Introduction

Acetabular component loosening with associated bone loss is a challenge in revision hip arthroplasty. Trabecular Metal (TM) by Zimmer Biomet has been shown to have greater implant survivorship for all-cause acetabular revision in small cohort retrospective studies. Our study aims to review outcomes of acetabular TM implants locally.

Objectives

Post-infective arthritis is an important sequalae of septic arthritis(SA). While total knee arthroplasty(TKA) is an effective treatment for said arthritis, previous SA brings challenges for treatment planning. Using prospectively collected data from a cohort of patients with knee SA, this study aims to determine the proportion of patients requiring eventual TKA, and risk factors of developing prosthetic joint Infection(PJI).

Since 1989 the Ganz periacetabular osteotomy has been performed in Christchurch for pain arising from hip dysplasia in selected patients. This review was performed to assess symptoms, function and radiographic appearances at a medium term follow up.

The results of 14 peri-acetabular osteotomies performed in 13 patients was evaluated. The mean age of the patients at the time of surgery was 23 years (range 17–44). The mean duration of follow up was 5 years (3 months to 13 years). The follow up examination included clinical evaluation, chart review and radiographic analysis. Of the 13 patients evaluated, improvement in pain was achieved in 12. One required a hip replacement and intermittent discomfort was noted in 3 resulting in restriction in activites. Complications included sciatic nerve palsy (1), leg length discrepancy (2), superficial wound infection (1), scar tenderness (2), numbness in lateral femoral cutaneous nerve distribution (5) and pain from prominent metalware (1). Improvement in femoral head coverage was seen in all patients on follow up x-ray with minimal progression of arthritic changes. Improvement in symptoms ranging from complete relief of pain and participation in high intensity sporting events to intermittent discomfort was achieved. One failure occurred requiring arthroplasty. Significant complications occurred but have largely resolved.

The osteotomy was successful in obtaining good relief of symptoms and has prevented the requirement for total hip replacement in this young active group.

Despite a variety of reports to the contrary it was felt by the Christchurch Orthopaedic group that the “wait” on the orthopaedic waiting list has been escalating rapidly to the point that a routine operation is now in the order of approximately 3 years from the time of GP referral.

A review of the time taken for GP referrals to be assessed by an Orthopaedic Surgeon was undertaken. The waiting lists from October 98 to May 02 were analysed, in addition to the operation outputs from the Burwood Hospital elective theatre records over the same period. Time taken from referral to be seen, time taken from been placed on the waiting list to receive an operation and volume of elective procedures were evaluated. A breakdown was made of those removed from the list vs those operated on. A major reduction in the waiting list over the last three years was secondary to 1/3 of the people on the list (1177) been “culled”. This was initiated in January 1999 and completed by January 2001. Since January 1999, 2538 patients had received their operations. The waiting list had dropped from 3303 to a low of 1164. It has since climbed to 2036. That waiting longer than 12 months for surgery, initially 64%, had dropped to 29% and has climbed back up to 40%. The figures have climbed dramatically since the waiting list initiative for arthroplasty was discontinued. The culling of the list has been responsible for removal of 1/3 of people off the original list without having an operation and has given a false sense of success in reducing the waiting list to various political interests. The criteria set for culling people assessed as requiring an operation has been set arbitrarily There is twice the number of patients waiting to see an orthopaedic surgeon than 2 years ago of which a proportion are requiring reassessment to be deemed eligible for an operation that they have already been assessed as requiring.

The waiting list initiative was effective as an addition to the regular DHB lists in maintaining the lists at a manageable level. Even if all those culled represented a group that no longer required their operation the current list cannot be considered to have such a group as they have all been recently reviewed and are in genuine need. There is an apparent lack of concern and denial over the current escalation in the numbers on the waiting list, and no plan instituted to address it.