Over 70,000 hip fractures occur annually in the UK. Both SIGN (111) and NICE (124) give guidance on optimal management of these patients. Both suggest cemented hemiarthroplasty should be used in those without contra-indications, as cemented implants are associated with less thigh pain, subsidence and a better functional outcome. Cardiorespiratory compromise secondary to bone cement implantation syndrome (BCIS) is however a concern in those with pre-existing cardiorespiratory disease (NYHA grade 3–4, pulmonary hypertension) or pathological fracture [3].

The aim of our study was to audit the practice of a University of Glasgow hospital with regard to cemented hemiarthroplasty.

We retrospectively reviewed data on all patients treated with hemiarthroplasty for hip fracture at the Southern General Hospital between 01/01/12-02/04/12. Patient demographics, pre-operative plan, procedure performed, ASA grade and pre-morbid mobility were recorded.

The diagnosis and treatment of hip disease in young adults has rapidly evolved over the past ten years. Despite the advancements of improved diagnostic skills and refinement of surgical techniques, the psychosocial impact hip disease has on the young adult has not yet been elucidated.

This observational study aimed to characterise the functional and psychosocial characteristics of a group of patients from our young hip clinic. 49 patients responded to a postal questionnaire which included the Oswestry Disability Index (ODI) and Hospital Anxiety and Depression Scale (HADS). Median age was 20 years (range 16-38) with a gender ratio of 2:1 (female: male). The most common diagnoses were Perthes' disease and developmental hip dysplasia. More than half of our patients had moderate to severe pain based on the Visual Analogue Scale (VAS) and at least a moderate disability based on the ODI. Thirty-two percent of patients were classified as having borderline to abnormal levels of depression and 49% of patients were classified as having borderline to abnormal levels of anxiety based on the HADS. Comparison of the ODI with the VAS and HADS anxiety and depression subscales showed a significant positive correlation (p<0.05). Multiple regression showed the ODI to be a significant predictor of the HADS anxiety and depression scores (regression coefficient 0.13, 95% confidence interval 0.06 to 0.21, p<0.05).

This study highlights the previously unrecognised psychosocial effects of hip disease in the young adult. A questionnaire which includes HADS may be of particular value in screening for depression and anxiety in young people with physical illness. This study also highlights that collaboration with psychologists and other health care providers may be required to achieve a multidisciplinary approach in managing these patients.

The ideal acetabular component is characterised by reliable, long-term fixation with physiological loading of bone and a low rate of wear. Trabecular metal is a porous construct of tantalum which promotes bony ingrowth, has a modulus of elasticity similar to that of cancellous bone, and should be an excellent material for fixation.

Between 2004 and 2006, 55 patients were randomised to receive either a cemented polyethylene or a monobloc trabecular metal acetabular component with a polyethylene articular surface. We measured the peri-prosthetic bone density around the acetabular components for up to two years using dual-energy x-ray absorptiometry.

We found evidence that the cemented acetabular component loaded the acetabular bone centromedially whereas the trabecular metal monobloc loaded the lateral rim and behaved like a hemispherical rigid metal component with regard to loading of the acetabular bone. We suspect that this was due to the peripheral titanium rim used for the mechanism of insertion.

Infection following hip arthroplasty although uncommon can have devastating outcomes. Obesity, defined as a BMI of ≥ 30, is a risk factor for infection in this population. Coagulase negative staphylococcus aureus (CNS) is the commonest causative organism isolated from infected arthroplasties. This study was performed to determine if there has been a change in the causative organisms isolated from infected hip arthroplasties and to see if there is a difference in obese patients.

Data on all deep infection following primary and revision hips was obtained from the surgical site infection register from April 1998 to Nov 2007. Case notes were reviewed retrospectively. There were 49 patients with 51 infected arthroplasties; 25 infected Primary THAs and 26 infected Revision THAs. We found a female preponderance in the infected primary and revision THAs (n=30). 63.2% of all patients had a BMI of ≥ 30, compared to only 34.7% of the non infected population (p< 0.0001). Over the period studied, CNS was the most common organism isolated (56.8%) followed by mixed organisms (37.2%) and staphylococcus aureus (25.4%). Multiple organisms were found exclusively in obese patients. In more than half of cases the causative organisms were resistant to more than two antibiotics.

This study shows that over the last 10 years, CNS continues to be the most frequently isolated organism in infected hip arthroplasties. Multiple organisms with multiple antibiotic resistances are common in obese patients. On this basis we recommend that combination antibiotic therapy should be considered in obese patients.

Introduction: The ideal acetabular component has low wear, permanent fixation and physiological bone loading. Recently trabecular metal has been promoted as reproducing the modulus of trabecular bone with a cementless fixation. The aim of this trial was to see if a monobloc trabecular backed polyethylene acetabular component loaded the pelvis physiologically as a cemented polyethylene component.

Method: Between 2004 and 2006 54 patients were ran-domised to a cemented polyethylene acetabular component versus a monobloc trabecular backed polyethylene acetabular component. The primary outcome measurement was bone density in peri-prosthetic acetabular regions of interest measured preoperatively and post operatively at 6 weeks and 1 year. Secondary outcomes measured were radiographic and functional outcomes (HHS and Oxford score).

Results: Radiographically 8 patients in the trabecular group had a significant gap in zone II which resolved in 6 by 1 year. The cemented group had 3 patients with a radiolucent line (zone 1) at 1 year. HHS and OXFORD scores improved with no significant difference between the groups. Both groups had significant loss of bone density in the ilium and ischium. The trabecular group produced a significant increase in bone density in the superolateral region. The cemented group produced increased bone density in the superomedial region.

Discussions and Conclusions: There is a significant reduction in BMD for both groups in the upper pelvis and ischium in keeping with finite element modelling predictions. The press-fit group relative to the cemented group resulted in decreased BMD in the superomedial peri-prosthetic region. The trabecular monobloc cup therefore behaves more like a rigid cementless shell despite the properties of trabecular metal.

Introduction: Hip resurfacing is a popular alternative to total hip arthroplasty. It aims to provide more physiological loading of the proximal femur, avoiding stress shielding and associated bone resorption. However, finite element analysis of hip resurfacing systems suggests stress shielding occurs in the femoral neck below the prosthesis and theoretically may lead to femoral neck fracture. Nevertheless, recent DEXA studies indicate femoral bone stock preservation with no evidence of stress shielding. It is not yet known what actually occurs in clinical practice. The aim of this study was to assess whether femoral neck resorption occurs in one particular type of hip resurfacing post operatively and quantify the degree of narrowing.

Methods: Femoral neck resorption of the Cormet 2000 metal-on-metal resurfacing prosthesis (Corin, UK) was assessed by measuring the prosthesis-neck ratio on postoperative radiographs. 39 prostheses (35 patients) were measured on plain AP pelvis radiographs taken immediately and mean 2 years post-operatively. Subsequent follow up radiographs were measured up to maximum 7 years follow up, mean 4.75 years.

Results: There was evidence of neck atrophy in 35/39 hips at an average of 2 years post operation, with the overall average neck narrowing from a ratio of 0.86 to 0.81 at 2 years. Average neck ratios were calculated up to 7 years post resurfacing; 25 hips measured at 3 years average ratio of 0.81, 20 at 4 years ratio 0.8, 25 at 5 years ratio 0.8, 9 at 6 years ratio 0.8, 1 at 7 years ratio 0.81.

Discussion: A degree neck resorption occurs with this resurfacing prosthesis by 2 years, however no further resorption appears to occur beyond this, to a maximum follow up of 7 years. This may indicate that early narrowing is more likely to be due to harmless bone adaption then a progressive absorption jeopardising the femoral neck.

Introduction: Despite clinical history, examination and plain radiography it is occasionally difficult to locate the origin of hip pain. This is particularly relevant where the management will be a total hip arthroplasty. Local anaesthetic arthrogram of the hip may provide a simple, safe and reliable test to determine if the hip is the source of the patient’s symptoms. The aim of this study was to establish the use of this investigation in the management of hip pain.

Methods: All local anaesthetic hip arthrograms were reviewed from 1999 to 2005. All patients had completed a pain questionnaire following the arthrogram. Patients were classified into 3 groups; 1) Mild osteoarthritic changes on plain radiographs with possible referred pathology; 2) Minimal radiological changes but no obvious other pathology to refer pain; 3) Previous hip arthroplasty with unexplained pain. Those who subsequently had a primary or revision hip arthroplasty were assessed post-operatively by means of the Oxford hip score.

Results: Fifty-seven patients in total underwent a local anaesthetic hip arthrogram. From all the groups 34 patients obtained pain relief and 24 proceeded to primary or revision hip arthroplasty. Twenty three (96%) had a satisfactory post-operative outcome at an average follow-up of 2 years (average Oxford score 28). The remaining 10 patients with positive arthrograms are still waiting for surgery. All negative arthrogram patients were successfully discharged.

Discussion: A positive response to local anaesthetic hip arthrogram predicts a successful response to surgery. This permits accurate information of the results of hip surgery to be given to patients and aids in a management plan for a group of patients that can be otherwise challenging.