In 2002 the UK government in its attempt to reduce long total joint arthroplasty waiting lists, arranged for local councils via NHS trusts to send patients abroad for their surgery. In theory it was a win-win situation where pressures upon surgeons were reduced, trusts could reach government targets and of course, patients got their operation with a bonus holiday! Unfortunately, it was not until patients had returned from their surgery that problems with this method of waiting list reduction were realised. The majority of patients were discharged after only one check up and often had very little in the way of post operative physiotherapy. A few presented to our clinic with more serious complaints with two cases eventually requiring revision surgery.

We undertook a case-control study looking at an age and sex matched group of patients who underwent total knee arthroplasty, Group A (Belgium) and Group B (Local Institution) during the same time period from November 2003 to November 2004. We compared their Oxford knee score (OKS), Knee society score (KSS) and SF12 physical and mental component scores.

Introduction: The aims of this study are:

To report and validate the early migration rates of the collarless polished tapered hip replacement using manual and computer measurements

To report early clinical results of the CPT hip

Patients and methods: 80 patients undergoing primary total hip replacement in a single centre were prospectively recruited into the trial. There were 59 females and 21 males: age range 31–84 years, (mean 68 years sd 9.86). Surgery was performed through an anterolateral approach in all cases. A standard cementing technique using a cement gun and cement restrictor was employed. The patients had standardised anteroposterior standing hip radiographs taken post operatively, then yearly. The migration was measured along the long axis of the femoral component In the anteroposterior plane, using the tip of the greater trochanter as a bony landmark. Measurements were made by two independent observers (specialist registrars). Plain radiographs were measured manually using a ruler and set square and digitised images using a software package designed in-house at Dundee University. Correction for magnification was incorporated. Hip assessments were performed at each review by an independent reviewer.

Results: The mean migration rates and 95% confidence intervals (Cl) and mean Harris pain and Harris hip scores and Std Deviations were:

There was no significant difference between inter or intra observer measurements for hip migration.

This is the first study to date that we are aware of that describes the subsidence rates of the CPT hip which includes validation by inter and intra observer readings.

Introduction: The aims of this paper are to compare the results of Measuring migration rates on radiographs manually and by computer assisted analysis of digitised images.

Methods: Standardised anteroposterior standing hip radiographs taken post operatively and then yearly following hip replacement were used. The radiographs were then scanned at 150 dpi (gray scale) and saved as tif files. The migration was measured manually by drawing a line along the long axis of the femoral component connecting the distal tip, to the notch, which is used to impact the stem proximally. This gives us the length of the hip replacement and an axis along which migration can be measured. The tip of the greater trochanter was selected as a bony landmark. On the plain radiographs two sets of readings were made by one observer. The digitized images were then analysed in the same way using a software package (designed in-house at the University of Dundee). Two sets of readings were performed by observer one and a second set by an independent observer. Statistics: Inter and Intra observer rates were calculated using a paired sample t test.

Results: For the manual readings intra observer mean difference was 0.53mm (Cl 0.31–0.74mm). Comparing manual vs computer readings for observer one there was a correlation of 0.89. For the computer readings intra observer mean difference was 0.36mm (CI 0.64–0.8mm) and inter observer mean difference 0.16 mm, both non-significant differences. This evidence shows that the readings made manually and by computer were not significantly different and that there was no significant inter and intra observer variation. The advantage of computer storage and reading being the faster analysis, the ability to store and access large numbers of radiographs. The disadvantages being the need to scan the radiographs to allow measurement.

Aims: To compare incidence of abductor dysfunction using two direct lateral approaches, a more conventional approach and a new modified approach that reliably identifies and separately detaches gluteus minimus from the greater trochanter to allow its subsequent secure repair. Methods: We followed-up 73 patients who had undergone total hip arthroplasty by a single senior surgeon using one of two direct lateral approaches. With the more conventional approach (33 patients) medius and minimus were not reliable detached separately from the trochanter; minimus was either detached en mass with the anterior half of medius or detached during capsulotomy/capsulectomy. The new modified approach (40 patients), developed after careful study of the anatomy of the attachments of the glutei, involved division of the anterior half of medius leaving a 1 cm cuff of tissue attached to the trochanter and allowed reliable identification and separate detachment of minimus. Stay sutures were used in a novel way to achieve a more secure reattachment to try and reduce the risk of failure of the repair. Abductor function was assessed by Trendelenberg testing at 1-year post-arthroplasty. Results: The incidence of abductor dysfunction was 12% with the more conventional approach and 2.5% with the new modified approach. Conclusions: A significantly reduced incidence of abductor dysfunction occurred with our new modified approach and we believe this provides evidence for the importance of separate identification of gluteus minimus and its careful reattachment in ensuring good abductor function.

Aims: Remaining bone stock at revision total hip arthroplasty (THA) determines the procedure and is related to outcome. This study was carried out to determine the radiological effect on bone stock of patients waiting for surgery. Methods: The hospital notes and AP pelvic radiographs of all (19) patients (22 hips) who underwent revision surgery for symptomatic aseptic loosening of a heterogeneous group of THAs over the last 2 years were obtained. The Hahnemann University Hospital (HUH) Classification and Staging System for Revision THA (a purely radiological classification that evaluates both the acetabular and the femoral bone stock, any component instability and sepsis and that correlates well with functional outcome) was used to evaluate bone stock on the initial clinic and the immediate preoperative radiographs. The effect of delay on the planned procedure was also recorded. Results: The average time delay for all patients was 57 weeks. 12/22 hips deteriorated radiologically by an average of 1.3 points (range 1–3) on the HUH Classification. In 7/12 it altered the procedure to be carried out. Conclusions: This preliminary study suggests that a delay to revision hip surgery is associated with a reduction in bone stock and hence potential functional outcome. It can also detrimentally affect the planned procedure. This study reinforces the need for minimal delay in symptomatic patients with aseptic loosening of THA.

We report a review of 33 hips (32 patients) which had required repeat open reduction for congenital dislocation of the hip. They were followed up for a mean of 76 months (36 to 132). Factors predisposing to failure of the initial open reduction were simultaneous femoral or pelvic osteotomy, inadequate inferior capsular release, and inadequate capsulorrhaphy. Avascular necrosis had developed in more than half the hips, usually before the final open reduction. At review, 11 of the hips (one-third) were in Severin grade 3 or worse; five had significant symptoms and only ten were asymptomatic and radiographically normal. Once redisplacement has occurred after primary open reduction, attempts to reduce the head by closed means or by pelvic or femoral osteotomy are usually unsuccessful and a further open reduction is necessary.

We reviewed the prevalence of avascular necrosis (AVN) in a series of patients with sickle cell disease, using radiography and magnetic resonance imaging. We found AVN of at least one hip in 11 of 27 patients (41%). This is a significantly greater prevalence than reported. MRI was not as helpful in patients with sickle cell disease as it is in patients with AVN from other causes; it detected no more cases than radiography.

Survivorship analysis is a useful way of expressing the long-term results of joint replacement: it provides a means of comparing the life span of one type of prosthesis with another. However, such studies should include a full life-table and the confidence intervals for the survival rates at given times. At least 40 surviving prostheses are required to provide reliable results.