Principles of bone preservation and restoration of biomechanical alignment should be followed during revision total hip arthroplasty (THA). Where possible, conservative femoral revision techniques and even reconstructive de-escalation involving using primary stems should be considered. This study aims to investigate the outcome of patients who have undergone conservative femoral revision THA in our Institution.

We retrospectively identified patients from our Institution's revision arthroplasty database who had cemented, or un-cemented primary stems implanted during revision THA of a previous stemmed femoral implant. Our primary outcome measure was all-cause re-revision THA with a secondary outcome measure of improvement in Oxford hip score (OHS). Radiographic evidence of stem loosening and post-op complications were recorded.

Between 02/12/2014 to 12/12/2019, there were 226 patients identified with a mean follow up of 2 years (1–5 years). The majority of cases were represented by Paprosky type 1 (63%) and type 2 (25%) femoral defects. There were 45 patients (20%) who underwent impaction bone grafting (IBG) and 43 patients (19%) who had a cement in cement (CinC) femoral revision and cemented primary stem in 137 (60%), 1 uncemented stem with no IBG or CinC revision. Kaplan Meier survival for all-cause re-revision THA was 93.7% (95% CI: 88.3 – 100) at 3 years. The reasons for re-revision included 4 periprosthetic fractures, 4 dislocations, 1 deep infection, 1 loosening of femoral component and 1 loosening of acetabular component. Pre- and post-operative OHS scores were available in 137 hips (60%) with a mean improvement of 13. Radiographic review revealed 7% of cases with evidence of loosening in 1 or more Gruen zones.

Our early results support the use of conservative femoral revision THA techniques where appropriate, with low complication and re-revision rates. Revisions using primary femoral components, where appropriate, should be considered in surgical planning to avoid unnecessary reconstructive escalation.

Introduction

There are conflicting reports about the efficacy of injection to the thumb carpometacarpal joint (CMCJ) for osteoarthritis (OA). The accuracy of joint injection without radiological control is unclear. We investigated the accuracy of blind injection and recorded their immediate and short term efficacy.

Background

The current treatment options available for Trapezio-metacarpal arthritis are injection, splint and ultimately surgery. The injections are predominantly done by General practitioners and no data is available to specialist.

Objective: The practice of routine admission of isolated sternal fractures for observation is still widespread in the UK in spite of evidence to the contrary. We undertook a cross-sectional telephone survey of management of isolated sternal fractures in the UK.

Methods: We contacted 85 acute admitting units over a three month period and were able to get a response from 67 units.

Results: Most of the hospitals were district general hospitals (52) and situated in England (49)(Wales 4, Scotland 11, Northern Ireland 3). The orthopaedic department was the commonest admitting department (26) (General Surgery 19, Cardiothoracic Surgery 11, Accident & Emergency 9, Acute Medicine 2). 51 units would routinely admit isolated sternal fractures for observation. Other indications for admission include pain control (33), abnormal cardiac enzymes (28), social circumstances (23), abnormal electrocardiogram (6), and low oxygen saturation (5). Chest X-ray was performed on admission in all hospitals. 57 hospitals perform routine ECG and Cardiac enzymes prior to admission and 6 hospitals routinely carry out Echo-cardiogram subsequently. Patients were admitted for overnight observation and discharged the next day in all hospitals. Patients were not followed up on discharge except 3 units, where 2 hospitals with Cardio-thoracic unit would follow-up patients on discharge, and 1 hospital regularly advised GP follow-up.

Discussion: We found that the current practice of management of isolated sternal fractures in the UK did not conform to available evidence. A review of the literature indicated that patients with isolated sternal fractures are at low risk of significant cardiac, pulmonary or mediastinal complications and do not need extensive investigations or routine admission. In this instance, evidence based practice might help us to better utilise finite resources without jeopardising patient care.