survival was significantly better in females, no effect from pre-operative diagnosis was seen. 73% of these patients had 6mm tibial inserts, we postulate that the deterioration in survival is related to accelerated poly-ethylene wear beyond 10 years.

We have undertaken to review Bankart stabilisations performed by the senior author in Newcastle since 1998.

We employ a modification of the technique as described by Rowe et al, but without a coracoid osteotomy and using suture anchors. Where there is also an element of inferior instability this was combined with a capsular shift at the same time. We performed a retrospective case note review of all patients in the study period, following this all patients were sent out a postal questionnaire based on the Oxford Instability Score (OIS).

A total of 50 Bankart repairs were performed in the study period, no significant wound infections or haematomas were recorded. 3 patient had further dislocations and required revision surgery; a further 2 patients had ongoing symptoms of instability one of which has had revision.

Response rate to the questionnaire was 62%. Mean OIS for patients following primary stabilisation was 21.7 (possible scores from 12 – excellent outcome to 60 – poor outcome). OIS following Bankart stabilisation of the shoulder has not been previously reported. These results compare favourably to original scores published by Carr et al (1999) who included both patients treated by surgery and physiotherapy alone.

The OIS was shown to be very sensitive in detecting instability symptoms noted at clinical review. The response pattern of the scores closely mirrored that from Carr and co-workers.

Hip resurfacing is being performed more frequently in the United Kingdom. The possible benefits include more accurate restoration of leg length, femoral offset and femoral anteversion than occurs after total hip arthroplasty (THA).

We compared anteroposterior radiographs from 26 patients who had undergone hybrid THA (uncemented cup/cemented stem), with 28 who had undergone Birmingham Hip Resurfacing arthroplasty (BHR). We measured the femoral offset, femoral length, acetabular offset and acetabular height with reference to the normal contralateral hip. The data were analysed by paired t-tests.

There was a significant reduction in femoral offset (p = 0.0004) and increase in length (p = 0.001) in the BHR group. In the THA group, there was a significant reduction in acetabular offset (p = 0.0003), but femoral offset and overall hip length were restored accurately. We conclude that hip resurfacing does not restore hip mechanics as accurately as THA.

Concern over long term outcomes in patients with silastic metatarsophalangeal implants prompted an assessment of such patients. We reviewed 21 single-stemmed silastic metatarsophalangeal arthroplasties in 18 patients with a mean follow-up of 18 years and 9 months. Eight operations were performed for hallux valgus, and 13 for hallux rigidus. Patients were assessed by clinical scoring, patient satisfaction, and radiographic grading. Patients treated for hallux rigidus achieved higher clinical scores than those treated for hallux valgus. This difference was statistically significant (p < 0.02). There was no correlation between radiographic appearance and clinical score, patient satisfaction, or time since implantation. Long-term changes to the bone stock did not cause clinical detriment, and in no case was late revision surgery necessary.

There has been widespread concern regarding silicone synovitis associated with early clinical detriment, together with progressive erosive bony changes seen with these implants. In our very long term review outcomes were surprisingly good, particularly in the surgical treatment of hallux rigidus in the over fifty age group.