The ability to drive represents autonomy and independence of individuals. For many patients not being able to drive severely restricts their social, personal and professional activities leading to adverse effects on their well being. This study assessed the current evidence on driving advice after total hip replacement (THR) and compared it with the real time ability of patients to drive their own cars after primary THR. We present a prospective review of car driving ability of 130 patients (80 males and 50 females) who were treated with THR. The results show that 105 patients (81%) were able to drive within 6–8 weeks after surgery. It took more than 12 weeks for 22 patients (17%) to start driving again. There was no reported deterioration in the driving ability after primary total hip replacement surgery. Conversely, 49 patients (38%) felt a subjective improvement in their driving capability after THR. Three patients (2%) were still not confident to drive even at 12 weeks post THR. In spite of the clear advice, only 69% practiced on a stationary car before driving on the road. In our study sample 67 patients (63.8%) had a right THR and 65 patients (61.9%) were manual car drivers and all were able to drive between 6–8 weeks. This study demonstrates that patients should not resume driving motor vehicles for a minimum period of six weeks following total hip replacement surgery. This is inclusive of automatic and manually operated automobiles, and irrespective of laterality of surgical interventions. Return to driving after a six week period should be based on the individual’s capability and confidence to control the vehicle safely. Patients should be given clear advice to practice on the stationary vehicles before starting to drive on the road.
Bone grafting is used extensively in orthopaedic reconstructive surgery. Revision hip arthroplasty often presents surgeons with difficult bone loss problems, which can sometimes be addressed using donated bone. This need for bone graft has increased in recent years with greater numbers of joint replacements and increasing life expectancy after replacement, particularly as prostheses are being implanted into younger patients. Current practice of bone banking involves careful donor selection, stringent screening tests and internal safety systems in bone banks to prevent the ever present threat of communicable diseases. Introduction of strict monitoring systems to prevent allograft-related diseases has rendered a significant number of primary hip replacement patients unsuitable for bone donation. This study audited the practice of bone banking at Portsmouth Hospitals NHS Trust to look into various factors responsible for exclusion of patients from bone banking. All 55 patients underwent screening in pre-operative assessment clinics using standard Proforma to assess their suitability for femoral head donation during the course of their primary hip replacement surgery. After the initial screening stage 33 patients (60%) were excluded due to variety of reasons. The majority of those excluded (23 patients) were not accepted as donors because of their potential risk of transmission of disease to the recipients. The situation is likely to become worse in future as the incidence of communicable diseases is rising in the UK. Alternative sources of bone grafts should be explored in future to meet the demands for, example auto-banking.
The aetiology and pathophysiology of non-union is still unclear, but in this condition there is an abnormal bone metabolism. The paracrine matrix RAS has been implicated in the regulation of bone remodeling and injury responses, possibly via its effects on kinins. The influence of the local RAS or the genetic influence of the ACE/ BK2R genes to bone remodelling may thus be central to the disorder, or augmented in these conditions. We thus compared the distribution of the ACE I/D and BK2R “+9/-9” functional polymorphisms in patients with non-union and compared them to appropriate control. Gene analysis was performed on buccal cells collected from all subjects and the data was analysed for 59 patients (46 males, 13 females; mean age 40.1±15.7 years) with non-union and 81 control subjects (49 males, 32 females; mean age 51.4±22.81 years. The overall genotype distribution was consistent with Hardy-Wein-berg equilibrium for the overall and individual groups for ACE ( As the -9 allele is associated with greater gene transcription and higher mRNA expression of the receptor we combined the -9/-9 homozygous and -9/+9 heterozygous groups and compared them with the homozygous +9/+9 groups. This showed a significant difference between the non-union and control groups, with the +9/+9 homozygous being less prominent in the former ( The B2BKR -9 allele is associated with the incidence of non-union in fracture healing, in this first study to address this question. We found no association with either the In conclusion, with previous findings that the absence of the -9 allele of the B2BKR +9/-9 polymorphism is associated with greater gene transcription and higher mRNA expression of the receptor our findings are suggestive that increased BK activity via the B2BKR may predispose to the development of non-union.
