Introduction

In specific conditions, infection may lead to bone loss and is difficult to treat¹. Current clinical approaches rely on the introduction of antibiotics. While these may be effective, there are concerns regarding the rise of antimicrobial resistance. There is therefore interest in the development of antimicrobial bone graft substitutes for dental and trauma surgery.

Patients need to know the benefits, risks and alternatives to any proposed treatment. Surgeons discussing the risk of a revision procedure becoming necessary, after a hip replacement can draw upon the orthopaedic literature and arthroplasty registries for long-term implant survival. However, early revision is required in a minority of cases. We have investigated the probability for revision hip replacement patients in terms of time-point and indication for revision.

Of the 9,411 Primary Total Hip Replacements (THR), undertaken by 22 surgeons, over an eleven-year period, between January 2004 and March 2015, 1.70% (160) were subsequently reported to the National Joint Registry (NJR) as revised. Each revision case was reviewed under the supervision of senior hip specialist consultants. The modes of failure of were identified through clinical, laboratory and imaging (x-rays, CT, MRI and Isotope scans) studies.

The revision rate for THRs was 0.58% in the first year. This was statistically higher than all subsequent years, P-Value <0.001. There was no statistical difference between any pair of subsequent years. Thereafter, the average revision rate was 0.30% per annum. The odds ratio for revision during the first post–operative year against the subsequent year average was 1.67.

The indications for the early hip revisions in the first three years were infection, dislocation and peri-prosthetic fracture. The data from this study can help better inform patients of the revision rates after a primary THR and allow surgeons to develop implant surveillance strategies among high-risk patients.

Background

Despite an ageing population and a rise in the number of joint replacements being performed, the mean age of patients undergoing surgery remains static. One explanation for this is continued concern over the risks of performing surgery on the very elderly. We aim to investigate the outcome of Total Knee Replacement (TKR) in a nonagenarian population.

Introduction

Despite an ageing population and a rise in the number of joint replacements being performed, the mean age of patients undergoing surgery remains static. One explanation for this is continued concern over the risks of performing surgery on the very elderly. The Elective Orthopaedic Centre, Epsom has an established patient reported outcome measures (PROMs) programme into which all patients are routinely enrolled. Post-operative complications, Oxford scores and Euro-Quol (EQ5-D) are collected to the second post-operative year.

Introduction

Alpha angles have been used to identify the precise area on the femoral head/neck junction that causes cam-type FAI. Now, computer programs are available to calculate the precise motion pattern of a hip joint and identify areas of FAI, dysplasia and other morphological abnormalities. We hypothesise that one cannot rely on the alpha angle alone to predict the precise area of resection required to remove cam impingement.

Introduction

The Metasul articulation was introduced in the early 1990's. It comprises a 28mm forged, cobalt-chrome head and a forged metal inlay, set into the polyethylene element of the acetabular component. During the 1990's and early 2000's anatomic sized MoM articulations were re-introduced for hip resurfacing and stemmed implant designs. Adverse tissue reactions to metal debris and corrosion products subsequently led to a decline in MoM usage.

Introduction: We present the results of a prospective study of the blood transfusion requirements in patients undergoing a Bernese periacetabular osteotomy (PAO) with the use of an intra-operative cell-saver and without pre-donated blood. These data were compared with an earlier audit of patients who underwent this procedure without use of a cell saver.

Material and Methods: A cohort of 50 patients (56 hips) underwent a PAO for hip dysplasia between December 2006 and November 2008 performed by the senior author. The average age was 29 years (17–51) and there were 38 females and 12 males. The average weight was 69.96 kg (46–110) and the mean duration of operation was 136 minutes (100–240). A cell saver (Fresenius-Hemocare, Germany) was used intra-operatively for this cohort. Pre-operative Hb, post-operative Hb taken the day after surgery and any units transfused were documented. A post-operative transfusion policy was adopted where a haemoglobin (Hb) concentration of < 7.5 g/dl was an indication for transfusion or where a patient was sufficiently symptomatic

Results: The mean pre-operative Hb was 13.60 g/dl (10.8–15.9) and the mean post-operative Hb was 9.91 g/dl (6.4–11.8). Overall 4 patients received post-operative allogenic blood transfusion; 3 patients receiving one unit and one patient receiving 2 units. No patients received intra-operative allogenic blood.

Conclusion: Compared to our previous audit, the use of the cell saver resulted in an improvement in the mean post-operative Hb, (9.2 g/dl compared to 8.0 g/dl). The transfusion rate was also reduced (7.27% compared to 10.8%)..