Aims

To compare the in vivo long-term fixation achieved by two acetabular components with different porous ingrowth surfaces using radiostereometric analysis (RSA).

Introduction: Excellent early and medium term results have been reported for hip resurfacing. This is a minimum 5 year clinical outcome review of the resurfacings performed by a single surgeon in an independent series.

Methods: There were 329 resurfacings (302 patients). The mean follow-up is 6.6 years (5 to 9.2). 2 patients were lost to follow-up and 6 have died due to unrelated causes. The mean age at the time of surgery was 56.0 years (28.2 to 75.5). Mann-Whitney U-test was used to analyse change in hip scores, and survival analysis was performed using the Kaplan-Meier analysis using SPSS statistical software package.

Results: The mean Harris Hip Score was 51.3 (7 to 91) pre-operatively and 94.3 (24 to 100) postoperatively (p< 0.001). The mean Oxford hip scores was 38.3 (16 to 60) pre-operatively and 15.9 (12 to 46) postoperatively (p< 0.001). The mean Western Ontario and McMaster Universities Osteoarthritis Index score was 47.9 (5 to 96) pre-operatively and 6.9 (0 to 58) postoperatively (p< 0.001). The University of California Los Angeles activity scale was 4.7 (1 to 9) pre-operatively and 7.5 (3 to 10) post-operatively (p< 0.001). Mean satisfaction at the latest follow up was 9.3 (3–10) out of 10.

There were ten revisions. Kaplan-Meier analysis showed survival of 96.5% (95% confidence interval 94.7 to 98.4) at 7 years taking revision for any cause as the end-point. There was a 3.9 times higher failure rate in women compared to men.

Discussion: Medium term results of hip resurfacing in this independent series are excellent and are comparable to those from the pioneering centre. Failure rates are significantly higher in women compared to men. Long term follow up results are still awaited, however careful consideration should be made when selecting patients for hip resurfacing particularly in women.

Introduction: Excellent early and medium term results have been reported for hip resurfacing. This is a minimum 5 year clinical outcome review of the resurfacings performed by a single surgeon in an independent series.

Methods: There were 329 resurfacings (302 patients). The mean follow-up is 6.6 years (5 to 9.2). 2 patients were lost to follow-up and 6 have died due to unrelated causes. The mean age at the time of surgery was 56.0 years (28.2 to 75.5). Mann-Whitney U-test was used to analyse change in hip scores, and survival analysis was performed using the Kaplan-Meier analysis using SPSS statistical software package.

Results: The mean Harris Hip Score was 51.3 (7 to 91) pre-operatively and 94.3 (24 to 100) postoperatively (p< 0.001). The mean Oxford hip scores was 38.3 (16 to 60) pre-operatively and 15.9 (12 to 46) postoperatively (p< 0.001). The mean Western Ontario and McMaster Universities Osteoarthritis Index score was 47.9 (5 to 96) pre-operatively and 6.9 (0 to 58) postoperatively (p< 0.001). The University of California Los Angeles activity scale was 4.7 (1 to 9) pre-operatively and 7.5 (3 to 10) post-operatively (p< 0.001). Mean satisfaction at the latest follow up was 9.3 (3–10) out of 10.

There were ten revisions. Kaplan-Meier analysis showed survival of 96.5% (95% confidence interval 94.7 to 98.4) at 7 years taking revision for any cause as the end-point. There was a 3.9 times higher failure rate in women compared to men.

Discussion: Medium term results of hip resurfacing in this independent series are excellent and are comparable to those from the pioneering centre. Failure rates are significantly higher in women compared to men. Long term follow up results are still awaited, however careful consideration should be made when selecting patients for hip resurfacing particularly in women.

Osteoporotic vertebral fractures predispose to significant morbidity in the elderly and are strongly associated with an overall decline in health, functional status and social drift.

In recent years various surgical morphoplastic techniques have been employed in an attempt to improve on the disappointing natural history of this manifestation of biological failure.

Current evidence supporting the use of kyphoplasty versus medical management alone in the management of these factures is limited and based on several small prospective cohort studies.

We present prospectively collected data supporting the use of kyphoplasty in a U.K. based population tested by examining Visual Analogue Pain Score (VAS), vertebral height, vertebral and kyphosis angles, Oswestry Disability Index and Hospital Anxiety and Depression Score (HADS).

50 patients in our kyphoplasty group have undergone 91 kyphoplasty procedures. With a mean follow up of 6 months, the mean post-operative VAS score was 3.8 versus a pre op score of 8.5. This reduction was maintained at 6 weeks and 6 months with mean scores of 3.3 and 2.7 respectively (p< 0.001).

Functional status ODI scoring improved from a pre-operative score of 54 to 47 post-operatively, to 40 at 6 weeks, and further, to 39 at 6 months. This result was reinforced by HADS scoring at the same time intervals recording 15.0, 11.2, 11.1 and 11.7 respectively.

Post-operative radiographs demonstrated a 24% mean increase in the vertebral angle (p< 0.01) with increases in the anterior, middle and posterior vertebral body heights of 19, 31 and 9% respectively (p< 0.001). No significant improvement of kyphosis angle was identified.

The Derby experience demonstrates that kyphoplasty can improve pain and functional status and may help correct deformity after osteoporotic vertebral compression fractures.

Our experience has encouraged further recruitment for kyphoplasty as the preferred management for those patients who fail to respond to initial non-operative management.