Aim: We wanted to ascertain if clinical examination confers any additional benefit to secondary/targeted ultrasound screening of neonatal hips.

Materials/Methods: Of the 30585 births (over a 6 year period) in the population served by our hospital, 2742 babies (8.96percent) were referred to the Hip Screening Clinic by the neonatologists and general practitioners. They were examined clinically and by US scans by the specialist consultants. The findings were documented prospectively. Of these, 1862 hips were normal on clinical examination, 841 hips tense (clinical examination inconclusive).

Results: 233 hips were identified as abnormal by the US scans (Graf method). 106 (45percent) of these were normal on clinical examination. In 88 of the hips with abnormal US scans (38percent), clinical examination could not be performed reliably as the babies were tense. None of the hips identified as abnormal on clinical examination were normal on US scans.

Conclusion/Discussion: US scanning of hips in at-risk babies by an experienced paediatric radiologist will identify all the abnormal hips. This will release the paediatric orthopaedic surgeon from routine clinical examination of all these babies. This time can be utilised for running other clinics. Babies found to have abnormal hips on US scanning may be seen by the orthopaedic surgeon for treatment and follow-up. Parents of babies with normal hip US scans may be reassured by a nurse practitioner or a paediatric physiotherapist. This should lead to better utilisation of resources and cost savings.

Aim: Controversy remains regarding the complications/necessity for removal of metalwork used in the fixation of paediatric orthopaedic surgery owing to potential complications of removal. It was the aim of this study to review all cases of metalwork removal performed in a prescribed year in order to ascertain the reasons for removal and complications of these surgeries.

Methods: All cases of metalwork removal performed under GA, from 1st January 2006 until 31st December 2006 in a regional paediatric orthopaedic unit, were reviewed. Data were obtained from case notes, computer and theatre records and radiographs. Details were obtained regarding demographic details, anatomic site, implant used, reasons for removal, problems of initial fixation and complications after removal.

Results: 34 buried kirschner wires were removed under general anaesthetic. Of other metal work, 38 implants were removed; 22 in males and 16 in females. The commonest age distribution was the 11–15 age groups. The most common anatomic site for removal was the forearm (42%) followed by the femur (18%) and ankle (18%). The most common implant removed was plate (53%), followed by Nancy nails (18%). Problems following initial insertion were found in 4 patients (10.5%) including re-fracture distal to forearm plates (both in patients with co-existing osteopaenia), bowing of forearm and decreased sensation over the thumb. Metal work was removed for symptoms in 13 cases (34%) and the rest for patient request or clinical indications. Complications after metalwork removal occurred in 8 (21%) patients and included re-fracture of forearm (2), hypertrophic scar, abscess, skin reaction, wound breakdown, excessive bruising and discomfort.

Conclusion: As routine removal of metalwork is generally considered not necessary, metalwork removal is often carried out for symptoms, at patient request as well as in patients with osteopaenia who have risk of fracture at the ends of metalwork. Parents need to be made aware of possible complications shown in the study, in order to give informed consent.

Aim: We wanted to ascertain if clinical examination confers any additional benefit to secondary/targeted ultrasound screening of neonatal hips.

Materials and Methods: Of the 30585 births (from 1997–2002) in the population served by our hospital, 2742 babies (8.96 percent) were referred to the Hip Screening Clinic by the neonatologists and general practitioners. They were examined clinically and by US scans by the specialist consultants. The findings were documented prospectively. Of these, 1862 hips were normal on clinical examination, 841 hips tense (clinical examination inconclusive).

Results: 233 hips were identified as abnormal by the US scans (Graf method). 106 (45 percent) of these were normal on clinical examination. In 88 of the hips with abnormal US scans (38 percent), clinical examination could not be performed reliably as the babies were tense. None of the hips identified as abnormal on clinical examination were normal on US scans.

Conclusion/Discussion: US scanning of hips in at-risk babies by an experienced paediatric radiologist will identify all the abnormal hips. This will release the paediatric orthopaedic surgeon from routine clinical examination of all these babies. This time can be utilised for running other clinics. Babies found to have abnormal hips on US scanning may be seen by the orthopaedic surgeon for treatment and follow-up. Parents of babies with normal hip US scans may be reassured by a nurse practitioner or a paediatric physiotherapist. This should lead to better utilisation of resources and cost savings.

Nonunions and segmental bone defects associated with infection are challenging problems faced by the orthopaedic surgeon. Antibiotic cement-coated (ACC) interlocking nails, prepared in the operating theatre using nails and materials generally available, can be used to treat these conditions. Two different types of moulds can be used (reusable or disposable).

Materials and Methods: The infected nonunion/segmental bone defect was treated by débridement followed by ACC nailing in 52 patients (12 female, 40 male, age range 16–86 years). Other procedures for deformity correction, bone defect etc were carried out simultaneously as indicated. Infected nonunion was seen in 34 patients, 1 was an acute fracture after external fixator. Segmental defect in the bone of 1 to 30 cm was seen in 17 patients. Anatomical sites included Femur (13), Tibia (11), Knee (12) and ankle (16).

Results: Limb salvage was achieved in 96% and amputation in 2 patients. Bony union was achieved in 41 of 49 patients (84%). In 3 patients (15%), control of infection was achieved with stable nonunion (1 patient) and stable nonunion with cement spacer (2 patients). Control of infection was achieved in 85%. Single procedure achieved this goal in 73%. Cement nail de-bonding occurred during removal in 9 patients and during insertion in 1 patient. The average follow-up was 16 months (1 to 60 m).

Conclusion: Dual goals of control of infection as well as stability to promote union can be achieved using this technique. Although useful for all infected nonunions, this technique is particularly useful for patients who are not ideal candidates for external fixators or those who do not want an external fixator.

The best type of stem fixation for revision hip arthroplasty is still controversial with regard to medium and long tem results. We wanted to ascertain the medium term results of revision hip arthroplasty using cemented collarless polished tapered femoral stem.

Methods: 44 hips in 39 patients (23 female, 16 male) who had revision THR for aseptic loosening with a minimum follow-up of 10 years were reviewed clinically, radiographically and by using the oxford hip score. Flanged cemented polyethylene cup and polished tapered cemented stem were used. Clinical and radiological evidence of failure and revision rates were determined. Details of grafting and reinforcement required at surgery and any complications in the operative and postoperative period were noted.

Results: The mean age of patients was 70 years (range 35–87 years). Femoral component alone was revised in 2 hips and both cup and stem were revised in 42 hips. Impaction grafting for acetabulum was required in 16 hips and for femur in 5 hips. Failure rate, with revision or excision arthroplasty as the end point, was 13.6% (Total 6 hips – cup and stem in 2 hips, cup only in 3 hips and excision arthroplasty with spacer for infection in 1 hip). The survival rate for femoral stem was 93% and for acetabular cup was 86%. Heterotopic ossification was seen in 9 hips, trochanteric bursitis in 5, short term thigh pain in 3. Mean last Oxford hip score was 30.5/60.

Conclusion: Revision hip arthroplasty using cemented tapered polished stem provides good results at 10 – 13 year follow-up.

Of the 30585 births (from 1997–2002) in the population served by our NHS trust, 2742 babies (8.96%) were referred to the hip screening clinic by the neonatologists and general practitioners. They were examined clinically and by US scans by the specialist consultants. The findings were documented prospectively. 233 hips were identified as abnormal by ultrasound scans (Graf). 45% (106) of these were normal on clinical examination. None of the hips identified as abnormal on clinical examination were normal on US scans. In 38% (88) clinical examination could not be reliably performed as the babies were tense.

Of the 1862 hips which were clinically normal, 106 (5.69%) had abnormal ultrasound findings. Furthermore, of the 841 babies who were tense on clinical examination, 88 (10.46%) babies had abnormal ultra-sonographic findings.

Ultrasound scanning of hips in at-risk babies by an experienced paediatric radiologist will identify all the abnormal hips. This will release the paediatric orthopaedic surgeon from routine clinical examination of all these babies. This time can be utilised for running other clinics. Babies found to have abnormal hips on US scanning may be seen by the orthopaedic surgeon for treatment and follow-up. Parents of babies with normal hip US scans may be reassured by a nurse practitioner or a paediatric physiotherapist.

The aim of this study was to ascertain the results and effectiveness of targeted screening of babies.

All the newborn babies (30585 births from 1997 to 2002) in the geographical area served by our trust were assessed by the paediatricians (neonatologists) and general practitioners (GP). They were assessed for abnormal hip examination finding including clinical instability and risk factors for DDH. The risk factors were positive family history, abnormal lie or presentation other than vertex during pregnancy or at birth, oligohydramnios or other congenital abnormalities. On referral, they were assessed clinically and by ultrasound (US) scan in a special Hip screening clinic.

The data were obtained prospectively. Over the period of these six years, 2742 babies were examined in the clinic. Many had more than one risk factor or abnormal hip examination finding (15.9% of babies with abnormal hips and 7.4% of babies with normal hips). Only five babies presented at or after 4 months of age (delayed presentation). They had been treated by the GP (1 patient), at a private hospital (1 patient) or were from outside our area (3 patients). All had abnormal hips on clinical examination. Of these, 3 were 3A or 3B Graf grade (US scan), 1 was 2B and another 2A+.

Screening of babies with above risk factors has identified all patients with abnormal hips in our area, thus avoiding late presentation of DDH. Raising awareness of GPs and paediatricians about these factors should also reduce the number babies to be seen in the hip screening clinic to minimum yet safe levels.

Aims: Etiopathogenesis of Osteoarthritis (OA) and the role of Prostaglandins in OA is not yet clear. We conducted this study to elucidate the levels of Prostaglandin E2 (PG E2) in different stages of OA of the knee joint and correlate this with the treatment of OA. Methods: Five controls (with symptoms after knee injury few months ago but normal by radiography and arthroscopy) and fifteen cases (diagnosed to have OA by radiography and confirmed and graded arthroscopically) had arthroscopic lavage with debridement as necessary. NSAIDs were stopped at least 2 weeks before sampling. Articular cartilage specimens from margins or from osteophytes and synovial tissue specimens adjacent to degenerated cartilage were obtained during arthroscopy. Plasma was obtained from ipsilateral femoral vein just before arthroscopy. The samples were stored in liquid nitrogen[−8° C] and extracted with organic solvent. PG E2 levels measured in duplicate by enzyme immunoassay. Wilcoxon rank sum test and Kauskal Willis one way analysis of variance test were used. Results: Higher PG E2 levels were found in articular cartilage samples from osteoarthritic knee as compared to controls. This was more evident in early and moderate OA than in late OA. Similar trend was seen in case of synovial tissue and plasma. However it reached statistical significance only in case of synovial tissue.[p=0.025]Conclusion: PG E2 levels are altered in case of OA [with statistically sigificant changes in the synovial tissue]. The changes are similar to the changes in activity of chondrocytes found by other workers. While this change can explain the symptomatic relief by NSAIDs in OA, it also raises the possibility of serious damage to the articular damage by NSAIDs as PG E2 maybe protective rather than destructive [Dingle et al 1991]