A unit of 12 orthopaedic surgeons serving a population catchment of 180,000 have collaborated to collect prospective data on a wide range of orthopaedic conditions, using well proven internationally validated scoring systems. All patients, rural and urban, public and private, in the region are being enrolled. This project is distinct from but complementary to National Joint Registry data. A benchmarking period of 2 years has been completed, and now prospective trials are being commenced. 4000 patient datasets have been obtained to date.

We report on the logistics of establishing a regional research program in a medium-sized New Zealand centre, and results achieved to date. We present our experience with a view to encouraging other centres to consider similar ventures.

Knee flexion is often decreased in severe arthritis causing pain, and functional limitations in lifestyles and occupations. Newer knee replacement designs offer the possibility of greater knee motion. The objective of our study was to compare the clinical outcomes, in particular the range of motion, in patients treated with a total knee arthroplasty using either a standard posterior stabilized knee prosthesis or a high flexion posterior stabilized knee prosthesis, with regard to return to function within 1 year of surgery.

This was a prospective randomized single blinded study. Forty patients were randomly assigned to receive either a standard fixed bearing posterior stabilized or a modified high flexion fixed bearing posterior stabilized Smith & Nephew Genesis II total knee joint replacement. Clinical outcomes were determined from data collected on all patients who were evaluated pre-operatively, at twelve weeks post-operatively, and at one year post-operatively. Data collected included SF-12, WOMAC, and Oxford knee scores, and knee range of motion measurements.

37 of 40 patients enrolled completed the study. 22 patients were randomized to receive a standard posterior stabilized fixed bearing Genesis II knee replacement and 22 were randomized to receive a Hi-Flex posterior stabilized fixed bearing knee replacement. ROM, quality of life, and clinical scores at 12 months will be presented.

After 2 fatalities from this condition at our institution in 2005, a retrospective review of elective surgical records from the previous five years was undertaken and we established 16 further non-fatal cases of Ogilvie’s Syndrome. (This work was presented as a poster at the Christchurch NZOA 2005). We have since prospectively recorded any occurrence of Ogilvie’s Syndrome after elective orthopaedic surgery.

Over the last 2 years since the previous report, we have identified a further 8 cases of Ogilvie’s Syndrome, with one further fatality. This little-known condition is far more prevalent than thought, and is often not diagnosed despite severe consequences. All surgeons should be aware of this condition. Early recognition and intervention is critical to patient survival. Hallmarks of the clinical presentation will be discussed, along with acute management guidelines.

Non-seated ceramic inserts have recently been identified as a common phenomenon in one popular modular ceramic system (16.4% of cases in Langdown et al. 2007. JBJS 89B (3):291–295). A preliminary audit at Tauranga Hospital demonstrated the same issue. However, most X-rays didn’t allow confirmation or exclusion of the problem.

A preliminary review of post-operative films of patients receiving modular ceramic acetabular implants at Tauranga Hospital was undertaken. A radiolucent jig was constructed to take images of three different modular ceramic acetabular systems. Images isocentered on the implants (seated & non-seated) were taken with variation in view given of the cup (rotation and plane of the X-ray beam relative to the implant face). Registrars & consultants were tested on their ability to detect non-seating on these images.

Two out of three acetabular systems showed non-seating in patients. Most films reviewed did not allow definitive decisions to be made about ceramic insert seating. The true incidence of non-seating in the arthroplasty population receiving modular ceramic implants is thus unknown. The images of the three systems taken in the radiolucent jig show the ability to detect non-seating is multifactorial. Implant specific differences in the shell and liner systems radiologic profile influence detection and education of surgeons may improve the chances of detection. The presence of the head of the femoral component limits detection of non-seating. The plane of the X-ray beam relative to the face of the cup along with the rotation of the non-seated region relative to the beam strongly influence detection. The plane of the X-ray beam relative to the face of the inserted acetabular component can be altered in post-operative films.

Typical post-arthroplasty hip films fail to consistently identify the occurrence of non-seating of modular ceramic acetabular inserts. Suggesting the true incidence remains unknown. Standard post-operative imaging needs to change to be confident of exclusion of this phenomenon in patients receiving modular ceramic implants.

The aim of this study was to

Report the clinical scores of patients placed on the waiting list for joint arthroplasty in Tauranga (CPAC, Oxford hip and knees scores, WOMAC and SF-12)

In this prospective study all patients complete Oxford hip or knee scores, SF-12, and WOMAC scores. An initial subset of patients (457) who had been entered onto the waiting list prior to May 2005 also completed CPAC scores. A literature search for published studies using Oxford, WOMAC, SF-12 and SF-36 scoring tools was performed using Medline and PubMed databases.

Four hundred and fifty seven waiting list patients completed all 4 scores. Results, including correlation between scoring systems and comparisons with international data are reported.

We found significant variation between internationally accepted scores and the CPAC scoring system. Current waiting list Oxford scores for Tauranga patients are significantly worse than those published in the literature although when including the entire group the difference is small. 2.04 (1.34–2.74 95% CI). After rescoring, patients reaching the certainty threshold, (cTT), and active review threshold, (aTT), have scores that are much worse than those in the published literature.

We present two cases of Ogilvie’s syndrome and to raise awareness of this rare but serious complication.

Methodology: Analysis of two recent cases at our institution. Subsequent 5 year retrospective audit of all joint replacement in Tauranga Hospital and analysis of patient records with a recorded gastrointestinal complication.

We report on two recent cases of Ogilvie’s Syndrome (acute colonic pseudo-obstruction) with subsequent caecal perforation after THJR. Case 1: A 49 year old woman underwent THJR for osteoarthritis. Postoperatively developed abdominal pain and distension. Underwent laparotomy for a perforated caecum 10 days following THJR. Died 24 hours later. Case 2: A 73 year old man underwent a revision THJR. Postoperatively developed a distended abdomen. Underwent laparotomy and caecostomy 10 days after THJR. Discharged 29 days after admission. Both cases had GA and spinal anaesthetics with intrathecal Morphine. Both failed to settle with conservative treatment. There was no mechanical obstruction in either case. Audit figures showed 21 other cases of non-mechanical bowel obstruction after hip or knee arthroplasty.

Ogilvie’s Syndrome is a rare “malignant” form of postoperative pseudo-obstruction characterised by massive dilatation of the large bowel which, if untreated, results in caecal perforation. It is rare following joint arthroplasty but if occurs has a high morbidity and mortality. Prompt recognition of the presenting features by orthopaedic surgeons with expedient general surgical intervention is necessary to avoid potentially fatal consequences.

Introduction: Impaction bone grafting in conjunction with a cemented polished double-taper stem as a technique for revision of the femoral component was introduced in 1987 at our institution.

Methods: As at January 2000, 540 cases in 487 patients had been performed by multiple surgeons. All procedures have been studied prospectively, and there are no patients lost to follow-up. We present the survivorship and outcome data for these patients.

Results: Survivorship at 15 years is 90.6 percent (95 percent confidence interval: 88–93 percent).

406 hips in 365 patients remain under active follow up, with 122 patients (134 hips) deceased.

Averaged clinical scores taken pre-operatively, 2 years post-operatively, and at latest follow-up show marked and sustained improvement: Charnley Pain 2.7, 5.5, 5.3; Charnley Function 2.1, 4.1, 3.6; Charnley Range of Motion 4.0, 5.4, 5.3; Harris Pain 19, 38, 36; Harris Function 18, 32, 28; and Oxford Hip Score 41, 22, 25.

There have been 45 failures (8.3 percent) at an average 7.6 year follow up (range 2.6 – 15.3 years). Technical error contributed to 13 of the 24 non-infective complications, but with improved technique plus the addition of long stemmed impaction grafting, there have been no technical errors since 1996.

Conclusion: Our results show that revision of the femoral component with impaction bone grafting is a reliable and durable technique with an acceptably low complication rate with excellent survivorship at 15 years.

Introduction and Aims: Impaction bone grafting in conjunction with a cemented polished double-taper stem as a technique for revision of the femoral component was introduced in 1987 at our institution. The aim of this study is to report on the outcome, survivorship, complications and radiological analysis of the first consecutive 540 cases performed in Exeter.

Method: As at January 2000, 540 cases in 487 patients had been performed by multiple surgeons. All procedures have been studied prospectively, and there are no patients lost to follow-up. We present the survivorship and outcome data for these patients.

Radiological analysis of the pre-operative, immediate post-operative and most recent follow-up radiographs was also performed. This included evaluation of the cement mantle and impacted allograft, stem subsidence within the cement mantle, presence of cortical healing and graft trabeculation on the follow-up radiographs, as well as appearance of radiolucencies and graft resorption.

Results: Survivorship at 15 years is 90.6 percent (95 percent confidence interval: 88–93 percent). Four hundred and six hips in 365 patients remain under active follow-up, with 122 patients (134 hips) deceased. Averaged clinical scores taken pre-operatively, two years post-operatively, and at latest follow-up, show marked and sustained improvement: Charnley Pain 2.7, 5.5, 5.3; Charnley Function 2.1, 4.1, 3.6; Charnley Range of Motion 4.0, 5.4, 5.3; Harris Pain 19, 38, 36; Harris Function 18, 32, 28; and Oxford Hip Score 41, 22, 25.

There have been 45 failures (8.3 percent) at an average 7.6-year follow-up (range 2.6–15.3 years). Technical error contributed to 13 of the 24 non-infective complications, but with improved technique plus the addition of long stemmed impaction grafting, there have been no technical errors since 1996.

Conclusion: Our results show that revision of the femoral component with impaction bone grafting is a reliable and durable technique with an acceptably low complication rate with excellent survivorship at 15 years.

A comparison of the clinical status and outcome of a group of patients treated with tw-stage revision using either excision arthroplasty or an articulating spacer (the Kiwi Prostalac) as the first stage is presented.

Clinical scores were obtained before revision, after the first stage, and after the second stage revision, along with the outcome of the success of the revision procedure in terms of eradication of the infection, from the two study groups. Seven patients received excision arthroplasty and eight were treated with the Kiwi Prostalac spacer, at the treating surgeon’s discretion.

A comparison of the clinical status of the two groups will be presented at the varying stages of treatment, along with hospitalisation duration, and morbidity and ultimate outcome.

Our results demonstrate that two-stage revision with an antibiotic cement-coated THJR prosthesis (The Kiwi Prostalac) is an effective and safe method of managing deep peri-prosthetic infection around a THJR with significant advantages to the patient.

Impaction bone grafting in conjunction with a cemented polished double-taper stem as a technique for revision of the femoral component was introduced in 1987 at our institution.

As at January 2000, 540 cases in 487 patients had been performed by multiple surgeons. All procedures have been studied prospectively, and there are no patients lost to follow-up. We present the survivorship and outcome data for these patients.

Survivorship at 15 years is 90.6 percent (95 percent confidence interval:88–93 percent). Four hundred and six hips in 365 patients remain under active follow up, with 122 patients (134 hips) deceased.

Averaged clinical scores taken preoperatively, 2 years postoperatively and at latest follow up showed marked and sustained improvement: Charnley Pain 2.7, 5.5, 5.3; Charnley Function 2.1, 4.1, 3.6; Charnley Range of Motion 4.0, 5.4, 5.3; Harris Pain 19, 38, 36; Harris Function 18, 32, 28; and Oxford Hip Score 41, 22, 25. There have been 45 failures (8.3 percent) at an average 7.6 year follow up (range 2.6–15.3 years). Technical error contributed to 13 of the 24 non-infective complications, but with improved technique plus the addition of long stemmed impaction grafting, there have been no technical errors since 1996.

Our results show that revision of the femoral component with impaction bone grafting is a reliable and durable technique with an acceptably low complication rate with excellent survivorship at 15 years.

The purpose of this study was to determine whether a laminar flow operating system reduces deep infection rates in Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA) and to examine the costs involved in implementing laminar flow technology. A retrospective analysis of deep infection rates in 759 patients who underwent THA and TKA was performed in one hospital prior to and after the introduction of a vertical laminar flow operating system together with the use of isolation body exhaust suits. A cost analysis was also performed on the cost of implementing laminar flow technology and the average inpatient hospital cost of managing a deep infection. A control group consisted of 387 THA and TKA performed in 2 years in a conventional operating theatre and follow up carried out to a mean of 29 months. There were 12 recorded deep infections, 3.1%. Case group consisted of 372 THA and TKA performed in 2 years after the introduction of a vertical laminar flow operating theatre together with the use of isolation body exhaust suits, with a mean follow up to 22 months. There were 4 recorded deep infections, 1.1%.

A comparison of deep infection rates yielded p value 0.06. There was a strong trend toward a reduction in deep infection rate in THA and TKA performed in the laminar flow theatre with the use of isolation body exhaust suits. The economic impact of deep infection in THA and TKA is vast and the cost of implementing laminar flow technology must be weighed against the deep infection rate as well as the number of operations performed at an institution.