Unicompartmental knee replacement (UKR) is an established treatment for single compartment end-stage knee arthrosis with good recorded survivorship. Although often used in more active, younger patients, patient selection remains controversial. To identify risk factors for early failure we compared patients with UKR failure requiring revision to total knee replacement (TKR) with a control group.

Between September 2002 and 2008, 812 Oxford Mobile Bearing Medial UKRs were implanted. 21 implants (20 patients) required revision to TKR within 5 years. The leading cause for revision was lateral compartment disease progression (11 patients). In the revision group, 17 patients were female (81%), average age at index surgery was 64.1 (range 48–81) and average BMI 31.8 (range 24.4–41.5).

Our UKR patients with early failure requiring revision were more likely to be female (p=0.0012) whilst age and BMI were similar between groups. Although the change in tibio-femoral valgus angle was similar, control group patients started in varus becoming valgus post-operatively, whereas revision group patients started in valgus and became more valgus post-operatively. This might explain lateral compartment disease progression as our leading cause of early failure. We believe females with medial compartment disease but valgus alignment are at greater risk of early failure and it is particularly important not to overstuff the medial compartment.

This study aims to assess the impact of re-configuration on provision of trauma care at Hospital A, in particular management of hip fractures.

Originally, Hospitals A and B both provided trauma and elective orthopaedic services. These services are undergoing re-configuration such that Hospital A will provide an elective orthopaedic service while Hospital B will provide an orthopaedic trauma service.

Two time periods, one prior to reconfiguration (time period 1) and one after reconfiguration (time period 2) were identified. All trauma patients presenting to Hospital A requiring surgery during the defined time periods were included.

During time period 1, 197 patients requiring surgery presented to Hospital A, 70 with hip fractures. During time period 2, 149 patients requiring surgery presented to Hospital A, 55 with hip fractures.

As part of the reconfiguration process, there was a reduction in dedicated trauma operating capacity at Hospital A with no equivalent increase in operating capacity at Hospital B.

During time period 1, 70% of patients with hip fractures were operated on within 36 hours, compared to 44% during time period 2.

During the re-configuration process, there was a statistically significant decrease in the percentage of patients with hip fractures meeting the recommended standards of care.

We have reviewed 22 patients at a mean of 30 years (28 to 31) after a whiplash injury. A complete recovery had been made in ten (45.5%) while one continued to describe severe symptoms. Persistent disability was associated with psychological distress but both improved in the period between 15 and 30 years after injury. After 30 years, ten patients (45.5%) were more disabled by knee than by neck pain.