Introduction:

Antimicrobial resistance is an important patient safety issue. Antibiotic Stewardship is one of the key strategies in tackling this problem. We present our data over a two year period from October 2011 to December 2013.

Introduction of new implants has been widely debated lately, mainly in response to the problems surrounding hip resurfacing and one company recalling its product. Medicines and Healthcare products Regulatory Agency (MHRA) also issued advice about the management and monitoring of patients implanted with metal-on-metal articulations.

In response to MHRA advice all the patients who underwent hip resurfacing in our hospital were assessed by two consultants according to MHRA guidelines. Here we present the findings from our District General Hospital.

Between November 2006 and March 2009 we performed 42 hip resurfacings in 39 patients. Nearly all the procedures were performed by a single surgeon (39 out of 42). There were 27 males (28 hips) and 12 females (14 hips). Mean age of the patients at the time of surgery was 55.6 years (age range 40–67 years). Patients were followed up for a mean of 49 months (range 33–66 months). 27 patients (28 hips) were asymptomatic at the time of last follow up.

Serum cobalt and chromium ion levels were measured in 21 patients (24 hips). Both the ion levels were within the recommended levels in 20 patients and over the recommended limit in 2 patients (one with bilateral hip resurfacing). MRI was diagnostic in 2 out of 5 patients. 5 patients (7 hips) were revised (one hip for neck resorption, 4 hips in 3 patients with lesions on MRI, 1 patient with bilateral hips for elevated serum ion levels)

Considering the revision rate (7 hips out of 42 hips, 16%), we do believe that the review of the hip resurfacings in spite of the controversies surrounding the diagnostic criteria is necessary. This group of patients need to have continued surveillance, preferably by a select group of surgeons.

Introduction: The aim of this paper was to test the hypothesis that for hips affected with Legg-Calve-Perthes’ (LCP) disease under the age of 8 years, surgery does not affect the outcome.

Methods: We performed a retrospective paired study of patients, who were diagnosed with LCP disease before the age of 8 years, to compare the radiological results after treatment between conservatively and surgicallytreated groups. One patient was selected from each group to create the pairs for this study. Each pair was strictly matched for gender, body mass index, age at onset, and stage at the first visit, Catterall and Herring grading and radiological at-risk signs. Each pair was assessed by comparing the values of five radiological measurements.

Results: From a cohort of 345 hips diagnosed with LCP disease 14 pairs (28 hips) fitted the criteria. The radiological measurements, which showed a statistically better result in the surgical groups, were Mose’s method (p = 0.019), the Acetabular-Head Index (p = 0.034). There were no statistical differences in the Slope of the Acetabular Roof (p = 0.37), Articulotrochanteric distance (p = 0.17) and Stulberg grading (p = 0.2). 5 pairs had a better Stulberg result in the operative group. Three of these 5 pairs were less than 6.5 years at the time of their surgical procedure. Three pairs had a better Stulberg result in the conservative group. Six pairs had no difference between the groups.

Discussion: We conclude that surgical treatment can improve the sphericity of the femoral head and provide greater acetabular cover than conservative treatment in hips of patients less than 8 years at the onset of LCP disease. However, the Stulberg grading was not affected. Our study supports the hypothesis that for hips affected with LCP disease under the age of 8 years, surgery does not affect the outcome.