Pre-existing hip pathology such as femoroacetabular impingement is believed by some, to have a direct causal relationship with osteoarthritis of the hip. The strength of this relationship remains unknown.

We investigate the prevalence of abnormal bone morphology in the symptomatic hip on the pre-operative anteroposterior pelvic radiograph of consecutive patients undergoing hip resurfacing. Rotated radiographs were excluded. One hundred patients, of mean age 53.5 years were included (range 33.4–71.4 years, 32% female). We examined the films for evidence of a cam-type impingement lesion (alpha angle >50.5°, a pistol grip, Pitt's pits, a medial hook, an os acetabuli and rim ossification), signs of acetabular retroversion or a pincer-type impingement lesion (crossover sign, posterior wall sign, ischial sign, coxa profunda, protrusio, coxa vara, Tonnis angle < 5°), and hip dysplasia (a Tonnis acetabular angle >14° and a lateral centre-edge angle of Wiberg <20°).

Pre-existing radiographic signs of pathology were present in a large proportion of hips with low grade (Tonnis grade 1–2) arthritis. There is a group of patients who presented with more advanced osteoarthritis in which we suspect abnormal bone morphology to be a causative factor but, for example, neck osteophytes obscure the diagnosis of a primary cam lesion.

Our findings corroborate those of Harris and Ganz. Impingement is radiographically detectable in a large proportion of patients who present with early arthritis of the hip, and therefore we agree that it is a likely pre-cursor for osteoarthritis. Treatments directed at reducing hip impingement may stifle the progression of osteoarthritis.

There are a growing number of younger patients with developmental dysplasia of hip, proximal femoral deformity and osteonecrosis seeking surgical intervention to restore quality of life, and the advent of ISTCs has resulted in a greater proportion of such cases being referred to existing NHS departments.

Bone-saving hip athroplasty is often advocated for younger active patients, as they are potential candidates for subsequent revision arthroplasty. If resurfacing is contraindicated, short bone-conserving stems may be an option. The rationale for short stems in cementless total hip arthroplasty is proximal load transfer and absence of distal fixation, resulting in preserved femoral bone stock and avoidance of thigh pain.

We have carried out 17 short stem hip replacements (Mini-hip, Corin Medical, Cirencester, UK) using ceramic bearings in 16 patients since June 2010. There were 14 females and 2 males, with a mean age of 50.1 years (range 35–63 years) at the time of the surgery. The etiology was osteoarthritis in 11, developmental dysplasia in 4, and osteonecrosis of the femoral head in one patient. All operations were performed through a conservative anterolateral (Bauer) approach. These patients are being followed and evaluated clinically with the Harris and Oxford hip scores, with follow-up at 6 weeks, 3 months, and annually thereafter.

Initital results have been encouraging in terms of pain relief, restoration of leg length (one of the objectives in cases of shortening) and rage of movement. Radiological assessment has shown restoration of hip biomechanics. Specific techniques are required to address varus, valgus and femoral deformity with leg length inequality.

There are two main groups of short stems, those that are neck-preserving and those that do not preserve the femoral neck. The latter group requires traditional techniques for revision. Another feature that differentiates them is the availability of modularity. The device we employed is neck-preserving and available with different neck lengths and offsets, which help in restoration of hip biomechanics.

The advantage of such short stems may be preservation of proximal femoral bone stock, decreased stress shielding and the ease of potential revision. Such devices may be a consideration for patients with malformations of the proximal femur. Long-term follow-up will be of value in determining if perceived benefits are realised in practice.

The aim of this study was to re-assess whether the use of a ‘one-knife technique’ can be considered as safe as the alternative practice of using separate skin and inside knives for elective orthopaedic surgery. A total of 609 knife blades from 203 elective orthopaedic operations, with equal numbers of skin, inside and control blades, were cultured using direct and enrichment media. We found 31 skin blades (15.3%), 22 inside blades (10.8%), and 13 control blades (6.4%) gave bacterial growth.

Of the 31 contaminated skin blades only three (9.7%) had growth of the same organism as found on the corresponding inside blade. It is not known whether contamination of deeper layers in the remaining 90% was prevented by changing the knife after the skin incision. The organisms cultured were predominantly coagulase-negative staphylococci and proprionibacterium species; both are known to be the major culprits in peri-prosthetic infection. Our study suggests that the use of separate skin and inside knives should be maintained as good medical practice, since the cost of a single deep infection in human and financial terms can be considerable.