We describe the clinical and radiological results of thirty eight consecutive total hip replacements, using the JRI Furlong Hydroxyapatite ceramic coated femoral component (JRI Instrumentation Ltd, London, UK) in patients under the age of 50 at the time of surgery. The mean age at the time of operation was 42 years (range 22 to 49 years). The average length of follow up was 10 years (range 63 to 170 months). All patients receiving a Furlong HAC THR were included regardless of their primary aetiology. These included patients on whom previous hip joint surgery had taken place.

The mean Harris hip score improved from 44 pre-operatively to 92 at the latest post-operative review. The mean WOMAC and Oxford scores at the latest review for this study were 29 and 16 respectively. Using the Charnley modification of the Merle d’Aubign_ and Postel hip score, at the latest follow up the mean scores were as follows: Pain 5.37, Function 5.47, and Range of Motion 5.71.

The mean pain visual analogue score was 1.1 and 94% of patients returned to outdoor activities or sports. There were no reports of thigh pain at any review. There was no loss to follow-up. There were no revisions of any femoral component. Radiological review of the femoral components revealed no continuous or progressive radiolucent lines around the stem. No osteolysis was noted. Using revision or impending revision as the end point at 12 years the cumulative survival for the stem was 100% (95% CI 89 to 100).

We present excellent clinical, radiological and survivrship results with the use of HAC components in young, active patients with varying primary pathology, after ten years use.

Periprosthetic fractures present an increasing workload as more hip arthroplasties are performed. They are often challenging to treat due to poor bone stock and patient frailty. We compare the early clinical and radiological results in 2 centres of 24 consecutive periprosthetic hip fractures in 24 patients, using a cannulated interlocked long stemmed titanium alloy femoral component with or without a hydroxyapatite (HA) coating (Cannulok revision prosthesis).

The mean age at the time of operation was 79 years (range 65 to 92.4 years). The average length of follow up was 1.17 years (range 3 months to 5.3 years). All patients receiving a Cannulok revision stem with a minimum follow up of 3 months were included regardless of their primary aetiology and number of previous surgical procedures. Patients were reviewed and scored using the Merle d’Aubigne and Postal Score, Harris Hip Score and the WOMAC index at latest review. Periprosthetic fractures were classified using the Vancouver classification. At latest radiological review we measured subsidence, new bone formation (including presence of callus), osteolysis and radiolucent lines in all areas of the stem.

Of the 24 fractures, 22 healed. In the 14 who had HA coated implants there was a 50% increase in bone. In the non-HA coated stems there was a 36% increase in bone radiologically. The mean Harris hip score was 74 at the latest post-operative review. The mean WOMAC and MDP scores were 48.7 and 7.7 respectively. The mean pain visual analogue score was 1.6 overall and 0 specifically for mid-thigh pain.

We present encouraging early clinical and radiological results of the Cannulok stem system for treatment of complex periprosthetic fractures. This implant provides early fracture stability and subsequent biological bonding with an improvement in bone mass.

We describe the clinical and radiological results of 120 consecutive revision hip replacements in 107 patients, using a titanium alloy femoral component fully coated with Hydroxyapatite ceramic (HAC). The mean age at operation was 71 years (range 36 to 92). The average length of follow up was 8.0 years (range 5.0 to 12.4). All patients receiving a JRI Furlong HAC coated femoral component (JRI Instrumentation Ltd, London, UK) with a minimum follow up of 5 years were included. These included patients on whom previous revision hip joint surgery had taken place.

Patients were independently reviewed and scored using the Harris Hip Score (HHS), the Charnley modification of the Merle d’Aubigne and Postel Score (MDP), and The Western Ontario and McMaster Universities Osteoarthritis index (WOMAC). Radiographs were assessed by three reviewers (blinded to clinical details) for new bone formation, osteolysis, osteointegration and radiolucent lines in each Gruen Zone.

The mean Harris hip score was 85.8 (range 42 to 100) at the latest post-operative review. The mean WOMAC and MDP scores were 34.5 and 14.8 respectively. The mean pain visual analogue score (range 0 to 10) was 1.2 overall and 0.5 specifically for mid-thigh pain. There were no revisions of any femoral component for aseptic loosening. There were four stem re-revisions (3 cases of infection, 1 recurrent dislocation). Radiological review of all femoral components, including the four mentioned, revealed stable bone ingrowth with no new radiolucent lines in any zone. Using revision or impending revision for aseptic loosening as the end point, at 10 years the cumulative survival for the stem was 100% (95% CI 94 to 100). We present excellent medium to long term clinical, radiological and survivorship results with the use of a fully HAC coated titanium stem in revision hip surgery.

Aims: Acute lateral dislocation of the patella has been associated with disruption of the medial restraints of the patella and following non-operative management, a redislocation rate of up to 44%. Methods: Ten patients who presented to the Accident and Emergency dept. following acute patella dislocation had an ultrasound scan (USS) performed by an experienced musculoskel-etal radiologist. Each patient had an arthroscopy and washout of the knee and repair of ruptured structures. The ultrasound reports have now been compared to the surgical findings to determine the effectiveness of this investigation. Results: The ultrasound scans identified deficiencies in the ligamentous attachments to the medial border of the patella in eight patients and these were confirmed at operation in the same eight. The USS diagnosis of haematoma or torn fibres in the vastus medialis obliquus (VMO) (5 patients) corresponded with tearing of this muscle at operation; however the degree of muscle injury was underestimated in two. The USS finding of free fluid around the medial collateral ligament (MCL) at the adductor tubercle in three patients was associated with the operative finding of disruption of the femoral origin of the medial patellofemoral ligament (MPFL). Haematomata detected on USS along the adductor longus in two patients proved to have disruption of the VMO attachment. Conclusions: We recommend the use of ultrasound for assessment of all patella dislocations to accurately locate tears of the retinaculum and help clinicians to understand the severity of injury to the soft tissue restraints of the patella.

Acute lateral dislocation of the patella has been associated with disruption of the medial restraints of the patella. Following non-operative management there is a redislocation rate of up to 44%. This is an observational study testing whether sonography is a reliable method of assessing the medial retinaculum after acute dislocation of the patella.

Ten patients following acute patellar dislocation had an ultrasound scan (USS) performed by an experienced musculoskeletal radiologist. Each patient subsequently had an examination under anaesthetic, arthroscopy, and repair of the ruptured structures. The ultrasound reports were compared to the surgical findings to determine the accuracy of this investigation.

USS located deficiencies in the ligamentous attachments to the medial border of the patella and the presence of avulsed bony fragments, all of which were confirmed at operation. The sonographic diagnosis of haematoma or torn fibres in the vastus medialis obliquus corresponded with our operative findings.

The most significant findings were the correlation of free fluid around the medial collateral ligament (MCL) with avulsion of the femoral attachment of the medial patellofemoral ligament (MPFL) and the presence of avulsed fragments of bone from the medial border of the patella.

Sonography, in cadaveric studies consistently identifies the retinacula and like MRI offers a distinctive constellation of findings that can be used in diagnosis and therefore play a significant role in directing surgical management of these patients. We have found Sonography to be readily available and accurate.

This report does not include surgical outcome since the follow up is short and incomplete. We do, however, feel that ultrasound shows the state of the soft tissue restraints of the patella following lateral dislocation.