Aims

Postoperative delirium (POD) and postoperative cognitive decline (POCD) are common surgical complications. In the UK, the Best Practice Tariff incentivizes the screening of delirium in patients with hip fracture. Further, a National Hip Fracture Database (NHFD) performance indicator is the reduction in the incidence of POD. To aid in its recognition, we sought to determine factors associated with POD and POCD in patients with hip fractures.

The hook screw method is a direct repair technique that permits ‘restitutio ad integrum’ for a functional segment. The surgical method of treating spondylolysis and grade 1 spondylolisthesis by spondylytic hook screw reduction and bone grafting in 34 patients is reported. Of these patients, 32 showed good to excellent results.

Aims: To compare the results of resurfacing hip arthroplasty with conventional total hip replacement and to find out any differences in complication rates, discharge patterns and the resulting financial implications.

Trial Design: Retrospective analysis comparing resurfacing hip arthroplasties to conventional total hip replacements in patients who were 65 years old or younger at the time of operation. Criteria for comparison were blood loss, post operative complications (including the need for blood transfusion), revision of arthroplasty and the length of hospital stay.

Materials and Methods: All patients who had resurfacing arthroplasty in our hospital were included in the study (77 patients), and a similar group who had total hip replacements in the same time period were randomly selected for comparison. Case notes, computer records as well as X-rays were used to identify postoperative complications, especially DVT’s ,PE’s, neuro-vascular injuries, infection, fractured neck of femur and the need for revision of an arthroplasty. A detailed analysis of all revision arthroplasties including the causes, failure pattern of implant and the type of revision hip arthroplasty used and its cost implication was made. We also compared the pre and post-operative haemoglobin and units of blood transfused, if any. A comparison was also made of discharge pattern of these two groups of patients. A student t-test was performed to observe any difference in these two group.

Results:

Resurface hip arthroplasty Group: Average age 52.1 years; pre-operative Hb 14.22gm/dl; postoperative Hb.10.95gm/dl; average blood loss 3.28 gm/dl; Total hips revised 12; Average length of stay 8.53 days.

Conclusions: 1.There were no appreciable differences between these two group as far as the usual complications, blood loss and length of stay are concerned. 2. There was appreciable difference in revision rate, which has significant cost implication for health authority and patients